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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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