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MRI Lower Extremity with contrast

2020 CPT/HCPCS 73719
Negotiated Private Fee $720.00
Prossam $500.00
Champva $304.40
First Medical $625.00
First Medical Vital $218.11
Plan de Salud Menonita $575.00
Menonita Vital $270.20
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $400.00
Mapfre $650.00
Mcs Classicare $542.50
MCS Life $620.00
Medicare Ambulatory Payment classification (APC)
MMM $341.03
MMM Vital $236.43
Panamerican Life $725.00
PMC $341.03
Tricare $366.44
Triple S Salud $650.00
Triple S Vital $487.50
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $218.11
Negotiated Maximus Charge $725.00
Discounted Cash Price $576.00

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