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Ultrasound breast bilateral limited

2020 CPT/HCPCS 76642
Negotiated Private Fee $106.00
Prossam $70.00
Champva $90.17
First Medical $30.00
First Medical Vital $63.11
Plan de Salud Menonita $75.00
Menonita Vital $81.71
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $48.00
Mapfre $35.00
Mcs Classicare $53.34
MCS Life $53.34
Medicare Ambulatory Payment classification (APC)
MMM $69.78
MMM Vital $63.55
Panamerican Life Not Covered
PMC $69.78
Tricare $88.38
Triple S Salud $30.00
Triple S Vital $26.00
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $26.00
Negotiated Maximus Charge $90.17
Discounted Cash Price $84.80

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