|
MRI Forearm w/o Contrast Right
|
Facility
OP
|
$1,530.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
1168910
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$764.69 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: United Healthcare Commercial |
$1,377.00
|
| Rate for Payer: Aetna of IA Commercial |
$1,377.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,377.00
|
| Rate for Payer: Aetna of IA Medicare |
$872.10
|
| Rate for Payer: Amerigroup Medicaid |
$772.19
|
| Rate for Payer: Amerigroup Medicare |
$772.65
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,147.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$765.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$764.69
|
| Rate for Payer: Medical Associates Commercial |
$1,147.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$765.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,071.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$776.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$902.70
|
| Rate for Payer: Wellmark IA HMO |
$983.32
|
| Rate for Payer: Wellmark IA PPO |
$1,081.65
|
|
|
MRI Forearm w/o Contrast Right
|
Facility
IP
|
$1,530.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
1168910
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,071.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,377.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,377.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,147.50
|
| Rate for Payer: Medical Associates Commercial |
$1,147.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,071.00
|
| Rate for Payer: United Healthcare Commercial |
$1,377.00
|
|
|
MRI Forearm w/ + w/o Contrast Left
|
Facility
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
1168896
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,148.00 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,476.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,476.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
|
|
MRI Forearm w/ + w/o Contrast Left
|
Facility
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
1168896
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$819.67 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,476.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,476.00
|
| Rate for Payer: Aetna of IA Medicare |
$934.80
|
| Rate for Payer: Amerigroup Medicaid |
$827.71
|
| Rate for Payer: Amerigroup Medicare |
$828.20
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,230.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$820.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$819.67
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$820.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$832.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,230.00
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$967.60
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI Forearm w/ + w/o Contrast Right
|
Facility
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
1168898
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$819.67 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,476.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,476.00
|
| Rate for Payer: Aetna of IA Medicare |
$934.80
|
| Rate for Payer: Amerigroup Medicaid |
$827.71
|
| Rate for Payer: Amerigroup Medicare |
$828.20
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,230.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$820.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$819.67
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$820.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$832.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,230.00
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$967.60
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI Forearm w/ + w/o Contrast Right
|
Facility
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
1168898
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,148.00 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,476.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,476.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
|
|
MRI Hand w/ Contrast Left
|
Facility
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
1168924
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$819.67 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,476.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,476.00
|
| Rate for Payer: Aetna of IA Medicare |
$934.80
|
| Rate for Payer: Amerigroup Medicaid |
$827.71
|
| Rate for Payer: Amerigroup Medicare |
$828.20
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,230.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$820.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$819.67
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$820.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$832.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,230.00
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$967.60
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI Hand w/ Contrast Left
|
Facility
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
1168924
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,148.00 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,476.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,476.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
|
|
MRI Hand w/ Contrast Right
|
Facility
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
1168926
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$819.67 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,476.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,476.00
|
| Rate for Payer: Aetna of IA Medicare |
$934.80
|
| Rate for Payer: Amerigroup Medicaid |
$827.71
|
| Rate for Payer: Amerigroup Medicare |
$828.20
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,230.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$820.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$819.67
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$820.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$832.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,230.00
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$967.60
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI Hand w/ Contrast Right
|
Facility
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
1168926
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,148.00 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,476.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,476.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
|
|
MRI Hand w/o Contrast Left
|
Facility
OP
|
$1,530.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
1168930
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$764.69 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,377.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,377.00
|
| Rate for Payer: Aetna of IA Medicare |
$872.10
|
| Rate for Payer: Amerigroup Medicaid |
$772.19
|
| Rate for Payer: Amerigroup Medicare |
$772.65
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,147.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$765.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$764.69
|
| Rate for Payer: Medical Associates Commercial |
$1,147.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$765.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,071.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$776.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare Commercial |
$1,377.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$902.70
|
| Rate for Payer: Wellmark IA HMO |
$983.32
|
| Rate for Payer: Wellmark IA PPO |
$1,081.65
|
|
|
MRI Hand w/o Contrast Left
|
Facility
IP
|
$1,530.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
1168930
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,071.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,377.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,377.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,147.50
|
| Rate for Payer: Medical Associates Commercial |
$1,147.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,071.00
|
| Rate for Payer: United Healthcare Commercial |
$1,377.00
|
|
|
MRI Hand w/o Contrast Right
|
Facility
OP
|
$1,530.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
1168932
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$764.69 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,377.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,377.00
|
| Rate for Payer: Aetna of IA Medicare |
$872.10
|
| Rate for Payer: Amerigroup Medicaid |
$772.19
|
| Rate for Payer: Amerigroup Medicare |
$772.65
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,147.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$765.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$764.69
|
| Rate for Payer: Medical Associates Commercial |
$1,147.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$765.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,071.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$776.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare Commercial |
$1,377.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$902.70
|
| Rate for Payer: Wellmark IA HMO |
$983.32
|
| Rate for Payer: Wellmark IA PPO |
$1,081.65
|
|
|
MRI Hand w/o Contrast Right
|
Facility
IP
|
$1,530.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
1168932
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,071.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,377.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,377.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,147.50
|
| Rate for Payer: Medical Associates Commercial |
$1,147.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,071.00
|
| Rate for Payer: United Healthcare Commercial |
$1,377.00
|
|
|
MRI Hand w/ + w/o Contrast Left
|
Facility
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
1168918
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$819.67 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,476.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,476.00
|
| Rate for Payer: Aetna of IA Medicare |
$934.80
|
| Rate for Payer: Amerigroup Medicaid |
$827.71
|
| Rate for Payer: Amerigroup Medicare |
$828.20
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,230.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$820.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$819.67
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$820.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$832.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,230.00
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$967.60
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI Hand w/ + w/o Contrast Left
|
Facility
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
1168918
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,148.00 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,476.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,476.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
|
|
MRI Hand w/ + w/o Contrast Right
|
Facility
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
1168920
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$819.67 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,476.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,476.00
|
| Rate for Payer: Aetna of IA Medicare |
$934.80
|
| Rate for Payer: Amerigroup Medicaid |
$827.71
|
| Rate for Payer: Amerigroup Medicare |
$828.20
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,230.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$820.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$819.67
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$820.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$832.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,230.00
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$967.60
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI Hand w/ + w/o Contrast Right
|
Facility
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
1168920
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,148.00 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,476.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,476.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
|
|
MRI Hip w/ Contrast Left
|
Facility
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
1168942
|
|
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 Hip w/ Contrast Left
|
Facility
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
1168942
|
|
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: 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 Hip w/ Contrast Right
|
Facility
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
1168944
|
|
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: 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 Hip w/ Contrast Right
|
Facility
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
1168944
|
|
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 Hip w/o Contrast Left
|
Facility
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
1168948
|
|
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 Hip w/o Contrast Left
|
Facility
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
1168948
|
|
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: 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 Hip w/o Contrast Right
|
Facility
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
1168950
|
|
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: 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
|
|
