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New Hampshire 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
$128.82 / $165.96 / $436.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $524.81 / $2,238.72
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.65 / $177.83 / $354.81
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$234.42 / $338.84 / $870.96
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $275.42 / $537.03
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.11 / $85.11 / $346.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $741.31 / $1,071.52
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.71 / $245.47 / $354.81
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$213.80 / $489.78 / $776.25
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$141.25 / $141.25 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $758.58 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$134.90 / $218.78 / $331.13
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$295.12 / $512.86 / $1,513.56
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $575.44 / $912.01
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$123.03 / $190.55 / $288.40
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$251.19 / $389.05 / $602.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $616.60 / $1,230.27
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.15 / $154.88 / $309.03
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$251.19 / $398.11 / $891.25
Well Sense
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$69.18 / $81.28 / $81.28