Thyroid imaging W/blood FL
| DETAIL FOR SERVICES: | Study | Radiopharmaceuticals | Radiologist reading (interpretation) |
| 2020 CPT/HCPCS Primary Code | 78013 | A9512 | Not provided by Hospital (may be billed separately) |
| Negotiated Private Fee | $68.00 | $37.00 | Not provided by Hospital (may be billed separately) |
| Prossam | $57.50 | As Cost By Supplier | Not provided by Hospital (may be billed separately) |
| Champva | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | |
| First Medical | $102.00 | As Cost By Supplier | Not provided by Hospital (may be billed separately) |
| First Medical Vital | $128.99 | Not Covered | Not provided by Hospital (may be billed separately) |
| Plan de Salud Menonita | $57.8 | As Cost By Supplier + 3% | Not provided by Hospital (may be billed separately) |
| Menonita Vital | $126.87 | $12.50 | Not provided by Hospital (may be billed separately) |
| Humana Gold Plus / Gold Choice | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | |
| Humana | $72.90 | $12.00 | Not provided by Hospital (may be billed separately) |
| Mapfre | Not contracted | Not provided by Hospital (may be billed separately) | |
| Mcsclassicare | $58.67 | As Cost By Supplier | Not provided by Hospital (may be billed separately) |
| MCS Life | $58.67 | As Cost By Supplier | Not provided by Hospital (may be billed separately) |
| Medicare | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | |
| MMM | $101.40 | Not provided by Hospital (may be billed separately) | |
| MMM Vital | $129.66 | $12.00 | Not provided by Hospital (may be billed separately) |
| Panamerican Life | Not contracted | Not provided by Hospital (may be billed separately) | |
| PMC | $101.40 | Not provided by Hospital (may be billed separately) | |
| Tricare | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | |
| Triple S Salud | $68.00 | Not Covered | Not provided by Hospital (may be billed separately) |
| Triple S Vital | $124.95 | Not Covered | Not provided by Hospital (may be billed separately) |
| Triple S Advantage | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | |
| Negotiated Minimum Charge | $57.50 | $12.00 | Not provided by Hospital (may be billed separately) |
| Negotiated Maximum Charge | $129.66 | $12.50 | Not provided by Hospital (may be billed separately) |
| Discounted Cash Price | $54.40 | $29.60 | Not provided by Hospital (may be billed separately) |
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