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MR pelvis with and without contrast

2020 CPT/HCPCS 72197
Negotiated Private Fee $730.00
Prossam $500.00
Champva $391.47
First Medical $625.00
First Medical Vital $279.36
Plan de Salud Menonita $575.00
Menonita Vital $349.53
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $575.00
Mapfre $650.00
Mcs Classicare $581.26
MCS Life $620.00
Medicare Ambulatory Payment classification (APC)
MMM $419.92
MMM Vital $305.84
Panamerican Life $775.00
PMC $419.92
Tricare $371.83
Triple S Salud $650.00
Triple S Vital $262.50
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $279.36
Negotiated Maximus Charge $775.00
Discounted Cash Price $584.00

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