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CT Lower Extremity with contrast

2020 CPT/HCPCS 73701
Negotiated Private Fee $400.00
Prossam $260.00
Champva $185.34
First Medical $275.00
First Medical Vital $138.52
Plan de Salud Menonita $300.00
Menonita Vital $185.05
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 $190.47
MMM Vital $161.92
Panamerican Life $350.00
PMC $190.47
Tricare $180.33
Triple S Salud $300.00
Triple S Vital $240.00
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $138.52
Negotiated Maximus Charge $350.00
Discounted Cash Price $320.00

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