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Hawaii 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

Facilitymedian $123 · 10th–90th $110$1450%10%20%10th90th$123Professionalmedian $347 · 10th–90th $117$1,2590%5%10th90th$347$20.0$50.0$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$109.65 / $123.03 / $144.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $501.19 / $1,288.25
Aetna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$109.65 / $151.36 / $537.03
Aetna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$223.87 / $309.03 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $549.54 / $870.96
Cigna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$95.50 / $141.25 / $208.93
Cigna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$213.80 / $436.52 / $741.31
HMSA
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,621.81 / $1,819.70
HMSA
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$147.91 / $151.36 / $158.49
HMSA
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$1,258.93 / $1,258.93 / $1,318.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $416.87 / $489.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$109.65 / $128.82 / $151.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$251.19 / $288.40 / $338.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $1,230.27 / $2,570.40
United
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$87.10 / $147.91 / $831.76
United
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$257.04 / $512.86 / $1,513.56
University Health Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $794.33 / $1,584.89
University Health Alliance
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$125.89 / $162.18 / $239.88
University Health Alliance
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$316.23 / $645.65 / $1,412.54