XR lumbar spine minimum 4 views
| 2020 CPT/HCPCS | 72110 |
| Negotiated Private Fee | $93.75 |
| Prossam | $35.00 |
| Champva | $49.38 |
| First Medical | $42.00 |
| First Medical Vital | $26.19 |
| Plan de Salud Menonita | $46.00 |
| Menonita Vital | $34.95 |
| Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
| Humana | $44.00 |
| Mapfre | $48.00 |
| Mcs Classicare | $37.42 |
| MCS Life | $48.00 |
| Medicare | Ambulatory Payment classification (APC) |
| MMM | $36.21 |
| MMM Vital | $30.64 |
| Panamerican Life | $48.00 |
| PMC | $36.21 |
| Tricare | $49.38 |
| Triple S Salud | $46.00 |
| Triple S Vital | $26.19 |
| Triple S Advantage | Ambulatory Payment classification (APC) |
| Negotiated Minimum Charge | $26.19 |
| Negotiated Maximus Charge | $49.38 |
| Discounted Cash Price | $75.00 |
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