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New York 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
$111.15 / $133.41 / $291.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.86 / $475.00 / $1,170.45
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$110.32 / $143.49 / $322.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$237.52 / $335.00 / $701.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.90 / $222.54 / $254.34
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.47 / $84.71 / $189.29
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$74.87 / $74.87 / $74.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.58 / $424.29 / $1,432.69
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$99.41 / $126.05 / $258.63
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$225.17 / $285.50 / $958.15
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.25 / $345.47 / $503.72
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$124.22 / $124.22 / $124.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.05 / $770.61 / $2,221.98
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.84 / $151.38 / $340.25
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$199.25 / $554.32 / $1,572.24
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.92 / $488.23 / $1,358.71
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.63 / $141.78 / $247.81
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$220.04 / $287.68 / $523.80
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.02 / $505.00 / $680.98
Excellus BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.97 / $128.87 / $227.18
Excellus BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$198.40 / $363.62 / $461.35
Fidelis
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.42 / $352.42 / $352.42
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.14 / $444.95 / $946.16
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$136.99 / $152.78 / $259.89
MVP Health Care
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$124.22 / $124.22 / $124.22
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$334.81 / $725.00 / $1,892.47
MVP Health Care
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$84.48 / $157.11 / $335.35
MVP Health Care
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$199.25 / $530.00 / $1,207.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.39 / $429.08 / $1,273.74
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$93.39 / $117.82 / $280.58
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$195.25 / $271.20 / $934.26
Univera
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$126.74 / $126.74 / $368.63
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.66 / $501.70 / $900.20
Univera
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.97 / $163.82 / $286.38
Univera
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$219.69 / $363.62 / $602.61