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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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