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MRI Chest with and without contrast

2020 CPT/HCPCS 71552
Negotiated Private Fee $730.00
Prossam $500.00
Champva $481.83
First Medical $625.00
First Medical Vital $349.88
Plan de Salud Menonita $575.00
Menonita Vital $460.30
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $650.00
Mapfre $650.00
Mcs Classicare $435.12
MCS Life $496.00
Medicare Ambulatory Payment classification (APC)
MMM $468.80
MMM Vital $402.76
Panamerican Life $775.00
PMC $468.80
Tricare $489.02
Triple S Salud $650.00
Triple S Vital $262.50
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $349.88
Negotiated Maximus Charge $775.00
Discounted Cash Price $584.00

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