|
MRI Abdomen w/ + w/o Contrast
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
1168730
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,195.60 |
| Max. Negotiated Rate |
$1,537.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,537.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,537.20
|
| Rate for Payer: Cash Price |
$1,366.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,281.00
|
| Rate for Payer: Medical Associates Commercial |
$1,281.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,195.60
|
| Rate for Payer: United Healthcare Commercial |
$1,537.20
|
|
|
MRI Abdomen w/ + w/o Contrast
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
1168730
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$853.66 |
| Max. Negotiated Rate |
$1,537.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,537.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,537.20
|
| Rate for Payer: Aetna of IA Medicare |
$973.56
|
| Rate for Payer: Amerigroup Medicaid |
$862.03
|
| Rate for Payer: Amerigroup Medicare |
$862.54
|
| Rate for Payer: Cash Price |
$1,366.40
|
| Rate for Payer: Cash Price |
$1,366.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,281.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$854.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$853.66
|
| Rate for Payer: Medical Associates Commercial |
$1,281.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$854.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,195.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$866.81
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$866.30
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,281.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,281.00
|
| Rate for Payer: United Healthcare Commercial |
$1,537.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,007.72
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI Ankle w/ Contrast Left
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
1168744
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$717.50 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
|
|
MRI Ankle w/ Contrast Left
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
1168744
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$512.30 |
| Max. Negotiated Rate |
$1,357.18 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Aetna of IA Medicare |
$584.25
|
| Rate for Payer: Amerigroup Medicaid |
$517.32
|
| Rate for Payer: Amerigroup Medicare |
$517.62
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$512.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$512.30
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$512.50
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$520.19
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$519.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$768.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$768.75
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$604.75
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI Ankle w/ Contrast Right
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
1168746
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$512.30 |
| Max. Negotiated Rate |
$1,357.18 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Aetna of IA Medicare |
$584.25
|
| Rate for Payer: Amerigroup Medicaid |
$517.32
|
| Rate for Payer: Amerigroup Medicare |
$517.62
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$512.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$512.30
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$512.50
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$520.19
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$519.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$768.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$768.75
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$604.75
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI Ankle w/ Contrast Right
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
1168746
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$717.50 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
|
|
MRI Ankle w/o Contrast Left
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
1168750
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$510.30 |
| Max. Negotiated Rate |
$1,081.65 |
| Rate for Payer: Aetna of IA Commercial |
$918.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$918.90
|
| Rate for Payer: Aetna of IA Medicare |
$581.97
|
| Rate for Payer: Amerigroup Medicaid |
$515.30
|
| Rate for Payer: Amerigroup Medicare |
$515.60
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$765.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$510.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$510.30
|
| Rate for Payer: Medical Associates Commercial |
$765.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$510.50
|
| Rate for Payer: Midlands Choice Commercial |
$714.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$518.16
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$517.85
|
| Rate for Payer: Oscar Health of IA Commercial |
$765.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$765.75
|
| Rate for Payer: United Healthcare Commercial |
$918.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$602.39
|
| Rate for Payer: Wellmark IA HMO |
$983.32
|
| Rate for Payer: Wellmark IA PPO |
$1,081.65
|
|
|
MRI Ankle w/o Contrast Left
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
1168750
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$714.70 |
| Max. Negotiated Rate |
$918.90 |
| Rate for Payer: Aetna of IA Commercial |
$918.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$918.90
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$765.75
|
| Rate for Payer: Medical Associates Commercial |
$765.75
|
| Rate for Payer: Midlands Choice Commercial |
$714.70
|
| Rate for Payer: United Healthcare Commercial |
$918.90
|
|
|
MRI Ankle w/o Contrast Right
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
1168752
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$714.70 |
| Max. Negotiated Rate |
$918.90 |
| Rate for Payer: Aetna of IA Commercial |
$918.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$918.90
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$765.75
|
| Rate for Payer: Medical Associates Commercial |
$765.75
|
| Rate for Payer: Midlands Choice Commercial |
$714.70
|
| Rate for Payer: United Healthcare Commercial |
$918.90
|
|
|
