2020 CPT/HCPCS | 73700 |
Negotiated Private Fee | $350.00 |
Prossam | $260.00 |
Champva | $143.17 |
First Medical | $275.00 |
First Medical Vital | $110.80 |
Plan de Salud Menonita | $300.00 |
Menonita Vital | $133.46 |
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 | $153.90 |
MMM Vital | $116.78 |
Panamerican Life | $300.00 |
PMC | $153.90 |
Tricare | $139.56 |
Triple S Salud | $300.00 |
Triple S Vital | $240.00 |
Triple S Advantage | Ambulatory Payment classification (APC) |
Negotiated Minimum Charge | $110.80 |
Negotiated Maximus Charge | $300.00 |
Discounted Cash Price | $280.00 |
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