MRI scan of lower spinal canal with and without contrast
| 2020 CPT/HCPCS | 72158 |
| Negotiated Private Fee | $730.00 |
| Prossam | $500.00 |
| Champva | $367.51 |
| First Medical | $625.00 |
| First Medical Vital | $262.52 |
| Plan de Salud Menonita | $647.00 |
| Menonita Vital | $311.23 |
| Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
| Humana | $725.00 |
| Mapfre | $650.00 |
| Mcs Classicare | $387.50 |
| MCS Life | $465.00 |
| Medicare | Ambulatory Payment classification (APC) |
| MMM | $402.91 |
| MMM Vital | $272.33 |
| Panamerican Life | $775.00 |
| PMC | $402.91 |
| Tricare | $349.50 |
| Triple S Salud | $650.00 |
| Triple S Vital | $262.50 |
| Triple S Advantage | Ambulatory Payment classification (APC) |
| Negotiated Minimum Charge | $262.52 |
| Negotiated Maximus Charge | $775.00 |
| Discounted Cash Price | $584.00 |
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