CM-2018-1948 - 11/16/20184RAN
DIAGNOSTIC IMAGING
October 26, 2018
Tyler Jarl, PHR, SHRM-CP
Benefits Manager/FMLA Coordinator
Human Resources
City of Round Rock
901 Round Rock Ave 3006
Round Rock, TX 78681
Dear Tyler:
This Revised Letter of Agreement ("LOA") is a follow-up to our conversation regarding Austin Radiological Association
("ARA") providing imaging services for City of Round Rock fire and police personnel for their annual physicals ("CRR").
Patients will be referred from Rock Care Clinic which is exclusive to City of Round Rock employees.
ARA agrees to provide imaging services to employees of CRR at the following discount:
• 40% discount off of our billed charges for Chest X -Rays
• 55% discount off of our billed charges for CT's
These rates are inclusive of the professional and technical component of the exam and shall include the cost of the
exam, reading the film, and preparation of the report. Written results will be electronically transmitted (faxed) to
Rock Care Clinic at (855) 508-7432. When sending your employees to ARA for the above services, please notate the
top of the ARA Referral Form with "City of Round Rock - Employee." This will alert ARA staff to bill the City of Round
Rock directly rather than the patient or patient's insurance. When scheduling services, please contact our central
scheduling at 512.453.6100 and inform the staff that this is a "Client Account."
For a listing of ARA's locations, please visit our website at www.ausrad.com, ARA will bill CRR on a monthly basis for
imaging services provided during the previous month for employees. By signing this LOA you are obligated to pay
ARA's invoice within thirty (30) days after the receipt of said invoice.
This LOA is effective the date on which it is executed below ("Effective Date") and shall remain in effect unless
terminated by either party upon 30 days prior written notice. Additionally, if CRR does not make payment as stated
above, ARA may give CRR written notice that the payment must be received within ten (10) days. If payment is not
received within the stated period, ARA may terminate this LOA without further notice.
Please return the executed LOA to me via fax at 512.519.3451 or email to the address listed below. Once it is
received, I will notify ARA staff of our agreement.
Thank you for choosing ARA as your imaging provider and we look forward to providing quality imaging services to
you and your patients. Feel free to contact me at 512.795.5100 x5345 or Dianna Johnson at x5254 if you have any
questions.
Sincerely, a
Daphne lmel
Contract Administrator
Email:, ime diRausrad.com
Laurie Hadley, 4
City Manager, City of Round Rock
em - 2 6 4- liq4j
Austin Radiological Association
f—Jr4�rJ'S
Effective Date
12554 Riata Vista Circle Aestin, Texas 78727 512.7954100 512.519.3491 fax www.ausradcom
ATq?Am
DIAGNOSTIC IMAGING
Prices effective 10.26 2018 and are subject to change if ARA's prices
change
There will have an additional contrast charge for any exam ordered
with contrast. The amount charged for contrast is based on the
patient's weight
**'Any highlighted exam is a "Wellness Exam" and does not receive
further discounts""
CPT
CPT Desc
55% Discount
0066T
SCRNG VIRT COLONOGRAPHY
$
315.00
0067T
DIAD VIRT COLONOGRAPHY
$
382.50
0146T
CCTA W/WO DYE
$
810.00
0147T
ICT AN GIOG RAP HY,CORO NARY
$
810.00
0148T
CT ANGIO CORONARY ARTERIE
$
1,315.80
0150T
CT ANGIOGRAPHY,CONGENITAL
$
376.20
0151T
CT ANGIOGRAPHY,CORONARY
$
247.50
70450
CT BRAIN W/O CONTRAST
$
247.50
70460
CT BRAIN W/CONTRAST
$
292.50
70470
CT BRAIN W & W/O CONTRAST
$
360.00
70480
CT ORBIT/SELLA W/O CONT
$
247.50
70481
Cr ORBIT/SELLA W/CONT
$
292.50
70482
CT ORBIT/SELLA W & W/O CO
$
360.00
70486
CTMAXILLOFACIAL W/O CON
$
247.50
70487
CT MAXILLOFACIAL W/CONTR
