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2020 CPT/HCPCS 73100
Negotiated Private Fee $50.00
Prossam $17.00
Champva $34.76
First Medical $19.00
First Medical Vital $24.33
Plan de Salud Menonita $24.00
Menonita Vital $23.39
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $20.00
Mapfre $24.00
Mcs Classicare $24.00
MCS Life $24.00
Medicare Ambulatory Payment classification (APC)
MMM $30.07
MMM Vital $23.39
Panamerican Life $26.00
PMC $30.07
Tricare $35.17
Triple S Salud $26.00
Triple S Vital $18.52
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $17.00
Negotiated Maximus Charge $35.17
Discounted Cash Price $40.00

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