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Virginia 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
$118.59 / $175.22 / $782.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.58 / $485.73 / $844.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$108.70 / $154.00 / $234.65
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$218.95 / $335.00 / $478.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.72 / $387.11 / $640.00
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$98.96 / $123.76 / $191.45
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$203.75 / $260.56 / $472.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$523.69 / $534.78 / $3,388.21
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$123.53 / $129.12 / $170.75
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$394.58 / $411.25 / $777.26
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
$299.11 / $664.46 / $1,399.91
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$88.03 / $146.47 / $268.48
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$208.28 / $469.53 / $1,190.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.95 / $371.94 / $458.10
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$97.93 / $120.97 / $145.32
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$212.02 / $254.43 / $311.80
Medcost
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$170.34 / $250.02 / $402.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.00 / $466.00 / $1,122.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.56 / $613.00 / $1,354.19
Sentara
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$115.75 / $156.72 / $243.95
Sentara
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$253.09 / $470.49 / $823.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.82 / $544.84 / $1,478.23
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$84.69 / $136.71 / $211.92
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$202.52 / $386.36 / $1,134.22