CT thoracic spine without contrast
| 2020 CPT/HCPCS | 72128 |
| Negotiated Private Fee | $350.00 |
| Prossam | $260.00 |
| Champva | $143.53 |
| First Medical | $275.00 |
| First Medical Vital | $111.31 |
| Plan de Salud Menonita | $300.00 |
| Menonita Vital | $133.46 |
| Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
| Humana | $275.00 |
| Mapfre | $300.00 |
| Mcs Classicare | $210.00 |
| MCS Life | $225.00 |
| Medicare | Ambulatory Payment classification (APC) |
| MMM | $154.65 |
| MMM Vital | $116.78 |
| Panamerican Life | $300.00 |
| PMC | $154.65 |
| Tricare | $139.91 |
| Triple S Salud | $300.00 |
| Triple S Vital | $126.00 |
| Triple S Advantage | Ambulatory Payment classification (APC) |
| Negotiated Minimum Charge | $111.31 |
| Negotiated Maximus Charge | $300.00 |
| Discounted Cash Price | $280.00 |
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