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CT Upper Extremity before and after contrast

2020 CPT/HCPCS 73202
Negotiated Private Fee $450.00
Prossam $260.00
Champva $239.83
First Medical $275.00
First Medical Vital $172.37
Plan de Salud Menonita $300.00
Menonita Vital $227.66
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $280.00
Mapfre $325.00
Mcs Classicare $310.00
MCS Life $315.00
Medicare Ambulatory Payment classification (APC)
MMM $236.78
MMM Vital $199.21td>
Panamerican Life $400.00
PMC $236.78
Tricare $243.43
Triple S Salud $300.00
Triple S Vital $240.00
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $172.37
Negotiated Maximus Charge $400.00
Discounted Cash Price $360.00

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