|
MRI Hip w/ + w/o Contrast Right
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
1168938
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$461.25 |
| Max. Negotiated Rate |
$1,116.05 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,013.16
|
| Rate for Payer: Wellmark IA PPO |
$1,116.05
|
|
|
MRI Humerus w/ Contrast Left
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 73219 LT
|
| Hospital Charge Code |
1168960
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$738.00 |
| 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: Aetna of IA Medicare |
$934.80
|
| Rate for Payer: Amerigroup Medicaid |
$945.95
|
| Rate for Payer: Amerigroup Medicare |
$745.38
|
| 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 |
$738.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$936.77
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$738.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$950.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$848.70
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$967.60
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,013.16
|
| Rate for Payer: Wellmark IA PPO |
$1,116.05
|
|
|
MRI Humerus w/ Contrast Left
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 73219 LT
|
| Hospital Charge Code |
1168960
|
|
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 Humerus w/ Contrast Right
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 73219 RT
|
| Hospital Charge Code |
1168962
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$738.00 |
| 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: Aetna of IA Medicare |
$934.80
|
| Rate for Payer: Amerigroup Medicaid |
$945.95
|
| Rate for Payer: Amerigroup Medicare |
$745.38
|
| 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 |
$738.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$936.77
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$738.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$950.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$848.70
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$967.60
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,013.16
|
| Rate for Payer: Wellmark IA PPO |
$1,116.05
|
|
|
MRI Humerus w/ Contrast Right
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 73219 RT
|
| Hospital Charge Code |
1168962
|
|
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 Humerus w/o Contrast Left
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT 73218 LT
|
| Hospital Charge Code |
1168966
|
|
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 Humerus w/o Contrast Left
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT 73218 LT
|
| Hospital Charge Code |
1168966
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$688.50 |
| 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 |
$882.50
|
| Rate for Payer: Amerigroup Medicare |
$695.38
|
| 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 |
$688.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$873.94
|
| Rate for Payer: Medical Associates Commercial |
$1,147.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$688.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,071.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$886.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$791.78
|
| Rate for Payer: United Healthcare Commercial |
$1,377.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$902.70
|
| Rate for Payer: Wellmark IA HMO WHPI |
$724.60
|
| Rate for Payer: Wellmark IA PPO |
$798.18
|
|
|
MRI Humerus w/o Contrast Right
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT 73218 RT
|
| Hospital Charge Code |
1168968
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$688.50 |
| 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 |
$882.50
|
| Rate for Payer: Amerigroup Medicare |
$695.38
|
| 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 |
$688.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$873.94
|
| Rate for Payer: Medical Associates Commercial |
$1,147.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$688.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,071.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$886.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$791.78
|
| Rate for Payer: United Healthcare Commercial |
$1,377.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$902.70
|
| Rate for Payer: Wellmark IA HMO WHPI |
$724.60
|
| Rate for Payer: Wellmark IA PPO |
$798.18
|
|
|
MRI Humerus w/o Contrast Right
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT 73218 RT
|
| Hospital Charge Code |
1168968
|
|
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 Humerus w/ + w/o Contrast Left
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 73220 LT
|
| Hospital Charge Code |
1168954
|
|
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 Humerus w/ + w/o Contrast Left
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 73220 LT
|
| Hospital Charge Code |
1168954
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$738.00 |
| 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: Aetna of IA Medicare |
$934.80
|
| Rate for Payer: Amerigroup Medicaid |
$945.95
|
| Rate for Payer: Amerigroup Medicare |
$745.38
|
| 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 |
$738.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$936.77
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$738.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$950.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$848.70
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$967.60
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,013.16
|
| Rate for Payer: Wellmark IA PPO |
$1,116.05
|
|
|
MRI Humerus w/ + w/o Contrast Right
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 73220 RT
|
| Hospital Charge Code |
1168956
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$738.00 |
| 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: Aetna of IA Medicare |
$934.80
|
| Rate for Payer: Amerigroup Medicaid |
$945.95
|
| Rate for Payer: Amerigroup Medicare |
$745.38
|
| 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 |
$738.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$936.77
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$738.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$950.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$848.70
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$967.60
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,013.16
|
| Rate for Payer: Wellmark IA PPO |
$1,116.05
|
|
|
MRI Humerus w/ + w/o Contrast Right
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 73220 RT
|
| Hospital Charge Code |
1168956
|
|
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 Knee w/ Contrast Left
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73722 LT
|
| Hospital Charge Code |
1168978
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$461.25 |
| Max. Negotiated Rate |
$1,116.05 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,013.16
|
| Rate for Payer: Wellmark IA PPO |
$1,116.05
|
|
|
MRI Knee w/ Contrast Left
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73722 LT
|
| Hospital Charge Code |
1168978
|
|
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 Knee w/ Contrast Right
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73722 RT
|
| Hospital Charge Code |
1168980
|
|
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 Knee w/ Contrast Right
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73722 RT
|
| Hospital Charge Code |
1168980
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$461.25 |
| Max. Negotiated Rate |
$1,116.05 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,013.16
|
| Rate for Payer: Wellmark IA PPO |
$1,116.05
|
|
|
MRI Knee w/o Contrast Left
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73721 LT
|
| Hospital Charge Code |
1168984
|
|
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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$724.60
|
| Rate for Payer: Wellmark IA PPO |
$798.18
|
|
|
MRI Knee w/o Contrast Left
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73721 LT
|
| Hospital Charge Code |
1168984
|
|
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 Knee w/o Contrast Right
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73721 RT
|
| Hospital Charge Code |
1168986
|
|
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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$724.60
|
| Rate for Payer: Wellmark IA PPO |
$798.18
|
|
|
MRI Knee w/o Contrast Right
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73721 RT
|
| Hospital Charge Code |
1168986
|
|
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 Knee w/ + w/o Contrast Left
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 73723 LT
|
| Hospital Charge Code |
1168972
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$459.45 |
| Max. Negotiated Rate |
$1,116.05 |
| 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 |
$588.91
|
| Rate for Payer: Amerigroup Medicare |
$464.04
|
| 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 |
$459.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$583.20
|
| Rate for Payer: Medical Associates Commercial |
$765.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$459.45
|
| Rate for Payer: Midlands Choice Commercial |
$714.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$591.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$528.37
|
| Rate for Payer: United Healthcare Commercial |
$918.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$602.39
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,013.16
|
| Rate for Payer: Wellmark IA PPO |
$1,116.05
|
|
|
MRI Knee w/ + w/o Contrast Left
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 73723 LT
|
| Hospital Charge Code |
1168972
|
|
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 Knee w/ + w/o Contrast Right
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 73723 RT
|
| Hospital Charge Code |
1168974
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$459.45 |
| Max. Negotiated Rate |
$1,116.05 |
| 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 |
$588.91
|
| Rate for Payer: Amerigroup Medicare |
$464.04
|
| 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 |
$459.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$583.20
|
| Rate for Payer: Medical Associates Commercial |
$765.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$459.45
|
| Rate for Payer: Midlands Choice Commercial |
$714.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$591.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$528.37
|
| Rate for Payer: United Healthcare Commercial |
$918.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$602.39
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,013.16
|
| Rate for Payer: Wellmark IA PPO |
$1,116.05
|
|
|
MRI Knee w/ + w/o Contrast Right
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 73723 RT
|
| Hospital Charge Code |
1168974
|
|
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
|
|
