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MRI scan of lower spinal canal with and without contrast

2020 CPT/HCPCS 72158
Negotiated Private Fee $730.00
Prossam $500.00
Champva $367.51
First Medical $625.00
First Medical Vital $262.52
Plan de Salud Menonita $647.00
Menonita Vital $311.23
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $725.00
Mapfre $650.00
Mcs Classicare $387.50
MCS Life $465.00
Medicare Ambulatory Payment classification (APC)
MMM $402.91
MMM Vital $272.33
Panamerican Life $775.00
PMC $402.91
Tricare $349.50
Triple S Salud $650.00
Triple S Vital $262.50
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $262.52
Negotiated Maximus Charge $775.00
Discounted Cash Price $584.00

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