XR shoulder minimum 2 views
| 2020 CPT/HCPCS | 73030 |
| Negotiated Private Fee | $50.00 |
| Prossam | $20.00 |
| Champva | $35.10 |
| First Medical | $29.00 |
| First Medical Vital | $24.58 |
| Plan de Salud Menonita | $28.00 |
| Menonita Vital | $23.64 |
| Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
| Humana | $23.00 |
| Mapfre | $24.00 |
| Mcs Classicare | $24.00 |
| MCS Life | $24.00 |
| Medicare | Ambulatory Payment classification (APC) |
| MMM | $30.39 |
| MMM Vital | $23.64 |
| Panamerican Life | $30.00 |
| PMC | $30.39 |
| Tricare | $35.86 |
| Triple S Salud | $29.00 |
| Triple S Vital | $22.42 |
| Triple S Advantage | Ambulatory Payment classification (APC) |
| Negotiated Minimum Charge | $20.00 |
| Negotiated Maximus Charge | $35.86 |
| Discounted Cash Price | $40.00 |
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