2020 CPT/HCPCS | 72156 |
Negotiated Private Fee | $730.00 |
Prossam | $500.00 |
Champva | $368.22 |
First Medical | $625.00 |
First Medical Vital | $263.03 |
Plan de Salud Menonita | $647.00 |
Menonita Vital | $311.81 |
Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
Humana | $725.00 |
Mapfre | $650.00 |
Mcs Classicare | $387.50 |
MCS Life | $465.00 |
Medicare | Ambulatory Payment classification (APC) |
MMM | $413.51 |
MMM Vital | $272.83 |
Panamerican Life | $775.00 |
PMC | $413.51 |
Tricare | $350.89 |
Triple S Salud | $650.00 |
Triple S Vital | $262.50 |
Triple S Advantage | Ambulatory Payment classification (APC) |
Negotiated Minimum Charge | $263.03 |
Negotiated Maximus Charge | $775.00 |
Discounted Cash Price | $584.00 |
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