MRI Upper Extremity with and without contrast
| 2020 CPT/HCPCS | 73220 |
| Negotiated Private Fee | $730.00 |
| Prossam | $500.00 |
| Champva | $476.93 |
| First Medical | $625.00 |
| First Medical Vital | $342.77 |
| Plan de Salud Menonita | $575.00 |
| Menonita Vital | $410.16 |
| Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
| Humana | $650.00 |
| Mapfre | $650.00 |
| Mcs Classicare | $445.63 |
| MCS Life | $523.13 |
| Medicare | Ambulatory Payment classification (APC) |
| MMM | $415.71 |
| MMM Vital | $358.89 |
| Panamerican Life | $775.00 |
| PMC | $415.71 |
| Tricare | $454.87 |
| Triple S Salud | $650.00 |
| Triple S Vital | $487.50 |
| Triple S Advantage | Ambulatory Payment classification (APC) |
| Negotiated Minimum Charge | $342.77 |
| Negotiated Maximus Charge | $775.00 |
| Discounted Cash Price | $584.00 |
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