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MRI scan of lower spinal canal without contrast

2020 CPT/HCPCS 72148
Negotiated Private Fee $650.00
Prossam $500.00
Champva $217.25
First Medical $625.00
First Medical Vital $155.50
Plan de Salud Menonita $575.00
Menonita Vital $184.39
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $650.00
Mapfre $650.00
Mcs Classicare $455.00
MCS Life $520.00
Medicare Ambulatory Payment classification (APC)
MMM $273.55
MMM Vital $161.34
Panamerican Life $650.00
PMC $273.55
Tricare $208.82
Triple S Salud $650.00
Triple S Vital $262.50
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $155.50
Negotiated Maximus Charge $650.00
Discounted Cash Price $520.00

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