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MRI scan of lower spinal canal with contrast

2020 CPT/HCPCS 72149
Negotiated Private Fee $720.00
Prossam $500.00
Champva $311.39
First Medical $625.00
First Medical Vital $222.15
Plan de Salud Menonita $700.00
Menonita Vital $264.36
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $725.00
Mapfre $650.00
Mcs Classicare $387.50
MCS Life $542.50
Medicare Ambulatory Payment classification (APC)
MMM $344.03
MMM Vital $231.32
Panamerican Life $725.00
PMC $344.03
Tricare $296.62
Triple S Salud $650.00
Triple S Vital $262.50
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $222.15
Negotiated Maximus Charge $725.00
Discounted Cash Price $576.00

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