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XR mandible less 4 views

2020 CPT/HCPCS 70100
Negotiated Private Fee $45.00
Prossam $17.00
Champva $39.33
First Medical $19.00
First Medical Vital $27.53
Plan de Salud Menonita $24.00
Menonita Vital $26.18
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $23.00
Mapfre $24.00
Mcs Classicare $24.00
MCS Life $24.00
Medicare Ambulatory Payment classification (APC)
MMM $25.86
MMM Vital $26.18
Panamerican Life $30.00
PMC $25.86
Tricare $40.05
Triple S Salud $28.00
Triple S Vital $13.74
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $17.00
Negotiated Maximus Charge $39.33
Discounted Cash Price $36.00

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