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Nebraska 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
$104.47 / $341.05 / $947.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.33 / $475.00 / $2,070.19
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.20 / $243.60 / $536.75
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$207.97 / $335.00 / $1,438.72
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.61 / $709.76 / $709.76
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$82.96 / $184.94 / $243.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.69 / $607.86 / $646.53
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$191.16 / $204.34 / $216.05
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$377.54 / $403.54 / $430.50
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$603.00 / $603.00 / $603.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$419.36 / $722.85 / $1,100.44
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$137.34 / $238.76 / $308.33
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$282.02 / $482.04 / $847.99
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$1,016.96 / $1,016.96 / $1,016.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.16 / $858.60 / $6,146.58
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$135.19 / $219.18 / $921.60
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$347.71 / $579.52 / $5,551.18
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$361.64 / $372.18 / $603.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.88 / $782.08 / $1,459.73
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.14 / $299.18 / $534.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.51 / $793.17 / $1,048.51
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$133.96 / $217.68 / $279.08
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$278.17 / $509.98 / $728.45