CT Upper Extremity with contrast
| 2020 CPT/HCPCS | 73201 |
| Negotiated Private Fee | $400.00 |
| Prossam | $260.00 |
| Champva | $227.20 |
| First Medical | $275.00 |
| First Medical Vital | $159.15 |
| Plan de Salud Menonita | $300.00 |
| Menonita Vital | $182.43 |
| Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
| Humana | $280.00 |
| Mapfre | $325.00 |
| Mcs Classicare | $245.00 |
| MCS Life | $280.00 |
| Medicare | Ambulatory Payment classification (APC) |
| MMM | $187.94 |
| MMM Vital | $159.63 |
| Panamerican Life | $350.00 |
| PMC | $187.94 |
| Tricare | $219.04 |
| Triple S Salud | $300.00 |
| Triple S Vital | $240.00 |
| Triple S Advantage | Ambulatory Payment classification (APC) |
| Negotiated Minimum Charge | $159.15 |
| Negotiated Maximus Charge | $350.00 |
| Discounted Cash Price | $320.00 |
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