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Wyoming 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
$104.47 / $104.47 / $106.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.86 / $475.00 / $526.19
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.27 / $140.00 / $179.07
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$221.58 / $335.00 / $347.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$853.00 / $1,402.00 / $2,590.00
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$277.00 / $455.00 / $840.00
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$576.00 / $947.00 / $1,750.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.79 / $742.19 / $1,512.32
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$128.74 / $194.61 / $408.57
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$340.91 / $565.00 / $1,199.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578.49 / $719.52 / $2,175.81
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.80 / $205.98 / $383.91
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$396.49 / $508.28 / $1,810.60