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MRI Lower Extremity with and without contrast

2020 CPT/HCPCS 73720
Negotiated Private Fee $730.00
Prossam $500.00
Champva $391.48
First Medical $625.00
First Medical Vital $279.11
Plan de Salud Menonita $575.00
Menonita Vital $348.96
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $650.00
Mapfre $650.00
Mcs Classicare $581.26
MCS Life $620.00
Medicare Ambulatory Payment classification (APC)
MMM $418.25
MMM Vital $305.34
Panamerican Life $775.00
PMC $418.25
Tricare $454.87
Triple S Salud $650.00
Triple S Vital $487.50
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $279.11
Negotiated Maximus Charge $775.00
Discounted Cash Price $584.00

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