|
MRI LE Joint w/ Contrast Left
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 73722 LT
|
| Hospital Charge Code |
1168996
|
|
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 LE Joint w/ Contrast Left
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 73722 LT
|
| Hospital Charge Code |
1168996
|
|
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 LE Joint w/ Contrast Right
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 73722 RT
|
| Hospital Charge Code |
1168998
|
|
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 LE Joint w/ Contrast Right
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 73722 RT
|
| Hospital Charge Code |
1168998
|
|
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 LE Joint w/o Contrast Left
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 73721 LT
|
| Hospital Charge Code |
1169002
|
|
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 LE Joint w/o Contrast Left
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 73721 LT
|
| Hospital Charge Code |
1169002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$724.60 |
| 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 |
$724.60
|
| Rate for Payer: Wellmark IA PPO |
$798.18
|
|
|
MRI LE Joint w/o Contrast Right
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 73721 RT
|
| Hospital Charge Code |
1169004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$724.60 |
| 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 |
$724.60
|
| Rate for Payer: Wellmark IA PPO |
$798.18
|
|
|
MRI LE Joint w/o Contrast Right
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 73721 RT
|
| Hospital Charge Code |
1169004
|
|
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 LE Joint w/ + w/o Contrast Left
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 73723 LT
|
| Hospital Charge Code |
1168990
|
|
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 LE Joint w/ + w/o Contrast Left
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 73723 LT
|
| Hospital Charge Code |
1168990
|
|
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 LE Joint w/ + w/o Contrast Right
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 73723 RT
|
| Hospital Charge Code |
1168992
|
|
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 LE Joint w/ + w/o Contrast Right
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 73723 RT
|
| Hospital Charge Code |
1168992
|
|
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 LE Non Joint w/ Contrast Left
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
CPT 73719 LT
|
| Hospital Charge Code |
1169014
|
|
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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,013.16
|
| Rate for Payer: Wellmark IA PPO |
$1,116.05
|
|
|
MRI LE Non Joint w/ Contrast Left
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
CPT 73719 LT
|
| Hospital Charge Code |
1169014
|
|
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 LE Non Joint w/ Contrast Right
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 73719 RT
|
| Hospital Charge Code |
1169016
|
|
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 LE Non Joint w/ Contrast Right
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 73719 RT
|
| Hospital Charge Code |
1169016
|
|
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 LE Non Joint w/o Contrast Left
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 73718 LT
|
| Hospital Charge Code |
1169020
|
|
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 LE Non Joint w/o Contrast Left
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 73718 LT
|
| Hospital Charge Code |
1169020
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$724.60 |
| 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 |
$724.60
|
| Rate for Payer: Wellmark IA PPO |
$798.18
|
|
|
MRI LE Non Joint w/o Contrast Right
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT 73718 RT
|
| Hospital Charge Code |
1169022
|
|
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 LE Non Joint w/o Contrast Right
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT 73718 RT
|
| Hospital Charge Code |
1169022
|
|
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 LE Non Joint w/ + w/o Contrast Left
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT 73720 LT
|
| Hospital Charge Code |
1169008
|
|
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 |
$1,013.16
|
| Rate for Payer: Wellmark IA PPO |
$1,116.05
|
|
|
MRI LE Non Joint w/ + w/o Contrast Left
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT 73720 LT
|
| Hospital Charge Code |
1169008
|
|
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 LE Non Joint w/ + w/o Contrast Right
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT 73720 RT
|
| Hospital Charge Code |
1169010
|
|
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 |
$1,013.16
|
| Rate for Payer: Wellmark IA PPO |
$1,116.05
|
|
|
MRI LE Non Joint w/ + w/o Contrast Right
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT 73720 RT
|
| Hospital Charge Code |
1169010
|
|
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 Pancreas w+w/o Contrast
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
2410310
|
|
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
|
|
