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MRI Upper Extremity with and without contrast

2020 CPT/HCPCS 73220
Negotiated Private Fee $730.00
Prossam $500.00
Champva $476.93
First Medical $625.00
First Medical Vital $342.77
Plan de Salud Menonita $575.00
Menonita Vital $410.16
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $650.00
Mapfre $650.00
Mcs Classicare $445.63
MCS Life $523.13
Medicare Ambulatory Payment classification (APC)
MMM $415.71
MMM Vital $358.89
Panamerican Life $775.00
PMC $415.71
Tricare $454.87
Triple S Salud $650.00
Triple S Vital $487.50
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $342.77
Negotiated Maximus Charge $775.00
Discounted Cash Price $584.00

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