Tumor Imaging Spect (3D)
| DETAIL FOR SERVICES: | Study | Radiopharmaceuticals | Radiologist reading (interpretation) |
| 2020 CPT/HCPCS Primary Code | 78803 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Negotiated Private Fee | $125.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Prossam | $130.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Champva | Ambulatory Payment classification (APC) | Provided when is required study | Not provided by Hospital (may be billed separately) |
| First Medical | $125.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| First Medical Vital | $245.20 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Plan de Salud Menonita | $110.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Menonita Vital | $299.01 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Humana Gold Plus / Gold Choice | Ambulatory Payment classification (APC) | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Humana | $125.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Mapfre | Not contracted | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Mcsclassicare | $220.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| MCS Life | $220.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Medicare | Ambulatory Payment classification (APC) | Provided when is required study | Not provided by Hospital (may be billed separately) |
| MMM | $204.05 | Not provided by Hospital (may be billed separately) | |
| MMM Vital | $245.20 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Panamerican Life | Not contracted | Provided when is required study | Not provided by Hospital (may be billed separately) |
| PMC | $204.05 | Not provided by Hospital (may be billed separately) | |
| Tricare | Ambulatory Payment classification (APC) | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Triple S Salud | $125.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Triple S Vital | $148.52 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Triple S Advantage | Ambulatory Payment classification (APC) | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Negotiated Minimum Charge | $110.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Negotiated Maximum Charge | $299.01 | Provided when is required study | Not provided by Hospital (may be billed separately) |
| Discounted Cash Price | $100.00 | Provided when is required study | Not provided by Hospital (may be billed separately) |
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