Board-certified radiologist final signed reports for a cash-pay functional medicine clinic, priced per report with no minimum and no platform fee.
Discovery call, 30 July 2026. Seguin, Texas.
Quinn Functional Health opens 31 August 2026 as a cash-pay, membership-model functional medicine clinic. You see the stage three and stage four oncology patients yourself; your PAs see everyone else. Patients move through advanced testing, nutrition, nurse coaching, IV and ozone therapy, hyperbarics and red light, then come back to you in three to four weeks with their results in hand.
You bought a Butterfly IQ3 to scan at the point of care, and you are RVT and ARRT(S) credentialed, so the scanning is not the problem. You need the other half: an official report signed by a US board-certified radiologist you can hand to a patient's oncologist or endocrinologist without it being questioned.
Your real turnaround requirement is the visit cycle, not the clock.
You told us this is not a STAT situation and that two to three weeks would be fine, because the report only has to be in hand when the patient returns. We quote our routine tier of under 24 hours anyway. The report is then never the thing holding up a visit, and if a scan turns up something that changes a plan, you know the same day.
General and limited vascular ultrasound, read and signed as final diagnostic reports.
| In scope | Typical exams |
|---|---|
| Abdominal | Complete and limited abdomen, liver, gallbladder and biliary, renal and retroperitoneal |
| Small parts | Thyroid and soft tissue neck, scrotal, superficial masses |
| Pelvic | Prostate and bladder, transabdominal, complete or limited |
| Vascular | Carotid duplex, lower extremity venous duplex for DVT |
Out of scope at your request: transvaginal, obstetric, musculoskeletal and echocardiography. All are covered by the same panel and the same rate ladder if you add them later, and adding them is an email, not a new contract. Transrectal prostate imaging needs an endocavitary probe the IQ3 does not have, so prostate work here is transabdominal.
Clinical history, technique, comparison, findings and a numbered impression, electronically signed by the reading radiologist with name and credentials. No preliminary tier, nothing needing a second read. The value is not that a report exists; it is whose name is on it. A report signed by an American Board of Radiology certified radiologist is the version an oncologist puts in a chart.
A membership clinic almost always ends up wanting carotid screening in a wellness panel. Before you build it into an offering: the USPSTF recommends against carotid screening in asymptomatic adults with no history of stroke or TIA. Cash removes the coverage argument, not the standard-of-care one, and an incidental finding on a study you did not need creates a workup you then own. Carotid duplex for a symptomatic patient is a different conversation entirely.
Four steps, from probe to signed PDF in the patient's chart.
| Stage | What happens | |
|---|---|---|
| 1 | You scan | Butterfly IQ3 at the point of care. Studies land in Butterfly Cloud with demographics and your worksheet attached. |
| 2 | Images reach us | One of two routes, depending on your Butterfly subscription. Both are set out below. |
| 3 | A radiologist signs | Routed by body part to a board-certified radiologist licensed in Texas, read, and signed as final. |
| 4 | Report returns | Delivered to your secure AstraRad portal as a clean printable PDF, ready to attach or hand over. |
We checked this properly rather than telling you it should be fine. Cerbo is not ONC-certified and offers no FHIR, so the document API is the right path rather than a shortcut; their HL7 lab feed carries a setup fee and multi-week timelines. Portal delivery works from the first study, so nothing waits on this.
You are RVT and ARRT(S), so this will be familiar. Each study needs the standard technologist worksheet: indication and relevant history, measurements, laterality, and anything you saw at the bedside that will not be obvious from the images. For vascular, the usual velocity and waveform documentation. We send our templates during onboarding; if you already have ones you prefer, we read from yours.
Carotid duplex under the ACR parameter expects angle-corrected peak-systolic and end-diastolic velocities at multiple levels on each side: a heavier acquisition than a general abdominal study, and the one place a handheld probe needs deliberate technique rather than just a good image. Your IQ3's vascular presets support angle correction, so this is a protocol conversation, not an equipment problem.
You get a small named reading group rather than an anonymous queue, plus a direct line for case discussion. Want to talk a finding through before you see the patient? That call gets set up.
Contractual, not an average we hope to hit. Miss a tier on a study and that study carries a per-report credit.
Routine carries no multiplier and is what this proposal is priced at. You choose priority per study, not per contract. Across our whole book, 99.4% of reports landed inside their SLA tier over the trailing twelve months and median STAT turnaround is 28 minutes, measured monthly rather than quoted from a brochure.
