Mammography of one breast
| DETAIL FOR SERVICES: | Study | Radiologist reading (interpretation) |
| 2020 CPT/HCPCS Primary Code | 77065 | Not provided by Hospital (may be billed separately) |
| Negotiated Private Fee | $140.0 | Not provided by Hospital (may be billed separately) |
| Prossam | $32.50 | Not provided by Hospital (may be billed separately) |
| Champva | $130.90 | Not provided by Hospital (may be billed separately) |
| First Medical | $25.00 | Not provided by Hospital (may be billed separately) |
| First Medical Vital | $66.71 | Not provided by Hospital (may be billed separately) |
| Plan de Salud Menonita | $37.75 | Not provided by Hospital (may be billed separately) |
| Menonita Vital | $62.37 | Not provided by Hospital (may be billed separately) |
| Humana Gold Plus / Gold Choice | $94.71 | Not provided by Hospital (may be billed separately) |
| Humana | $42.50 | Not provided by Hospital (may be billed separately) |
| Mapfre | $43.50 | Not provided by Hospital (may be billed separately) |
| Mcsclassicare | $39.00 | Not provided by Hospital (may be billed separately) |
| MCS Life | $37.00 | Not provided by Hospital (may be billed separately) |
| Medicare | $130.90 | Not provided by Hospital (may be billed separately) |
| MMM | $87.11 | Not provided by Hospital (may be billed separately) |
| MMM Vital | $67.75 | Not provided by Hospital (may be billed separately) |
| Panamerican Life | $22.50 | Not provided by Hospital (may be billed separately) |
| PMC | $87.11 | Not provided by Hospital (may be billed separately) |
| Tricare | $130.90 | Not provided by Hospital (may be billed separately) |
| Triple S Salud | $32.50 | Not provided by Hospital (may be billed separately) |
| Triple S Vital | $21.06 | Not provided by Hospital (may be billed separately) |
| Triple S Advantage | $94.71 | Not provided by Hospital (may be billed separately) |
| Negotiated Minimum Charge | $21.06 | Not provided by Hospital (may be billed separately) |
| Negotiated Maximum Charge | $130.90 | Not provided by Hospital (may be billed separately) |
| Discounted Cash Price | $112.00 | Not provided by Hospital (may be billed separately) |
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