MRI Ankle w/o Contrast Right
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
1168752
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$510.30 |
| Max. Negotiated Rate |
$1,081.65 |
| Rate for Payer: Aetna of IA Commercial |
$918.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$918.90
|
| Rate for Payer: Aetna of IA Medicare |
$581.97
|
| Rate for Payer: Amerigroup Medicaid |
$515.30
|
| Rate for Payer: Amerigroup Medicare |
$515.60
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$765.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$510.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$510.30
|
| Rate for Payer: Medical Associates Commercial |
$765.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$510.50
|
| Rate for Payer: Midlands Choice Commercial |
$714.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$518.16
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$517.85
|
| Rate for Payer: Oscar Health of IA Commercial |
$765.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$765.75
|
| Rate for Payer: United Healthcare Commercial |
$918.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$602.39
|
| Rate for Payer: Wellmark IA HMO |
$983.32
|
| Rate for Payer: Wellmark IA PPO |
$1,081.65
|
|
|
MRI Ankle w/ + w/o Contrast Left
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
1168738
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$512.30 |
| Max. Negotiated Rate |
$1,357.18 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Aetna of IA Medicare |
$584.25
|
| Rate for Payer: Amerigroup Medicaid |
$517.32
|
| Rate for Payer: Amerigroup Medicare |
$517.62
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$512.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$512.30
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$512.50
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$520.19
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$519.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$768.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$768.75
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$604.75
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI Ankle w/ + w/o Contrast Left
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
1168738
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$717.50 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
|
|
MRI Ankle w/ + w/o Contrast Right
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
1168740
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$512.30 |
| Max. Negotiated Rate |
$1,357.18 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Aetna of IA Medicare |
$584.25
|
| Rate for Payer: Amerigroup Medicaid |
$517.32
|
| Rate for Payer: Amerigroup Medicare |
$517.62
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$512.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$512.30
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$512.50
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$520.19
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$519.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$768.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$768.75
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$604.75
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI Ankle w/ + w/o Contrast Right
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
1168740
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$717.50 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
|
|
MRI Brain w/ Contrast
|
Facility
|
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
1168798
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$891.80 |
| Max. Negotiated Rate |
$1,146.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,146.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,146.60
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$955.50
|
| Rate for Payer: Medical Associates Commercial |
$955.50
|
| Rate for Payer: Midlands Choice Commercial |
$891.80
|
| Rate for Payer: United Healthcare Commercial |
$1,146.60
|
|
|
MRI Brain w/ Contrast
|
Facility
|
OP
|
$1,274.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
1168798
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$636.75 |
| Max. Negotiated Rate |
$1,357.18 |
| Rate for Payer: Aetna of IA Commercial |
$1,146.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,146.60
|
| Rate for Payer: Aetna of IA Medicare |
$726.18
|
| Rate for Payer: Amerigroup Medicaid |
$642.99
|
| Rate for Payer: Amerigroup Medicare |
$643.37
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$955.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$637.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$636.75
|
| Rate for Payer: Medical Associates Commercial |
$955.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$637.00
|
| Rate for Payer: Midlands Choice Commercial |
$891.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$646.56
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$646.17
|
| Rate for Payer: Oscar Health of IA Commercial |
$955.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$955.50
|
| Rate for Payer: United Healthcare Commercial |
$1,146.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$751.66
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI Brain w/o Contrast
|
Facility
|
OP
|
$1,189.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
1168800
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$594.26 |
| Max. Negotiated Rate |
$1,081.65 |
| Rate for Payer: Aetna of IA Commercial |
$1,070.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,070.10
|
| Rate for Payer: Aetna of IA Medicare |
$677.73
|
| Rate for Payer: Amerigroup Medicaid |
$600.09
|
| Rate for Payer: Amerigroup Medicare |
$600.44
|
| Rate for Payer: Cash Price |
$951.20
|
| Rate for Payer: Cash Price |
$951.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$891.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$594.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$594.26
|
| Rate for Payer: Medical Associates Commercial |
$891.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$594.50
|
| Rate for Payer: Midlands Choice Commercial |
$832.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$603.42
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$603.06
|
| Rate for Payer: Oscar Health of IA Commercial |
$891.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$891.75
|
| Rate for Payer: United Healthcare Commercial |
