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2020 CPT/HCPCS 74021
Negotiated Private Fee $65.00
Prossam $23.00
Champva $43.88
First Medical Not covered
First Medical Vital $30.71
Plan de Salud Menonita $33.00
Menonita Vital $29.73
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $28.00
Mapfre $40.00
Mcs Classicare $26.10
MCS Life $26.10
Medicare Ambulatory Payment classification (APC)
MMM $36.51
MMM Vital $29.73
Panamerican Life Not Covered
PMC $36.51
Tricare $44.91
Triple S Salud $35.00
Triple S Vital $15.60
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $15.60
Negotiated Maximus Charge $44.91
Discounted Cash Price $52.00

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