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2020 CPT/HCPCS 73140
Negotiated Private Fee $40.00
Prossam $12.00
Champva $38.28
First Medical $14.00
First Medical Vital $26.80
Plan de Salud Menonita $20.00
Menonita Vital $25.43
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $16.00
Mapfre $16.00
Mcs Classicare $16.00
MCS Life $16.00
Medicare Ambulatory Payment classification (APC)
MMM $24.88
MMM Vital $25.43
Panamerican Life $22.00
PMC $24.88
Tricare $39.02
Triple S Salud $22.00
Triple S Vital $13.66
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $12.00
Negotiated Maximus Charge $39.02
Discounted Cash Price $32.00

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