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XR lumbar spine bending only

2020 CPT/HCPCS 72120
Negotiated Private Fee $60.00
Prossam $23.00
Champva $41.78
First Medical $26.00
First Medical Vital $29.25
Plan de Salud Menonita $32.00
Menonita Vital $29.13
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $33.00
Mapfre $36.00
Mcs Classicare $32.00
MCS Life $32.00
Medicare Ambulatory Payment classification (APC)
MMM $31.57
MMM Vital $29.13
Panamerican Life $35.00
PMC $31.57
Tricare $42.48
Triple S Salud $41.00
Triple S Vital $14.82
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $14.82
Negotiated Maximus Charge $42.48
Discounted Cash Price $48.00

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