|
MRA Abdomen
|
Facility
|
IP
|
$1,594.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
1168633
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,115.80 |
| Max. Negotiated Rate |
$1,434.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,434.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,434.60
|
| Rate for Payer: Cash Price |
$1,275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,195.50
|
| Rate for Payer: Medical Associates Commercial |
$1,195.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,115.80
|
| Rate for Payer: United Healthcare Commercial |
$1,434.60
|
|
|
MRA Abdomen
|
Facility
|
OP
|
$1,594.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
1168633
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$717.30 |
| Max. Negotiated Rate |
$1,434.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,434.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,434.60
|
| Rate for Payer: Aetna of IA Medicare |
$908.58
|
| Rate for Payer: Amerigroup Medicaid |
$919.42
|
| Rate for Payer: Amerigroup Medicare |
$724.47
|
| Rate for Payer: Cash Price |
$1,275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,195.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$717.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$910.49
|
| Rate for Payer: Medical Associates Commercial |
$1,195.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$717.30
|
| Rate for Payer: Midlands Choice Commercial |
$1,115.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$923.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$824.89
|
| Rate for Payer: United Healthcare Commercial |
$1,434.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$940.46
|
|
|
MRA Chest
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
1168641
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$633.50 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Aetna of IA Commercial |
$814.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$814.50
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$678.75
|
| Rate for Payer: Medical Associates Commercial |
$678.75
|
| Rate for Payer: Midlands Choice Commercial |
$633.50
|
| Rate for Payer: United Healthcare Commercial |
$814.50
|
|
|
MRA Chest
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
1168641
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$407.25 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Aetna of IA Commercial |
$814.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$814.50
|
| Rate for Payer: Aetna of IA Medicare |
$515.85
|
| Rate for Payer: Amerigroup Medicaid |
$522.00
|
| Rate for Payer: Amerigroup Medicare |
$411.32
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$678.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$407.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$516.94
|
| Rate for Payer: Medical Associates Commercial |
$678.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$407.25
|
| Rate for Payer: Midlands Choice Commercial |
$633.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$524.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$468.34
|
| Rate for Payer: United Healthcare Commercial |
$814.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$533.95
|
|
|
MRA Head w/ Contrast
|
Facility
|
IP
|
$1,147.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
1168651
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$802.90 |
| Max. Negotiated Rate |
$1,032.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,032.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,032.30
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$860.25
|
| Rate for Payer: Medical Associates Commercial |
$860.25
|
| Rate for Payer: Midlands Choice Commercial |
$802.90
|
| Rate for Payer: United Healthcare Commercial |
$1,032.30
|
|
|
MRA Head w/ Contrast
|
Facility
|
OP
|
$1,147.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
1168651
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$516.15 |
| Max. Negotiated Rate |
$1,032.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,032.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,032.30
|
| Rate for Payer: Aetna of IA Medicare |
$653.79
|
| Rate for Payer: Amerigroup Medicaid |
$661.59
|
| Rate for Payer: Amerigroup Medicare |
$521.31
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$860.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$516.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$655.17
|
| Rate for Payer: Medical Associates Commercial |
$860.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$516.15
|
| Rate for Payer: Midlands Choice Commercial |
$802.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$664.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$593.57
|
| Rate for Payer: United Healthcare Commercial |
$1,032.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$676.73
|
|
|
MRA Head w/o Contrast
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
1168653
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$749.00 |
| Max. Negotiated Rate |
$963.00 |
| Rate for Payer: Aetna of IA Commercial |
$963.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$963.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$802.50
|
| Rate for Payer: Medical Associates Commercial |
$802.50
|
| Rate for Payer: Midlands Choice Commercial |
$749.00
|
| Rate for Payer: United Healthcare Commercial |
$963.00
|
|
|
MRA Head w/o Contrast
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
1168653
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$481.50 |
| Max. Negotiated Rate |
$963.00 |
| Rate for Payer: Aetna of IA Commercial |
$963.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$963.00
|
| Rate for Payer: Aetna of IA Medicare |
$609.90
|
| Rate for Payer: Amerigroup Medicaid |
$617.18
|
| Rate for Payer: Amerigroup Medicare |
$486.31
