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CT Lower Extremity before and after contrast

2020 CPT/HCPCS 73702
Negotiated Private Fee $450.00
Prossam $260.00
Champva $216.27
First Medical $275.00
First Medical Vital $166.77
Plan de Salud Menonita $300.00
Menonita Vital $224.77
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $285.00
Mapfre $325.00
Mcs Classicare $310.00
MCS Life $304.00
Medicare Ambulatory Payment classification (APC)
MMM $95.30
MMM Vital $196.67
Panamerican Life $400.00
PMC $95.30
Tricare $211.69
Triple S Salud $300.00
Triple S Vital $240.00
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $95.30
Negotiated Maximus Charge $400.00
Discounted Cash Price $360.00

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