MR pelvis without contrast
| 2020 CPT/HCPCS | 72195 |
| Negotiated Private Fee | $650.00 |
| Prossam | $500.00 |
| Champva | $265.43 |
| First Medical | $625.00 |
| First Medical Vital | $190.39 |
| Plan de Salud Menonita | $575.00 |
| Menonita Vital | $247.04 |
| Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
| Humana | $650.00 |
| Mapfre | $650.00 |
| Mcs Classicare | $390.00 |
| MCS Life | $455.00 |
| Medicare | Ambulatory Payment classification (APC) |
| MMM | $292.01 |
| MMM Vital | $216.16 |
| Panamerican Life | $650.00 |
| PMC | $292.01 |
| Tricare | $252.77 |
| Triple S Salud | $650.00 |
| Triple S Vital | $255.94 |
| Triple S Advantage | Ambulatory Payment classification (APC) |
| Negotiated Minimum Charge | $190.39 |
| Negotiated Maximus Charge | $650.00 |
| Discounted Cash Price | $520.00 |
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