XR pelvis minimum 3 views
| 2020 CPT/HCPCS | 72190 |
| Negotiated Private Fee | $70.00 |
| Prossam | $23.00 |
| Champva | $42.83 |
| First Medical | $26.00 |
| First Medical Vital | $29.97 |
| Plan de Salud Menonita | $34.00 |
| Menonita Vital | $28.97 |
| Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
| Humana | $28.00 |
| Mapfre | $32.00 |
| Mcs Classicare | $32.00 |
| MCS Life | $32.00 |
| Medicare | Ambulatory Payment classification (APC) |
| MMM | $32.16 |
| MMM Vital | $28.97 |
| Panamerican Life | $32.00 |
| PMC | $32.16 |
| Tricare | $43.86 |
| Triple S Salud | $34.00 |
| Triple S Vital | $15.20 |
| Triple S Advantage | Ambulatory Payment classification (APC) |
| Negotiated Minimum Charge | $15.20 |
| Negotiated Maximus Charge | $43.86 |
| Discounted Cash Price | $56.00 |
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