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CT scan of abdomen and pelvis without contrast

2020 CPT/HCPCS 74176
Negotiated Private Fee $450.00
Prossam $450.00
Champva $201.68
First Medical $275.00
First Medical Vital $142.97
Plan de Salud Menonita $300.00
Menonita Vital $164.32
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $412.50
Mapfre $400.00
Mcs Classicare $252.00
MCS Life $285.00
Medicare Ambulatory Payment classification (APC)
MMM $183.82
MMM Vital $143.78
Panamerican Life Not covered
PMC $183.82
Tricare $196.88
Triple S Salud $450.00
Triple S Vital $217.43
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $142.97
Negotiated Maximus Charge $450.00
Discounted Cash Price $360.00

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