XR orbit minimum 4 views
| 2020 CPT/HCPCS | 70200 |
| Negotiated Private Fee | $50.00 |
| Prossam | $29.00 |
| Champva | $49.50 |
| First Medical | $33.00 |
| First Medical Vital | $34.65 |
| Plan de Salud Menonita | $35.00 |
| Menonita Vital | $33.29 |
| Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
| Humana | $35.00 |
| Mapfre | $35.00 |
| Mcs Classicare | $35.00 |
| MCS Life | $35.00 |
| Medicare | Ambulatory Payment classification (APC) |
| MMM | $33.21 |
| MMM Vital | $33.29 |
| Panamerican Life | $40.00 |
| PMC | $33.21 |
| Tricare | $50.49 |
| Triple S Salud | $41.00 |
| Triple S Vital | $17.48 |
| Triple S Advantage | Ambulatory Payment classification (APC) |
| Negotiated Minimum Charge | $29.00 |
| Negotiated Maximus Charge | $49.50 |
| Discounted Cash Price | $40.00 |
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