XR pelvis 1 or 2 views
| 2020 CPT/HCPCS | 72170 |
| Negotiated Private Fee | $60.00 |
| Prossam | $14.00 |
| Champva | $28.42 |
| First Medical | $16.00 |
| First Medical Vital | $20.33 |
| Plan de Salud Menonita | $27.00 |
| Menonita Vital | $22.80 |
| Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
| Humana | $22.00 |
| Mapfre | $23.00 |
| Mcs Classicare | $23.00 |
| MCS Life | $23.00 |
| Medicare | Ambulatory Payment classification (APC) |
| MMM | $26.14 |
| MMM Vital | $22.80 |
| Panamerican Life | $20.00 |
| PMC | $26.14 |
| Tricare | $28.89 |
| Triple S Salud | $27.00 |
| Triple S Vital | $10.67 |
| Triple S Advantage | Ambulatory Payment classification (APC) |
| Negotiated Minimum Charge | $10.67 |
| Negotiated Maximus Charge | $28.89 |
| Discounted Cash Price | $48.00 |
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