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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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