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MRI Upper Extremity without contrast

2020 CPT/HCPCS 73218
Negotiated Private Fee $650.00
Prossam $500.00
Champva $298.53
First Medical $625.00
First Medical Vital $213.08
Plan de Salud Menonita $575.00
Menonita Vital $243.00
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $600.00
Mapfre $650.00
Mcs Classicare $390.00
MCS Life $455.00
Medicare Ambulatory Payment classification (APC)
MMM $287.31
MMM Vital $252.55
Panamerican Life $650.00
PMC $287.31
Tricare $303.39
Triple S Salud $650.00
Triple S Vital $487.50
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $213.08
Negotiated Maximus Charge $650.00
Discounted Cash Price $520.00

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