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CT Upper Extremity without contrast

2020 CPT/HCPCS 73200
Negotiated Private Fee $350.00
Prossam $260.00
Champva $159.01
First Medical $275.00
First Medical Vital $115.12
Plan de Salud Menonita $300.00
Menonita Vital $133.46
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $275.00
Mapfre $300.00
Mcs Classicare $245.00
MCS Life $280.00
Medicare Ambulatory Payment classification (APC)
MMM $153.44
MMM Vital $127.86
Panamerican Life $300.00
PMC $153.44
Tricare $160.84
Triple S Salud $300.00
Triple S Vital $240.00
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $115.12
Negotiated Maximus Charge $300.00
Discounted Cash Price $280.00

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