Initial Evaluation ocupational
| 2020 CPT/HCPCS/DRG | 97167 |
| Negotiated Private Fee | $100.00 |
| Prossam | $60.00 |
| Champva | $99.07 |
| First Medical | $29.00 |
| First Medical Vital | $25.38 |
| Plan de Salud Menonita | $25.00 |
| Menonita Vital | $65.15 |
| Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
| Humana | $50.00 |
| Mapfre | No Contracted |
| Mcs Classicare | $72.27 |
| MCS Life | $72.27 |
| Medicare | Ambulatory Payment classification (APC) |
| MMM | By Therapy Network |
| MMM Vital | Not Contracted |
| Panamerican Life | Not Contracted |
| PMC | By Therapy Network |
| Tricare | $103.48 |
| Triple S Salud | Not Covered |
| Triple S Vital | Not Covered |
| Triple S Advantage | Ambulatory Payment classification (APC) |
| Negotiated Minimum Charge | $25.00 |
| Negotiated Maximus Charge | $99.07 |
| Discounted Cash Price | $80.00 |
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