$1,070.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$701.51
|
| Rate for Payer: Wellmark IA HMO |
$983.32
|
| Rate for Payer: Wellmark IA PPO |
$1,081.65
|
|
|
MRI Brain w/o Contrast
|
Facility
|
IP
|
$1,189.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
1168800
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$832.30 |
| Max. Negotiated Rate |
$1,070.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,070.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,070.10
|
| Rate for Payer: Cash Price |
$951.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$891.75
|
| Rate for Payer: Medical Associates Commercial |
$891.75
|
| Rate for Payer: Midlands Choice Commercial |
$832.30
|
| Rate for Payer: United Healthcare Commercial |
$1,070.10
|
|
|
MRI Brain w/ + w/o Contrast
|
Facility
|
OP
|
$1,274.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
1168796
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$636.75 |
| Max. Negotiated Rate |
$1,357.18 |
| Rate for Payer: Aetna of IA Commercial |
$1,146.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,146.60
|
| Rate for Payer: Aetna of IA Medicare |
$726.18
|
| Rate for Payer: Amerigroup Medicaid |
$642.99
|
| Rate for Payer: Amerigroup Medicare |
$643.37
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$955.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$637.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$636.75
|
| Rate for Payer: Medical Associates Commercial |
$955.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$637.00
|
| Rate for Payer: Midlands Choice Commercial |
$891.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$646.56
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$646.17
|
| Rate for Payer: Oscar Health of IA Commercial |
$955.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$955.50
|
| Rate for Payer: United Healthcare Commercial |
$1,146.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$751.66
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI Brain w/ + w/o Contrast
|
Facility
|
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
1168796
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$891.80 |
| Max. Negotiated Rate |
$1,146.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,146.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,146.60
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$955.50
|
| Rate for Payer: Medical Associates Commercial |
$955.50
|
| Rate for Payer: Midlands Choice Commercial |
$891.80
|
| Rate for Payer: United Healthcare Commercial |
$1,146.60
|
|
|
MRI Chest w/o Contrast
|
Facility
|
OP
|
$1,722.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
1168824
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$860.66 |
| Max. Negotiated Rate |
$1,549.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,549.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,549.80
|
| Rate for Payer: Aetna of IA Medicare |
$981.54
|
| Rate for Payer: Amerigroup Medicaid |
$869.09
|
| Rate for Payer: Amerigroup Medicare |
$869.61
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,291.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$861.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$860.66
|
| Rate for Payer: Medical Associates Commercial |
$1,291.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$861.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,205.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$873.92
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$873.40
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,291.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,291.50
|
| Rate for Payer: United Healthcare Commercial |
$1,549.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,015.98
|
| Rate for Payer: Wellmark IA HMO |
$983.32
|
| Rate for Payer: Wellmark IA PPO |
$1,081.65
|
|
|
MRI Chest w/o Contrast
|
Facility
|
IP
|
$1,722.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
1168824
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,205.40 |
| Max. Negotiated Rate |
$1,549.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,549.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,549.80
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,291.50
|
| Rate for Payer: Medical Associates Commercial |
$1,291.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,205.40
|
| Rate for Payer: United Healthcare Commercial |
$1,549.80
|
|
|
MRI Elbow w/ Contrast Left
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
1168842
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$512.30 |
| Max. Negotiated Rate |
$1,357.18 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Aetna of IA Medicare |
$584.25
|
| Rate for Payer: Amerigroup Medicaid |
$517.32
|
| Rate for Payer: Amerigroup Medicare |
$517.62
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$512.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$512.30
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$512.50
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$520.19
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$519.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$768.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$768.75
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$604.75
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI Elbow w/ Contrast Left
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
1168842
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$717.50 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
|
|
MRI Elbow w/ Contrast Right
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
1168844
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$512.30 |
| Max. Negotiated Rate |
$1,357.18 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Aetna of IA Medicare |
$584.25
|
| Rate for Payer: Amerigroup Medicaid |
$517.32
|
| Rate for Payer: Amerigroup Medicare |
$517.62
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$512.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$512.30
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$512.50
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$520.19
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$519.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$768.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$768.75
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$604.75
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
