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Florida 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
$62.50 / $92.82 / $367.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.00 / $425.00 / $707.72
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$62.50 / $127.50 / $344.64
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$187.50 / $282.87 / $462.42
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.74 / $225.12 / $496.19
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$80.98 / $142.40 / $222.70
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$124.22 / $124.22 / $332.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.89 / $492.11 / $1,272.71
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$76.95 / $126.00 / $228.13
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$160.72 / $340.20 / $1,108.40
Florida Blue
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$121.89 / $121.89 / $121.89
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.60 / $457.95 / $976.21
Florida Blue
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.32 / $129.51 / $163.50
Florida Blue
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$197.23 / $316.26 / $859.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.09 / $209.28 / $387.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.14 / $438.44 / $1,068.15
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.09 / $99.70 / $214.50
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$193.63 / $290.45 / $774.92
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.38 / $233.38 / $233.38
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$76.29 / $76.29 / $76.29
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$157.08 / $157.08 / $157.08