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CT thoracic spine before and after contrast

2020 CPT/HCPCS 72130
Negotiated Private Fee $450.00
Prossam $260.00
Champva $221.19
First Medical $275.00
First Medical Vital $164.98
Plan de Salud Menonita $300.00
Menonita Vital $222.73
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $285.00
Mapfre $325.00
Mcs Classicare $300.00
MCS Life $296.00
Medicare Ambulatory Payment classification (APC)
MMM $229.71
MMM Vital $194.89
Panamerican Life $400.00
PMC $229.71
Tricare $215.86
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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