Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Assessment by trained clinical staff of implant and/or foreign body for MR safety, including identification and verification of implant components from appropriate sources, analyzing current MR conditional status of individual components and systems, and consulting published professional guidance with written report, initial 15 minutes
Low
$17
Average
$53
Median
$23
High
$186
Each hospital's average Wellmark rate, under the methodology and billing class chosen below.
28 hospitals; the 90th percentile is 5.9× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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42 hospital rates
iThe hospitals that file a Wellmark rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Allen Memorial Hospital Corporation Waterloo, IA case rate · outpatient | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 2 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · both | 4 | $19 | $17 | $5 | 26% | — | $10 – $22 |
| 3 | Central Iowa Hospital Corporation Des Moines, IA case rate · outpatient | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 4 | Central Iowa Hospital Corporation Des Moines, IA fee schedule · both | 4 | $19 | $17 | $5 | 26% | — | $10 – $22 |
| 5 | Central Iowa Hospital Corporation West Des Moines, IA fee schedule · both | 4 | $19 | $17 | $5 | 26% | — | $10 – $22 |
| 6 | Diley Ridge Medical Center Canal Winchester, OH facility · other · both | 1 | $104 | $104 | — | — | — | $104 – $104 |
| 7 | Grinnell Regional Medical Center Grinnell, IA case rate · outpatient | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 8 | Grinnell Regional Medical Center Grinnell, IA fee schedule · both | 4 | $19 | $17 | $5 | 26% | — | $10 – $22 |
| 9 | MercyOne Genesis Davenport Medical Center IA 52803; 2140 53rd Avenue Bettendorf, IA facility · fee schedule · outpatient | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 10 | MercyOne Genesis Davenport West Medical Center Davenport, IA facility · fee schedule · outpatient | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 11 | MercyOne Genesis Silvis Medical Center Silvis, IL facility · fee schedule · outpatient | 1 | $26 | $26 | — | — | — | $26 – $26 |
| 12 | Mount Carmel East Reynoldsburg, OH facility · other · both | 1 | $104 | $104 | — | — | — | $104 – $104 |
| 13 | Mount Carmel Grove City Grove City, OH facility · other · both | 1 | $104 | $104 | — | — | — | $104 – $104 |
| 14 | Mount Carmel New Albany Surgical Hospital New Albany, OH facility · other · both | 1 | $104 | $104 | — | — | — | $104 – $104 |
| 15 | Mount Carmel St Ann's Lewis Center, OH facility · other · both | 1 | $104 | $104 | — | — | — | $104 – $104 |
| 16 | Northwest Iowa Hospital Corporation Sioux City, IA case rate · outpatient | 1 | $24 | $24 | — | — | — | $24 – $24 |
| 17 | Northwest Iowa Hospital Corporation Sioux City, IA fee schedule · both | 4 | $19 | $17 | $5 | 26% | — | $10 – $22 |
| 18 | Saint Alphonsus Medical Center - Baker City Baker City, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $45 | $45 | — | — | — | $45 – $45 |
| 19 | Saint Alphonsus Medical Center - Nampa Nampa, ID facility · percent of total billed charges · bothfrom % of charges | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 20 | Saint Alphonsus Medical Center - Ontario Ontario, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $43 | $43 | — | — | — | $43 – $43 |
| 21 | Saint Alphonsus Regional Medical Center - Boise Boise, ID facility · percent of total billed charges · bothfrom % of charges | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 22 | Saint Francis Hospital and Medical Center Hartford, CT facility · other · both | 1 | $120 | $120 | — | — | — | $120 – $120 |
| 23 | St Luke's Methodist Hospital Marion, IA case rate · outpatient | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 24 | St Luke's Methodist Hospital Marion, IA fee schedule · both | 4 | $19 | $17 | $5 | 26% | — | $10 – $22 |
| 25 | The Finley Hospital Dubuque, IA case rate · outpatient | 1 | $24 | $24 | — | — | — | $24 – $24 |
← Payers reporting CPT 76014 · Snapshot 20261111T120946Z-9134e7f7