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XR temporomandibular joint, open and closed mouth; bilateral

2020 CPT/HCPCS 70330
Negotiated Private Fee $80.00
Prossam $23.00
Champva $54.78
First Medical $26.00
First Medical Vital $38.35
Plan de Salud Menonita $40.00
Menonita Vital $36.86
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $33.00
Mapfre $38.00
Mcs Classicare $38.00
MCS Life $38.00
Medicare Ambulatory Payment classification (APC)
MMM $36.24
MMM Vital $36.86
Panamerican Life $40.00
PMC $36.24
Tricare $55.73
Triple S Salud $40.00
Triple S Vital $19.35
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $23.00
Negotiated Maximus Charge $54.78
Discounted Cash Price $64.00

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