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X-Ray, lower back, minimum four views

2020 CPT/HCPCS 72110
Negotiated Private Fee $75.00
Prossam $35.00
Champva $51.97
First Medical $42.00
First Medical Vital $36.38
Plan de Salud Menonita $46.00
Menonita Vital $34.95
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $41.00
Mapfre $48.00
Mcs Classicare $37.42
MCS Life $48.00
Medicare Ambulatory Payment classification (APC)
MMM $44.95
MMM Vital $34.95
Panamerican Life $48.00
PMC $44.95
Tricare $53.29
Triple S Salud $46.00
Triple S Vital $21.50
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $21.50
Negotiated Maximus Charge $53.29
Discounted Cash Price $60.00

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