$
292.50
70488
CT MAXILLOFACIAL W & W/O
$
360.00
70490
CTSOFiTISSUE NECK W/O C
$
247.50
70491
CT SOFT TISSUE NECK W/CON
$
292.50
70492
CT SOFT TISSUE NECK W &
$
360.00
70496
CTA -HEAD W & W/0 CONTRAST
$
495.00
70498
CTA -NECK W & W/O CONTRAST
$
495.00
71250
CT CHEST W/O CONTRAST
$
247.50
71260
CT CHEST WITH CONTRAST
$
292.50
71270
CT CHEST W & W/O CONTRAST
$
360.00
71275
CTA -CHEST W & W/O CONTRAS
$
495.00
72125
CT C -SPINE W/O CONTRAST
$
247.50
72126
CT C -SPINE W/CONTRAST
$
292.50
72127
CT C -SPINE W/O & W/CONTRA
$
360.00
72128
CTT -SPINE W/O CONTRAST
$
247.50
72129
CTT -SPINE W/CONTRAST
$
292.50
72130
CTT -SPINE W & W/O CONTRA
$
360.00
72131
CT L -SPINE W/O CONTRAST
$
247.50
72132
CT L -SPINE W/CONTRAST
$
292.50
72133
CT L -SPINE W & W/O CONTRA
$
360.00
72191
CTA -PELVIS W & W/O CONTRA
$
495.00
72192
CT PELVIS W/O CONTRAST
$
247.50
City of Round Rock 10.26.2018
72193
CT PELVIS W/CONTRAST
$
292.50
72194
CT PELVIS W & W/O CONTRAS
$
360.00
73200
CT UPPER EXTREMITY
$
247.50
73201
CT UPPER EXTREMITY
$
292.50
73202
CT UPPER EXTREMITY
$
360.00
73206
CTA -UP EXT W & W/O CONTRA
$
495.00
73700
CT LWR EXT W/O CONTRAST
$
247.50
73701
CT LWR EXT W/CONTRAST
$
292.50
73702
CT LWR EXT W/O & W/CONTRA
$
360.00
73706
CTA -LOW EXT W & W/O CONTR
$
495.00
74150
CT ABDOMEN W/O CONTRAST
$
247.50
74160
CT ABDOMEN W/CONTRAST
$
292,50
74170
CT ABDOMEN W & W/O CONTRA
$
360.00
74174
CT ANGIO ABD/PELVIS W&WO
$
551.70
74175
CTA -ABDOMEN W & W/0 CONTR
$
495.00
74176
CT ABD/PELVIS W/O CONTRAS
$
495.00
74177
CT ABD/PELVIS W CONTRAST
$
585.00
74178
CT ABD/PELVIS W & or W/O
$
720.00
74261
CT COLONOGRAPHY DIAGNOSTI
$
427.95
74262
CT COLONOGRAPHY DIAGN05TI
$
480.60
74263
CT COLONOGRAPHY SCREENING
$
315.00
75571
CT HEART W/O CONTRAST
$
75.00
75572
CT HEART W CONTRAST EVAL
$
275.40
75573
Cr HEART W CONTRAST EVAL
$
391.50
75574
CT ANGIOGRAPHY HEART
$
607.05
75635
CTA-ABD AORTA & BILATERAL
$
495.00
76070
CT BONE DENSITY STUDY,
$
167.40
76355
CT QUID STEREOTACTIC LOC
$
526.95
76360
CT GUIDED NEEDLE BIOPSY
$
615.15
76362
CT GUIDANCE TISSUE
$
727.65
76365
CT GUIDED CYST ASPIRATION
$
615.15
76370
CT GUIDED PLACEMENT
$
220.50
76380
Ci LMTD FOLLOW UP STUDY
$
261.00
76497
UNLISTED CT PROCEDURE
$
375.30
77011
CT GUID STEREOTACTIC LOC
$
653.85
77012
CT GUIDED NEEDLE BIOPSY
$
429.75
77013
CT GUIDANCE TISSUE
$
727.65
77014
CT GUIDED PLACEMENT
$
225.90
77078
CT BONE DENSITY STUDY,
$
192.15
77079
CT BONE MINERAL DENSITY
$
137.25
78451
MYOCARDIAL PERFUSION IMAG
$
232.65
78452
MYOCARDIAL PERFUSION IMAG
$
397.35
78453
MYOCARDIAL PERFUSION IMAG
$
202.50
78454
MYOCARDIAL PERFUSION IMAG
$
194.85
78999
SPECT CT
$
246.60
G0297
LDCT FOR LUNG CA SCREENIN
$
247.50
58032
I LOW DOSE CT CHEST FOR LUN
$
87.75
CPT
CPT Desc
40% Discount
71045
CHEST 1 VIEW
$
36.60
71046
CHEST 2 VIEWS
$
55.80
71047
CHEST 3 VIEWS
$
72.00
City of Round Rock 10.26.2018
City of Round Rock
RO�UNO ROCK Agenda Item Summary
Agenda Number:
Title: Consider executing a Letter of Agreement with ARA for imaging services for
FD and PD employee physicals..
Type: City Manager Item
Governing Body: City Manager Approval
Agenda Date: 11/16/2018
Dept Director: Valerie Francois
Cost:
Indexes: Self -Funded Health Insurance
Attachments: LAF - Letter of Agreement with ARA for imaging services for FD and PD
employees. (00412579xA08F8), City of Round Rock LOA 10.26.2018
(00412587xA08F8)
Department: Human Resources Department
Text of Legislative File CM -2018.1948
Consider executing a Letter of Agreement with ARA for imaging services for FD and PD
employee physicals..
This agreement will provide a discount for imaging services for FD and PD employee
physicals that cannot be performed in Rockcare, the City's clinic.
Source of Funds: Self -Fund Health Insurance
City of Round Rock Page 7 Printed on 11/45!2018