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XR ribs bilateral 3 views

2020 CPT/HCPCS 71110
Negotiated Private Fee $90.00
Prossam $29.00
Champva $44.92
First Medical $33.00
First Medical Vital $31.44
Plan de Salud Menonita $30.00
Menonita Vital $30.74
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $31.00
Mapfre $40.00
Mcs Classicare $29.06
MCS Life $35.00
Medicare Ambulatory Payment classification (APC)
MMM $31.03
MMM Vital $30.74
Panamerican Life $40.00
PMC $31.03
Tricare $45.60
Triple S Salud $40.00
Triple S Vital $16.89
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $16.89
Negotiated Maximus Charge $45.60
Discounted Cash Price $72.00

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