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CT chest without contrast

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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