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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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