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CT cervical spine with contrast

2020 CPT/HCPCS 72126
Negotiated Private Fee $400.00
Prossam $260.00
Champva $187.43
First Medical $275.00
First Medical Vital $139.78
Plan de Salud Menonita $300.00
Menonita Vital $186.78
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $285.00
Mapfre $325.00
Mcs Classicare $245.00
MCS Life $280.00
Medicare Ambulatory Payment classification (APC)
MMM $192.51
MMM Vital $163.43
Panamerican Life $350.00
PMC $192.51
Tricare $182.73
Triple S Salud $275.00
Triple S Vital $115.50
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $115.50
Negotiated Maximus Charge $350.00
Discounted Cash Price $320.00

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