2020 CPT/HCPCS | 72196 |
Negotiated Private Fee | $720.00 |
Prossam | $500.00 |
Champva | $311.76 |
First Medical | $625.00 |
First Medical Vital | $222.16 |
Plan de Salud Menonita | $575.00 |
Menonita Vital | $285.26 |
Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
Humana | $650.00 |
Mapfre | $650.00 |
Mcs Classicare | $465.00 |
MCS Life | $542.50 |
Medicare | Ambulatory Payment classification (APC) |
MMM | $342.69 |
MMM Vital | $249.60 |
Panamerican Life | $725.00 |
PMC | $342.69 |
Tricare | $295.94 |
Triple S Salud | $650.00 |
Triple S Vital | $262.50 |
Triple S Advantage | Ambulatory Payment classification (APC) |
Negotiated Minimum Charge | $222.16 |
Negotiated Maximus Charge | $725.00 |
Discounted Cash Price | $576.00 |
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