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Delaware rates for HCPCS 72158

Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$109.57 / $142.24 / $323.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.86 / $475.00 / $542.30
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.27 / $140.00 / $222.45
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$221.58 / $335.00 / $374.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.21 / $642.59 / $1,267.33
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$78.52 / $120.71 / $203.63
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$212.37 / $499.85 / $1,121.09
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.97 / $381.78 / $492.38
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$105.91 / $105.91 / $1,109.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.08 / $508.40 / $1,318.37
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$90.46 / $133.38 / $256.36
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$208.70 / $391.80 / $1,184.98