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Idaho 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
$157.12 / $410.12 / $410.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.00 / $494.18 / $1,018.37
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.31 / $168.00 / $351.85
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$307.37 / $368.50 / $673.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.91 / $311.73 / $918.76
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$90.87 / $101.56 / $205.33
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$188.05 / $210.17 / $634.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,232.86 / $1,232.86 / $2,394.25
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$891.78 / $891.78 / $893.85
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$341.09 / $341.09 / $1,500.40
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$518.78 / $597.38 / $782.95
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$173.46 / $199.75 / $233.39
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$345.31 / $397.63 / $464.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $175.68 / $565.46
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$714.15 / $714.15 / $714.15
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$550.00 / $674.73 / $782.95
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$187.48 / $220.57 / $265.52
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$386.04 / $454.16 / $517.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.89 / $549.99 / $1,181.08
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$98.66 / $123.50 / $221.00
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$217.19 / $399.87 / $938.54