Per signed report, USD. No minimum volume, no monthly platform fee, no onboarding charge, no per-seat cost. If we do not sign a report, you do not pay for it.
| Studies per month | Per signed report | |
|---|---|---|
| Up to 100 | $44 | Quoted here |
| 101 to 200 | $39 | |
| 201 to 500 | $33 | |
| 500 and above | $29 |
The ladder moves automatically. You do not have to commit to a volume, renegotiate, or ask: when your monthly count crosses a tier, the lower rate applies to that month. You told us you suspect you will scan more than the 40 to 50 you quoted. If that happens, the price follows you down.
| Scenario | Studies | Rate | Monthly |
|---|---|---|---|
| Your stated low end | 40 | $44 | $1,760 |
| Your stated high end | 50 | $44 | $2,200 |
| First month, after 5 free | 50 | $44 | $1,980 |
| If you grow past 100 | 120 | $39 | $4,680 |
Exactly as Rafael offered on the call. Five signed reports at no charge, on real studies, so you see the report format, the turnaround and the workflow before any money changes hands. They are full final signed reports, not samples: you can use them clinically. Billing starts at report six.
Billing is a single monthly itemised invoice, per report, with any priority multipliers shown as separate line items. A prepaid wallet that studies draw down against is available instead if you prefer to pay in advance.
You have friends quoting $25 and are waiting on DocPanel. How to read both.
The work inside one report does not get cheaper with volume. The read, the subspecialty routing, the peer review, the Texas licensure, the malpractice cover and the signature cost the same at 40 studies a month as at 400. Volume only changes how far fixed cost spreads. So compare what is attached to the number:
On DocPanel, since you are waiting on them: the only price they publish is $199 per study, for consumer second-opinion reads; practice pricing is not published at all. You cannot compare us until they put a number in writing. And a preliminary read that still needs finalising is not cheaper, it is a second invoice.
Four positions, stated plainly. Evidence available before you sign.
| Item | Our position |
|---|---|
| Texas licensure |
Texas treats the practice of medicine as happening where the patient is, so a radiologist reading a patient in Seguin needs a full Texas medical license. Since 2017 the Texas Medical Board no longer issues its out-of-state telemedicine license, and grandfathered ones converted to full licenses on 1 September 2024. No shortcut exists. Roster mapping provided during onboarding. |
| HIPAA and your BAA |
A signed business associate agreement before any patient data moves, no pilot-data exception. Encryption in transit and at rest, a SHA-256 integrity hash on every image, role-scoped access, an append-only audit log, a documented breach process. No patient data is used for marketing, resale or model training. |
| Malpractice | Cover of $1M per claim and $3M annual aggregate, with per-state endorsements for every state we read into. Certificate on request, before you sign. |
| Credentialing | Because you are cash-pay, payer credentialing is not on your critical path and nothing waits on it. If you later bill insurance, our position is unchanged. |
One in twenty reports is independently double-read, blind, by a second subspecialist. Major discrepancy rate runs under 0.3%. You receive a monthly quality report covering turnaround by tier, SLA compliance and the discrepancy log.
The diagnostic study needs a licensed practitioner as the ordering provider, most naturally your PAs under delegated authority; worth writing into your protocol before the first scan. And Texas has a corporate-practice-of-medicine doctrine governing how a business not owned by a physician handles a physician's professional fee. There are well-trodden structures for this and it changes nothing in this proposal, but both are worth a short conversation with your attorney while you still have four weeks.
Working backwards from your soft opening, with four weeks in hand.
| Stage | What happens | Owner |
|---|---|---|
| Days 1–3 | BAA and service agreement signed. Texas-licensed reading group assigned. Portal accounts created for you and your PAs. | AstraRad |
| Days 3–5 | Butterfly Cloud set up. We confirm whether your subscription includes automatic DICOM forwarding and whether it unlocks pulsed-wave Doppler, which your vascular studies need, then configure the route. | Joint |
| Days 5–7 | Test study end to end. Worksheet templates agreed. Report format reviewed against what your referring specialists expect. | Joint |
| Days 8–10 | First live signed reports. Your 5 free reports run here. | AstraRad |
| Ongoing | Cerbo delivery scoped and implemented once the inbound path is confirmed. | AstraRad |
A first signed report within 10 business days of countersignature is our standard commitment, so signing in the first half of August leaves comfortable margin. Your only dependency is the Butterfly Cloud setup. De-identified sample reports follow separately, as Abhijeet promised on the call.
Signing authorises onboarding on these terms. It is not a volume commitment.
Final agreement is the signed MSA and BAA, sent for e-signature. If anything here does not match what you understood on the call, tell us and we will correct the document rather than explain it away.
Rafael Vieira · Chief Executive Officer · hello@astrarad.com
Abhijeet R. · Chief Operating Officer · clinical and operations
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