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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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