|
NM Bone Three Phase Study
|
Facility
OP
|
$1,439.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
1169190
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$719.21 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,295.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,295.10
|
| Rate for Payer: Aetna of IA Medicare |
$820.23
|
| Rate for Payer: Amerigroup Medicaid |
$726.26
|
| Rate for Payer: Amerigroup Medicare |
$726.70
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,079.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$719.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$719.21
|
| Rate for Payer: Medical Associates Commercial |
$1,079.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$719.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,007.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$730.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,079.25
|
| Rate for Payer: United Healthcare Commercial |
$1,295.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$849.01
|
| Rate for Payer: Wellmark IA HMO |
$879.16
|
| Rate for Payer: Wellmark IA PPO |
$967.08
|
|
|
NM Bone Three Phase Study
|
Facility
IP
|
$1,439.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
1169190
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,007.30 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,295.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,295.10
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,079.25
|
| Rate for Payer: Medical Associates Commercial |
$1,079.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,007.30
|
| Rate for Payer: United Healthcare Commercial |
$1,295.10
|
|
|
NM Cardiac Blood Pool Gated Single
|
Facility
IP
|
$1,439.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
1169208
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,007.30 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,295.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,295.10
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,079.25
|
| Rate for Payer: Medical Associates Commercial |
$1,079.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,007.30
|
| Rate for Payer: United Healthcare Commercial |
$1,295.10
|
|
|
NM Cardiac Blood Pool Gated Single
|
Facility
OP
|
$1,439.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
1169208
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$719.21 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,295.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,295.10
|
| Rate for Payer: Aetna of IA Medicare |
$820.23
|
| Rate for Payer: Amerigroup Medicaid |
$726.26
|
| Rate for Payer: Amerigroup Medicare |
$726.70
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,079.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$719.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$719.21
|
| Rate for Payer: Medical Associates Commercial |
$1,079.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$719.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,007.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$730.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,079.25
|
| Rate for Payer: United Healthcare Commercial |
$1,295.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$849.01
|
| Rate for Payer: Wellmark IA HMO |
$879.16
|
| Rate for Payer: Wellmark IA PPO |
$967.08
|
|
|
NM Gastric Emptying Study
|
Facility
OP
|
$1,439.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
1169236
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$719.21 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,295.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,295.10
|
| Rate for Payer: Aetna of IA Medicare |
$820.23
|
| Rate for Payer: Amerigroup Medicaid |
$726.26
|
| Rate for Payer: Amerigroup Medicare |
$726.70
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,079.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$719.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$719.21
|
| Rate for Payer: Medical Associates Commercial |
$1,079.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$719.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,007.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$730.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,079.25
|
| Rate for Payer: United Healthcare Commercial |
$1,295.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$849.01
|
| Rate for Payer: Wellmark IA HMO |
$879.16
|
| Rate for Payer: Wellmark IA PPO |
$967.08
|
|
|
NM Gastric Emptying Study
|
Facility
IP
|
$1,439.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
1169236
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,007.30 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,295.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,295.10
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,079.25
|
| Rate for Payer: Medical Associates Commercial |
$1,079.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,007.30
|
| Rate for Payer: United Healthcare Commercial |
$1,295.10
|
|
|
NM Gastrointestinal Blood Loss Imaging
|
Facility
OP
|
$2,452.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
1169242
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,225.51 |
| Max. Negotiated Rate |
$2,206.80 |
| Rate for Payer: Aetna of IA Commercial |
$2,206.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,206.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,397.64
|
| Rate for Payer: Amerigroup Medicaid |
$1,237.52
|
| Rate for Payer: Amerigroup Medicare |
$1,238.26
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,839.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,226.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,225.51
|
| Rate for Payer: Medical Associates Commercial |
$1,839.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,226.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,716.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,244.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,839.00
|
