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CT lumbar spine before and after contrast

2020 CPT/HCPCS 72133
Negotiated Private Fee $450.00
Prossam $260.00
Champva $220.13
First Medical $275.00
First Medical Vital $163.95
Plan de Salud Menonita $300.00
Menonita Vital $220.69
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $285.00
Mapfre $325.00
Mcs Classicare $300.00
MCS Life $294.00
Medicare Ambulatory Payment classification (APC)
MMM $228.57
MMM Vital $193.10
Panamerican Life $400.00
PMC $228.57
Tricare $214.80
Triple S Salud $300.00
Triple S Vital $126.00
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $126.00
Negotiated Maximus Charge $400.00
Discounted Cash Price $360.00

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