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2020 CPT/HCPCS 70250
Negotiated Private Fee $43.00
Prossam $20.00
Champva $36.51
First Medical $23.00
First Medical Vital $25.56
Plan de Salud Menonita $28.00
Menonita Vital $26.09
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $26.00
Mapfre $28.00
Mcs Classicare $25.00
MCS Life $25.00
Medicare Ambulatory Payment classification (APC)
MMM $28.39
MMM Vital $26.09
Panamerican Life $32.00
PMC $28.39
Tricare $37.26
Triple S Salud $34.00
Triple S Vital $13.35
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $20.00
Negotiated Maximus Charge $36.51
Discounted Cash Price $34.40

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