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$802.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$481.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$611.18
|
| Rate for Payer: Medical Associates Commercial |
$802.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$481.50
|
| Rate for Payer: Midlands Choice Commercial |
$749.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$620.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$553.73
|
| Rate for Payer: United Healthcare Commercial |
$963.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$631.30
|
|
|
MRA Head w/ + w/o Contrast
|
Facility
|
OP
|
$1,147.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
1168649
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$516.15 |
| Max. Negotiated Rate |
$1,032.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,032.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,032.30
|
| Rate for Payer: Aetna of IA Medicare |
$653.79
|
| Rate for Payer: Amerigroup Medicaid |
$661.59
|
| Rate for Payer: Amerigroup Medicare |
$521.31
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$860.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$516.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$655.17
|
| Rate for Payer: Medical Associates Commercial |
$860.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$516.15
|
| Rate for Payer: Midlands Choice Commercial |
$802.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$664.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$593.57
|
| Rate for Payer: United Healthcare Commercial |
$1,032.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$676.73
|
|
|
MRA Head w/ + w/o Contrast
|
Facility
|
IP
|
$1,147.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
1168649
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$802.90 |
| Max. Negotiated Rate |
$1,032.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,032.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,032.30
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$860.25
|
| Rate for Payer: Medical Associates Commercial |
$860.25
|
| Rate for Payer: Midlands Choice Commercial |
$802.90
|
| Rate for Payer: United Healthcare Commercial |
$1,032.30
|
|
|
MRA Neck w/ Contrast
|
Facility
|
IP
|
$1,147.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
1168681
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$802.90 |
| Max. Negotiated Rate |
$1,032.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,032.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,032.30
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$860.25
|
| Rate for Payer: Medical Associates Commercial |
$860.25
|
| Rate for Payer: Midlands Choice Commercial |
$802.90
|
| Rate for Payer: United Healthcare Commercial |
$1,032.30
|
|
|
MRA Neck w/ Contrast
|
Facility
|
OP
|
$1,147.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
1168681
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$516.15 |
| Max. Negotiated Rate |
$1,032.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,032.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,032.30
|
| Rate for Payer: Aetna of IA Medicare |
$653.79
|
| Rate for Payer: Amerigroup Medicaid |
$661.59
|
| Rate for Payer: Amerigroup Medicare |
$521.31
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$860.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$516.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$655.17
|
| Rate for Payer: Medical Associates Commercial |
$860.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$516.15
|
| Rate for Payer: Midlands Choice Commercial |
$802.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$664.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$593.57
|
| Rate for Payer: United Healthcare Commercial |
$1,032.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$676.73
|
|
|
MRA Neck w/o Contrast
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
1168683
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$481.50 |
| Max. Negotiated Rate |
$963.00 |
| Rate for Payer: Aetna of IA Commercial |
$963.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$963.00
|
| Rate for Payer: Aetna of IA Medicare |
$609.90
|
| Rate for Payer: Amerigroup Medicaid |
$617.18
|
| Rate for Payer: Amerigroup Medicare |
$486.31
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$802.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$481.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$611.18
|
| Rate for Payer: Medical Associates Commercial |
$802.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$481.50
|
| Rate for Payer: Midlands Choice Commercial |
$749.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$620.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$553.73
|
| Rate for Payer: United Healthcare Commercial |
$963.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$631.30
|
|
|
MRA Neck w/o Contrast
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
1168683
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$749.00 |
| Max. Negotiated Rate |
$963.00 |
| Rate for Payer: Aetna of IA Commercial |
$963.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$963.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$802.50
|
| Rate for Payer: Medical Associates Commercial |
$802.50
|
| Rate for Payer: Midlands Choice Commercial |
$749.00
|
| Rate for Payer: United Healthcare Commercial |
$963.00
|
|
|
MRA Neck w/ + w/o Contrast
|
Facility
|
OP
|
$1,147.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
1168679
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$516.15 |
| Max. Negotiated Rate |
$1,032.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,032.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,032.30
|
| Rate for Payer: Aetna of IA Medicare |
$653.79
|
| Rate for Payer: Amerigroup Medicaid |
