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MR pelvis with contrast

2020 CPT/HCPCS 72196
Negotiated Private Fee $720.00
Prossam $500.00
Champva $311.76
First Medical $625.00
First Medical Vital $222.16
Plan de Salud Menonita $575.00
Menonita Vital $285.26
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $650.00
Mapfre $650.00
Mcs Classicare $465.00
MCS Life $542.50
Medicare Ambulatory Payment classification (APC)
MMM $342.69
MMM Vital $249.60
Panamerican Life $725.00
PMC $342.69
Tricare $295.94
Triple S Salud $650.00
Triple S Vital $262.50
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $222.16
Negotiated Maximus Charge $725.00
Discounted Cash Price $576.00

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