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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