| Rate for Payer: United Healthcare Commercial |
$2,206.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,446.68
|
| Rate for Payer: Wellmark IA HMO |
$1,657.26
|
| Rate for Payer: Wellmark IA PPO |
$1,822.99
|
|
|
NM Gastrointestinal Blood Loss Imaging
|
Facility
IP
|
$2,452.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
1169242
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,716.40 |
| Max. Negotiated Rate |
$2,206.80 |
| Rate for Payer: Aetna of IA Commercial |
$2,206.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,206.80
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,839.00
|
| Rate for Payer: Medical Associates Commercial |
$1,839.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,716.40
|
| Rate for Payer: United Healthcare Commercial |
$2,206.80
|
|
|
NM Hepatobiliary Duct System Imaging
|
Facility
IP
|
$1,439.00
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
1169252
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,007.30 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,295.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,295.10
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,079.25
|
| Rate for Payer: Medical Associates Commercial |
$1,079.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,007.30
|
| Rate for Payer: United Healthcare Commercial |
$1,295.10
|
|
|
NM Hepatobiliary Duct System Imaging
|
Facility
OP
|
$1,439.00
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
1169252
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$719.21 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,295.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,295.10
|
| Rate for Payer: Aetna of IA Medicare |
$820.23
|
| Rate for Payer: Amerigroup Medicaid |
$726.26
|
| Rate for Payer: Amerigroup Medicare |
$726.70
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,079.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$719.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$719.21
|
| Rate for Payer: Medical Associates Commercial |
$1,079.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$719.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,007.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$730.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,079.25
|
| Rate for Payer: United Healthcare Commercial |
$1,295.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$849.01
|
| Rate for Payer: Wellmark IA HMO |
$879.16
|
| Rate for Payer: Wellmark IA PPO |
$967.08
|
|
|
NM Hepatobiliary System w/o Pharm
|
Facility
IP
|
$1,439.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
7960814
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,007.30 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,295.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,295.10
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,079.25
|
| Rate for Payer: Medical Associates Commercial |
$1,079.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,007.30
|
| Rate for Payer: United Healthcare Commercial |
$1,295.10
|
|
|
NM Hepatobiliary System w/o Pharm
|
Facility
OP
|
$1,439.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
7960814
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$719.21 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,295.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,295.10
|
| Rate for Payer: Aetna of IA Medicare |
$820.23
|
| Rate for Payer: Amerigroup Medicaid |
$726.26
|
| Rate for Payer: Amerigroup Medicare |
$726.70
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,079.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$719.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$719.21
|
| Rate for Payer: Medical Associates Commercial |
$1,079.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$719.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,007.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$730.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,079.25
|
| Rate for Payer: United Healthcare Commercial |
$1,295.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$849.01
|
| Rate for Payer: Wellmark IA HMO |
$879.16
|
| Rate for Payer: Wellmark IA PPO |
$967.08
|
|
|
NM Intestine Imaging
|
Facility
OP
|
$1,439.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
1169254
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$719.21 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,295.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,295.10
|
| Rate for Payer: Aetna of IA Medicare |
$820.23
|
| Rate for Payer: Amerigroup Medicaid |
$726.26
|
| Rate for Payer: Amerigroup Medicare |
$726.70
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,079.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$719.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$719.21
|
| Rate for Payer: Medical Associates Commercial |
$1,079.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$719.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,007.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$730.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,079.25
|
| Rate for Payer: United Healthcare Commercial |
$1,295.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$849.01
|
| Rate for Payer: Wellmark IA HMO |
$879.16
|
| Rate for Payer: Wellmark IA PPO |
$967.08
|
|
|
NM Intestine Imaging
|
Facility
IP
|
$1,439.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
1169254
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,007.30 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,295.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,295.10
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,079.25
|
| Rate for Payer: Medical Associates Commercial |
$1,079.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,007.30
|
| Rate for Payer: United Healthcare Commercial |
$1,295.10
|
|
|
NM Kidney Imaging w/ Flow w/ Pharm
|
Facility
IP
|
$1,439.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
1169262
