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Vancomycin

2020 CPT/HCPCS Primary Code 80202
Negotiated Private Fee $32.00
Prossam $74.00
Champva $13.54
First Medical $40.00
First Medical Vital $12.92
Plan de Salud Menonita $29.00
Menonita Vital $12.92
Humana Gold plus/ Gold choice $13.54
Humana $70.00
Mapfre $61.00
Mcs Classicare $13.54
MCS Life $50.40
Medicare $13.54
MMM $19.19
MMM Vital $11.70
Panamerican Life $50.00
PMC $19.19
Tricare $13.54
Triple S Salud $73.99
Triple S Vital $20.15
Triple S Advantage $33.44
Negotiated Minimum Charge $11.70
Negotiated Maximus Charge $74.00
Discounted Cash Price $25.60

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