XR mandible minimum 4 views
| 2020 CPT/HCPCS | 70110 |
| Negotiated Private Fee | $45.00 |
| Prossam | $29.00 |
| Champva | $44.58 |
| First Medical | $33.00 |
| First Medical Vital | $30.24 |
| Plan de Salud Menonita | $29.33 |
| Menonita Vital | $30.24 |
| Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
| Humana | $32.00 |
| Mapfre | $40.00 |
| Mcs Classicare | $29.77 |
| MCS Life | $31.52 |
| Medicare | Ambulatory Payment classification (APC) |
| MMM | $30.12 |
| MMM Vital | $30.24 |
| Panamerican Life | $35.00 |
| PMC | $30.12 |
| Tricare | $44.58 |
| Triple S Salud | $34.50 |
| Triple S Vital | $32.18 |
| Triple S Advantage | Ambulatory Payment classification (APC) |
| Negotiated Minimum Charge | $29.00 |
| Negotiated Maximus Charge | $44.58 |
| Discounted Cash Price | $36.00 |
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