2020 CPT/HCPCS/DRG | 92521 |
Negotiated Private Fee | $150.00 |
Prossam | $50.00 |
Champva | $137.18 |
First Medical | $30.00 |
First Medical Vital | $26.32 |
Plan de Salud Menonita | $30.00 |
Menonita Vital | $81.31 |
Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
Humana | $97.78 |
Mapfre | No Contracted |
Mcs Classicare | $20.02 |
MCS Life | $20.02 |
Medicare | Ambulatory Payment classification (APC) |
MMM | By Therapy Network |
MMM Vital | Not Contracted |
Panamerican Life | Not Contracted |
PMC | By Therapy Network |
Tricare | $136.06 |
Triple S Salud | Not Covered |
Triple S Vital | Not Covered |
Triple S Advantage | Ambulatory Payment classification (APC) |
Negotiated Minimum Charge | $20.02 |
Negotiated Maximus Charge | $137.18 |
Discounted Cash Price | $120.00 |
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