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Ultrasound, breast, unilateral with image documentation (sonomamography)

2020 CPT/HCPCS 76641
Negotiated Private Fee $106.00
Prossam $83.00
Champva $109.50
First Medical $60.00
First Medical Vital $76.73
Plan de Salud Menonita $75.00
Menonita Vital $99.65
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $58.00
Mapfre $35.00
Mcs Classicare $64.96
MCS Life $64.96
Medicare Ambulatory Payment classification (APC)
MMM $98.66
MMM Vital $77.50
Panamerican Life Not Covered
PMC $98.66
Tricare $107.90
Triple S Salud $60.00
Triple S Vital $53.00
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $35.00
Negotiated Maximus Charge $109.50
Discounted Cash Price $84.80

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