2020 CPT/HCPCS | 71250 |
Negotiated Private Fee | $350.00 |
Prossam | $260.00 |
Champva | $146.67 |
First Medical | $275.00 |
First Medical Vital | $113.06 |
Plan de Salud Menonita | $300.00 |
Menonita Vital | $133.42 |
Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
Humana | $275.00 |
Mapfre | $300.00 |
Mcs Classicare | $210.00 |
MCS Life | $225.00 |
Medicare | Ambulatory Payment classification (APC) |
MMM | $145.36 |
MMM Vital | $116.75 |
Panamerican Life | $300.00 |
PMC | $145.36 |
Tricare | $143.02 |
Triple S Salud | $300.00 |
Triple S Vital | $126.00 |
Triple S Advantage | Ambulatory Payment classification (APC) |
Negotiated Minimum Charge | $113.06 |
Negotiated Maximus Charge | $300.00 |
Discounted Cash Price | $280.00 |
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