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New Hampshire 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
$127.50 / $208.49 / $432.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.35 / $475.00 / $1,320.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$118.59 / $140.00 / $389.19
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$281.41 / $335.00 / $931.29
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.96 / $763.50 / $763.50
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$80.33 / $135.18 / $347.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.41 / $671.75 / $963.22
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$105.13 / $224.61 / $317.64
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$209.28 / $447.14 / $641.15
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$142.34 / $142.34 / $142.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.96 / $751.75 / $1,757.70
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$134.44 / $221.44 / $321.89
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$291.95 / $514.66 / $1,486.53
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.93 / $639.66 / $1,185.65
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.35 / $208.18 / $396.44
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$239.58 / $425.78 / $789.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.66 / $559.22 / $1,291.31
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.58 / $152.47 / $311.25
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$319.44 / $443.63 / $960.14
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.86 / $593.17 / $882.34
Well Sense
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$88.08 / $106.88 / $141.80
Well Sense
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$375.06 / $453.34 / $715.52