MRI Upper Extremity with contrast
| 2020 CPT/HCPCS | 73219 |
| Negotiated Private Fee | $720.00 |
| Prossam | $500.00 |
| Champva | $389.18 |
| First Medical | $625.00 |
| First Medical Vital | $279.22 |
| Plan de Salud Menonita | $575.00 |
| Menonita Vital | $330.82 |
| Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
| Humana | $650.00 |
| Mapfre | $650.00 |
| Mcs Classicare | $387.50 |
| MCS Life | $465.00 |
| Medicare | Ambulatory Payment classification (APC) |
| MMM | $335.72 |
| MMM Vital | $289.46 |
| Panamerican Life | $725.00 |
| PMC | $335.72 |
| Tricare | $366.41 |
| Triple S Salud | $650.00 |
| Triple S Vital | $487.50 |
| Triple S Advantage | Ambulatory Payment classification (APC) |
| Negotiated Minimum Charge | $279.22 |
| Negotiated Maximus Charge | $725.00 |
| Discounted Cash Price | $576.00 |
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