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Mammography, screening, bilateral

DETAIL FOR SERVICES: Study Radiologist reading (interpretation)
2020 CPT/HCPCS Primary Code 77067 Not provided by Hospital (may be billed separately)
Negotiated Private Fee $140.00 Not provided by Hospital (may be billed separately)
Prossam $37.50 Not provided by Hospital (may be billed separately)
Champva $133.35 Not provided by Hospital (may be billed separately)
First Medical $35.00 Not provided by Hospital (may be billed separately)
First Medical Vital $70.53 Not provided by Hospital (may be billed separately)
Plan de Salud Menonita $37.50 Not provided by Hospital (may be billed separately)
Menonita Vital $63.52 Not provided by Hospital (may be billed separately)
Humana Gold Plus / Gold Choice $100.16 Not provided by Hospital (may be billed separately)
Humana $47.50 Not provided by Hospital (may be billed separately)
Mapfre $50.50 Not provided by Hospital (may be billed separately)
Mcsclassicare $44.00 Not provided by Hospital (may be billed separately)
MCS Life $59.00 Not provided by Hospital (may be billed separately)
Medicare $133.35 Not provided by Hospital (may be billed separately)
MMM $92.00 Not provided by Hospital (may be billed separately)
MMM Vital $71.55 Not provided by Hospital (may be billed separately)
Panamerican Life $40.00 Not provided by Hospital (may be billed separately)
PMC $92.00 Not provided by Hospital (may be billed separately)
Tricare $97.42 Not provided by Hospital (may be billed separately)
Triple S Salud $32.50 Not provided by Hospital (may be billed separately)
Triple S Vital $19.50 Not provided by Hospital (may be billed separately)
Triple S Advantage $100.16 Not provided by Hospital (may be billed separately)
Negotiated Minimum Charge $19.50 Not provided by Hospital (may be billed separately)
Negotiated Maximum Charge $133.35 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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