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MRI Spinal Canal, thoracic with contrast

2020 CPT/HCPCS 72147
Negotiated Private Fee $720.00
Prossam $500.00
Champva $314.21
First Medical $625.00
First Medical Vital $224.18
Plan de Salud Menonita $700.00
Menonita Vital $265.82
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 $317.42
MMM Vital $232.59
Panamerican Life $725.00
PMC $317.42
Tricare $299.07
Triple S Salud $650.00
Triple S Vital $262.50
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $224.18
Negotiated Maximus Charge $725.00
Discounted Cash Price $576.00

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