$661.59
|
| Rate for Payer: Amerigroup Medicare |
$521.31
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$860.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$516.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$655.17
|
| Rate for Payer: Medical Associates Commercial |
$860.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$516.15
|
| Rate for Payer: Midlands Choice Commercial |
$802.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$664.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$593.57
|
| Rate for Payer: United Healthcare Commercial |
$1,032.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$676.73
|
|
|
MRA Neck w/ + w/o Contrast
|
Facility
|
IP
|
$1,147.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
1168679
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$802.90 |
| Max. Negotiated Rate |
$1,032.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,032.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,032.30
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$860.25
|
| Rate for Payer: Medical Associates Commercial |
$860.25
|
| Rate for Payer: Midlands Choice Commercial |
$802.90
|
| Rate for Payer: United Healthcare Commercial |
$1,032.30
|
|
|
MRI Abdomen w/ Contrast
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
1168732
|
|
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/ Contrast
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
1168732
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$768.60 |
| 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: Aetna of IA Medicare |
$973.56
|
| Rate for Payer: Amerigroup Medicaid |
$985.17
|
| Rate for Payer: Amerigroup Medicare |
$776.29
|
| 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 |
$768.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$975.61
|
| Rate for Payer: Medical Associates Commercial |
$1,281.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$768.60
|
| Rate for Payer: Midlands Choice Commercial |
$1,195.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$989.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$883.89
|
| Rate for Payer: United Healthcare Commercial |
$1,537.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,007.72
|
|
|
MRI Abdomen w/o Contrast
|
Facility
|
IP
|
$1,594.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
1168734
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,115.80 |
| Max. Negotiated Rate |
$1,434.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,434.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,434.60
|
| Rate for Payer: Cash Price |
$1,275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,195.50
|
| Rate for Payer: Medical Associates Commercial |
$1,195.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,115.80
|
| Rate for Payer: United Healthcare Commercial |
$1,434.60
|
|
|
MRI Abdomen w/o Contrast
|
Facility
|
OP
|
$1,594.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
1168734
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$717.30 |
| Max. Negotiated Rate |
$1,434.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,434.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,434.60
|
| Rate for Payer: Aetna of IA Medicare |
$908.58
|
| Rate for Payer: Amerigroup Medicaid |
$919.42
|
| Rate for Payer: Amerigroup Medicare |
$724.47
|
| Rate for Payer: Cash Price |
$1,275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,195.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$717.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$910.49
|
| Rate for Payer: Medical Associates Commercial |
$1,195.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$717.30
|
| Rate for Payer: Midlands Choice Commercial |
$1,115.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$923.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$824.89
|
| Rate for Payer: United Healthcare Commercial |
$1,434.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$940.46
|
|
|
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 |
$768.60 |
| 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: Aetna of IA Medicare |
$973.56
|
| Rate for Payer: Amerigroup Medicaid |
$985.17
|
| Rate for Payer: Amerigroup Medicare |
$776.29
|
| 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 |
$768.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$975.61
|
| Rate for Payer: Medical Associates Commercial |
$1,281.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$768.60
|
| Rate for Payer: Midlands Choice Commercial |
$1,195.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$989.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$883.89
|
| Rate for Payer: United Healthcare Commercial |
$1,537.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,007.72
|
|
|
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 Ankle w/ Contrast Left
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73722 LT
|
| Hospital Charge Code |
1168744
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$461.25 |
| 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: Aetna of IA Medicare |
$584.25
|
| Rate for Payer: Amerigroup Medicaid |
$591.22
|
| Rate for Payer: Amerigroup Medicare |
$465.86
|
| 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 |
$461.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$585.48
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$461.25
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$594.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$530.44
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$604.75
|
|
|
MRI Ankle w/ Contrast Left
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73722 LT
|
| 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 Right
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73722 RT
|
| 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
|
|
