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MRI lumbar spine with contrast

CPT 72158 · negotiated-rate distribution across hospitals in SD

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Hospitals
5
Min
$3,442.46
Median
$4,983.86
Max
$5,968
Range multiplier
1.7×

By payer (36 payers with published rates)

PayerHosp.RatesMinMedianMaxRange×
TRICARE472$376.09$1,896.95$3,542.799.4×
UnitedHealthcare536$1,438.64$5,035.24$5,9684.1×
Blue Cross Blue Shield527$1,176$4,572.82$5,9685.1×
Cigna424$4,932.48$5,086.62$5,086.621.0×
medica (commercial) 94265 [3081118]424$4,264.54$5,035.24$5,035.241.2×
govt employees health assn [3081090]424$3,391.08$5,035.24$5,035.241.5×
healthpartners [3081368]421$393$5,035.24$5,035.2412.8×
national telephone cooperative assn 52103 [3081149]416$3,391.08$5,035.24$5,035.241.5×
Meritain Health416$4,932.48$5,086.62$5,086.621.0×
risk admin svs [3081167]416$1,308.2$2,709.3$4,110.43.1×
Aetna412$4,624.2$4,752.65$4,881.11.1×
Humana510$335.46$5,138$5,96817.8×
tlc advantage llc [3081189]59$4,829.72$4,829.72$5,030.881.0×
avera health plans 46045 [3081018]59$3,776.43$4,983.86$4,983.861.3×
midlands choice 47080 [3081136]48$4,932.48$5,086.62$5,086.621.0×
allied benefit systems inc [3081320]48$4,932.48$5,086.62$5,086.621.0×
coresource 38225 [3081146]48$3,339.7$4,624.2$4,624.21.4×
employee benefit management 12x44 [3081079]48$4,367.3$4,624.2$4,624.21.1×
fedmed inc [3081283]48$4,881.1$4,983.86$4,983.861.0×
health partners sx009 [3081102]48$3,185.56$5,035.24$5,035.241.6×
key benefit administrators [3081332]48$4,932.48$5,086.62$5,086.621.0×
pacificsource health plans [3081333]48$4,367.3$4,624.2$4,624.21.1×
preferred one 41147 [3081160]48$4,932.48$5,086.62$5,086.621.0×
rocky mountain admin llc 83028 [3081168]48$4,110.4$4,624.2$4,624.21.1×
sanford health plan 91184 [3081174]48$4,624.2$4,983.86$4,983.861.1×
surest [3081369]48$3,391.08$5,035.24$5,035.241.5×
va ccn optum [3081339]44$319.49$1,438.64$1,901.066.0×
Medicare44$1,438.64$1,669.85$5,9684.1×
Multiplan24$4,624.2$4,804.03$4,983.861.1×
group and pension administrators inc [3081098]24$4,624.2$4,804.03$4,983.861.1×
va black hills health care system 12115 [3081206]44$319.49$1,438.64$1,901.066.0×
va black hills health care system 12115 [3081207]33$1,438.64$1,438.64$1,901.061.3×
VA Health33$1,438.64$1,438.64$1,901.061.3×
Health Net33$1,438.64$1,438.64$1,901.061.3×
triwest healthcare alliance [3081322]33$1,438.64$1,438.64$1,901.061.3×
minnesota health care programs 12k16 [3081295]12$1,556.81$1,556.81$1,556.811.0×

By hospital (top 200 by negotiated median, descending)

HospitalCitySTPayersGrossCashNeg minNeg medianNeg max
MONUMENT HEALTH SPEARFISH HOSPITALSPEARFISHSD6$5,352$5,352$1,176$5,968$5,968
MONUMENT HEALTH CUSTER HOSPITALCUSTERSD35$5,138$5,138$1,308.2$5,035.24$5,138
MONUMENT HEALTH LEAD-DEADWOOD HOSPITDEADWOODSD33$5,138$5,138$1,308.2$4,983.86$5,138
MONUMENT HEALTH STURGIS REGIONALSTURGISSD33$5,138$5,138$1,308.2$4,983.86$5,138
MONUMENT HEALTH RAPID CITY HOSPITALRAPID CITYSD31$5,138$5,138$319.49$3,442.46$4,932.48

Median is taken across all payer × plan combinations the hospital publishes. Cash and gross are the latest snapshot values. Range multiplier (max ÷ min) is a quick way to see which hospitals or payers vary the most.