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Georgia rates for HCPCS 72158

Mri Spinal Canal Lumbar W/O & W/Contr Matrl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$85.00 / $142.30 / $482.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.64 / $475.00 / $1,111.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.00 / $165.71 / $348.94
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$259.36 / $340.00 / $852.98
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.17 / $287.54 / $416.93
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$80.98 / $148.63 / $196.02
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$109.61 / $363.84 / $363.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.98 / $535.77 / $1,389.74
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$99.69 / $141.74 / $296.42
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$214.25 / $361.67 / $1,242.25
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.96 / $238.38 / $419.33
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$124.22 / $124.22 / $124.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.22 / $844.29 / $1,893.67
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$108.20 / $184.40 / $306.63
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$257.95 / $581.00 / $1,429.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.80 / $628.72 / $2,861.27
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$116.14 / $185.15 / $403.37
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$229.66 / $417.56 / $2,535.50
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.04 / $315.26 / $581.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.61 / $633.78 / $1,466.55
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$105.49 / $146.99 / $257.10
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$233.89 / $412.63 / $1,072.40