XR lumbar spine including bending views minimum 6 views
| 2020 CPT/HCPCS | 72114 |
| Negotiated Private Fee | $85.00 |
| Prossam | $35.00 |
| Champva | $63.57 |
| First Medical | $42.00 |
| First Medical Vital | $44.49 |
| Plan de Salud Menonita | $46.00 |
| Menonita Vital | $44.09 |
| Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
| Humana | $48.00 |
| Mapfre | $64.00 |
| Mcs Classicare | $32.00 |
| MCS Life | $32.00 |
| Medicare | Ambulatory Payment classification (APC) |
| MMM | $47.51 |
| MMM Vital | $44.09 |
| Panamerican Life | $48.00 |
| PMC | $47.51 |
| Tricare | $64.43 |
| Triple S Salud | $57.00 |
| Triple S Vital | $22.29 |
| Triple S Advantage | Ambulatory Payment classification (APC) |
| Negotiated Minimum Charge | $22.29 |
| Negotiated Maximus Charge | $64.43 |
| Discounted Cash Price | $68.00 |
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