XR skull less 4 views
| 2020 CPT/HCPCS | 70250 |
| Negotiated Private Fee | $43.00 |
| Prossam | $20.00 |
| Champva | $36.51 |
| First Medical | $23.00 |
| First Medical Vital | $25.56 |
| Plan de Salud Menonita | $28.00 |
| Menonita Vital | $26.09 |
| Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
| Humana | $26.00 |
| Mapfre | $28.00 |
| Mcs Classicare | $25.00 |
| MCS Life | $25.00 |
| Medicare | Ambulatory Payment classification (APC) |
| MMM | $28.39 |
| MMM Vital | $26.09 |
| Panamerican Life | $32.00 |
| PMC | $28.39 |
| Tricare | $37.26 |
| Triple S Salud | $34.00 |
| Triple S Vital | $13.35 |
| Triple S Advantage | Ambulatory Payment classification (APC) |
| Negotiated Minimum Charge | $20.00 |
| Negotiated Maximus Charge | $36.51 |
| Discounted Cash Price | $34.40 |
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