2020 CPT/HCPCS | 76870 |
Negotiated Private Fee | $100.00 |
Prossam | $60.00 |
Champva | $108.11 |
First Medical | $70.00 |
First Medical Vital | Not Covered |
Plan de Salud Menonita | $82.00 |
Menonita Vital | $75.23 |
Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
Humana | $68.00 |
Mapfre | $73.00 |
Mcs Classicare | $72.00 |
MCS Life | $72.00 |
Medicare | Ambulatory Payment classification (APC) |
MMM | $92.28 |
MMM Vital | $75.23 |
Panamerican Life | $90.00 |
PMC | $92.28 |
Tricare | $31.53 |
Triple S Salud | $82.00 |
Triple S Vital | $39.49 |
Triple S Advantage | Ambulatory Payment classification (APC) |
Negotiated Minimum Charge | $31.53 |
Negotiated Maximus Charge | $108.11 |
Discounted Cash Price | $80.00 |
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