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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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