XR hip bilateral 2 views
| 2020 CPT/HCPCS | 73521 |
| Negotiated Private Fee | $90.00 |
| Prossam | $25.00 |
| Champva | $42.13 |
| First Medical | $26.00 |
| First Medical Vital | $29.49 |
| Plan de Salud Menonita | $36.00 |
| Menonita Vital | $28.47 |
| Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
| Humana | $25.00 |
| Mapfre | $30.00 |
| Mcs Classicare | $30.05 |
| MCS Life | $30.00 |
| Medicare | Ambulatory Payment classification (APC) |
| MMM | $36.60 |
| MMM Vital | $28.47 |
| Panamerican Life | Not Covered |
| PMC | $36.60 |
| Tricare | $42.83 |
| Triple S Salud | $36.00 |
| Triple S Vital | $16.54 |
| Triple S Advantage | Ambulatory Payment classification (APC) |
| Negotiated Minimum Charge | $16.54 |
| Negotiated Maximus Charge | $42.83 |
| Discounted Cash Price | $72.00 |
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