2020 CPT/HCPCS | 72141 |
Negotiated Private Fee | $650.00 |
Prossam | $500.00 |
Champva | $216.90 |
First Medical | $625.00 |
First Medical Vital | $155.25 |
Plan de Salud Menonita | $635.00 |
Menonita Vital | $184.39 |
Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
Humana | $650.00 |
Mapfre | $650.00 |
Mcs Classicare | $325.00 |
MCS Life | $325.00 |
Medicare | Ambulatory Payment classification (APC) |
MMM | $278.32 |
MMM Vital | $161.34 |
Panamerican Life | $650.00 |
PMC | $278.32 |
Tricare | $208.46 |
Triple S Salud | $650.00 |
Triple S Vital | $262.50 |
Triple S Advantage | Ambulatory Payment classification (APC) |
Negotiated Minimum Charge | $155.25 |
Negotiated Maximus Charge | $650.00 |
Discounted Cash Price | $520.00 |
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