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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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