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XR temporomandibular joint, open and closed mouth; unilateral

2020 CPT/HCPCS 70328
Negotiated Private Fee $40.00
Prossam $14.00
Champva $35.46
First Medical $16.00
First Medical Vital $24.82
Plan de Salud Menonita $20.00
Menonita Vital $23.89
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $21.00
Mapfre $22.00
Mcs Classicare $23.32
MCS Life $28.80
Medicare Ambulatory Payment classification (APC)
MMM $24.05
MMM Vital $23.89
Panamerican Life $32.00
PMC $24.05
Tricare $36.21
Triple S Salud $27.00
Triple S Vital $12.55
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $14.00
Negotiated Maximus Charge $35.46
Discounted Cash Price $32.00

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