2020 CPT/HCPCS Primary Code | 87102 |
Negotiated Private Fee | $14.00 |
Prossam | $25.00 |
Champva | $8.41 |
First Medical | $20.00 |
First Medical Vital | $8.02 |
Plan de Salud Menonita | Not covered |
Menonita Vital | $8.02 |
Humana Gold plus/ Gold choice | $8.41 |
Humana | $23.00 |
Mapfre | $28.00 |
Mcs Classicare | $8.41 |
MCS Life | $28.00 |
Medicare | $8.41 |
MMM | $11.90 |
MMM Vital | $7.27 |
Panamerican Life | $15.00 |
PMC | $11.90 |
Tricare | $8.41 |
Triple S Salud | Not Covered |
Triple S Vital | Not Covered |
Triple S Advantage | $20.76 |
Negotiated Minimum Charge | $7.27 |
Negotiated Maximus Charge | $28.00 |
Discounted Cash Price | $11.20 |
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