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Ohio 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
$113.31 / $158.63 / $376.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.58 / $475.00 / $1,078.03
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$110.41 / $145.16 / $362.98
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$217.27 / $335.00 / $786.09
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.85 / $234.72 / $293.39
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$82.30 / $133.74 / $189.29
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$203.93 / $203.93 / $343.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.15 / $449.97 / $784.51
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$117.92 / $131.55 / $236.22
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$242.25 / $315.33 / $568.71
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.51 / $346.51 / $381.75
Aultcare
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$121.40 / $121.40 / $133.74
Aultcare
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$225.11 / $225.11 / $248.00
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.17 / $240.66 / $419.33
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$111.95 / $124.22 / $124.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.04 / $544.19 / $1,230.59
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.27 / $147.91 / $245.59
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$204.92 / $360.70 / $1,020.19
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$111.95 / $111.95 / $124.22
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.04 / $539.04 / $1,251.15
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.76 / $163.30 / $293.87
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$209.85 / $350.00 / $977.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.93 / $212.75 / $381.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.08 / $448.17 / $997.05
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.61 / $126.67 / $230.36
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$217.47 / $300.55 / $784.14