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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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