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XR lumbar spine minimum 4 views

2020 CPT/HCPCS 72110
Negotiated Private Fee $93.75
Prossam $35.00
Champva $49.38
First Medical $42.00
First Medical Vital $26.19
Plan de Salud Menonita $46.00
Menonita Vital $34.95
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $44.00
Mapfre $48.00
Mcs Classicare $37.42
MCS Life $48.00
Medicare Ambulatory Payment classification (APC)
MMM $36.21
MMM Vital $30.64
Panamerican Life $48.00
PMC $36.21
Tricare $49.38
Triple S Salud $46.00
Triple S Vital $26.19
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $26.19
Negotiated Maximus Charge $49.38
Discounted Cash Price $75.00

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