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Ultrasound pelvic complete

2020 CPT/HCPCS 76856
Negotiated Private Fee $110.00
Prossam $70.00
Champva $113.03
First Medical $40.00
First Medical Vital Not Covered
Plan de Salud Menonita $75.00
Menonita Vital $79.54
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $62.00
Mapfre $75.00
Mcs Classicare $75.00
MCS Life $75.00
Medicare Ambulatory Payment classification (APC)
MMM $91.16
MMM Vital $79.54
Panamerican Life $90.00
PMC $91.16
Tricare $111.04
Triple S Salud $75.00
Triple S Vital $41.22
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $40.00
Negotiated Maximus Charge $113.03
Discounted Cash Price $88.00

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