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XR ribs unilateral 2 views

2020 CPT/HCPCS 71100
Negotiated Private Fee $45.00
Prossam $23.00
Champva $37.56
First Medical $28.00
First Medical Vital $30.22
Plan de Salud Menonita $31.00
Menonita Vital $25.41
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $27.00
Mapfre $28.00
Mcs Classicare $28.00
MCS Life $28.00
Medicare Ambulatory Payment classification (APC)
MMM $24.71
MMM Vital $25.41
Panamerican Life $34.00
PMC $24.71
Tricare $43.86
Triple S Salud $35.00
Triple S Vital $16.89
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $16.89
Negotiated Maximus Charge $43.86
Discounted Cash Price $36.00

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