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,007.30 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,295.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,295.10
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,079.25
|
| Rate for Payer: Medical Associates Commercial |
$1,079.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,007.30
|
| Rate for Payer: United Healthcare Commercial |
$1,295.10
|
|
|
NM Kidney Imaging w/ Flow w/ Pharm
|
Facility
OP
|
$1,439.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
1169262
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$719.21 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,295.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,295.10
|
| Rate for Payer: Aetna of IA Medicare |
$820.23
|
| Rate for Payer: Amerigroup Medicaid |
$726.26
|
| Rate for Payer: Amerigroup Medicare |
$726.70
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,079.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$719.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$719.21
|
| Rate for Payer: Medical Associates Commercial |
$1,079.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$719.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,007.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$730.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,079.25
|
| Rate for Payer: United Healthcare Commercial |
$1,295.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$849.01
|
| Rate for Payer: Wellmark IA HMO |
$879.16
|
| Rate for Payer: Wellmark IA PPO |
$967.08
|
|
|
NM Liver Imaging Spect w/ Vascular Flow
|
Facility
OP
|
$2,452.00
|
|
|
Service Code
|
CPT 78206
|
| Hospital Charge Code |
1169280
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,225.51 |
| Max. Negotiated Rate |
$2,206.80 |
| Rate for Payer: Aetna of IA Commercial |
$2,206.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,206.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,397.64
|
| Rate for Payer: Amerigroup Medicaid |
$1,237.52
|
| Rate for Payer: Amerigroup Medicare |
$1,238.26
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,839.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,226.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,225.51
|
| Rate for Payer: Medical Associates Commercial |
$1,839.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,226.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,716.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,244.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,839.00
|
| Rate for Payer: United Healthcare Commercial |
$2,206.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,446.68
|
|
|
NM Liver Imaging Spect w/ Vascular Flow
|
Facility
IP
|
$2,452.00
|
|
|
Service Code
|
CPT 78206
|
| Hospital Charge Code |
1169280
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,716.40 |
| Max. Negotiated Rate |
$2,206.80 |
| Rate for Payer: Aetna of IA Commercial |
$2,206.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,206.80
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,839.00
|
| Rate for Payer: Medical Associates Commercial |
$1,839.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,716.40
|
| Rate for Payer: United Healthcare Commercial |
$2,206.80
|
|
|
NM Liver/Spleen Imaging
|
Facility
IP
|
$2,452.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
1169286
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,716.40 |
| Max. Negotiated Rate |
$2,206.80 |
| Rate for Payer: Aetna of IA Commercial |
$2,206.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,206.80
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,839.00
|
| Rate for Payer: Medical Associates Commercial |
$1,839.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,716.40
|
| Rate for Payer: United Healthcare Commercial |
$2,206.80
|
|
|
NM Liver/Spleen Imaging
|
Facility
OP
|
$2,452.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
1169286
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,225.51 |
| Max. Negotiated Rate |
$2,206.80 |
| Rate for Payer: Aetna of IA Commercial |
$2,206.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,206.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,397.64
|
| Rate for Payer: Amerigroup Medicaid |
$1,237.52
|
| Rate for Payer: Amerigroup Medicare |
$1,238.26
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,839.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,226.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,225.51
|
| Rate for Payer: Medical Associates Commercial |
$1,839.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,226.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,716.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,244.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,839.00
|
| Rate for Payer: United Healthcare Commercial |
$2,206.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,446.68
|
| Rate for Payer: Wellmark IA HMO |
$1,657.26
|
| Rate for Payer: Wellmark IA PPO |
$1,822.99
|
|
|
NM Myocardial Spect Multi Rest/Stress
|
Facility
IP
|
$3,005.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
1169308
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,103.50 |
| Max. Negotiated Rate |
$2,704.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,704.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,704.50
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,253.75
|
| Rate for Payer: Medical Associates Commercial |
$2,253.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,103.50
|
| Rate for Payer: United Healthcare Commercial |
$2,704.50
|
|
|
NM Myocardial Spect Multi Rest/Stress
|
Facility
OP
|
$3,005.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
1169308
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,501.90 |
| Max. Negotiated Rate |
$2,704.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,704.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,704.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,712.85
|
| Rate for Payer: Amerigroup Medicaid |
$1,516.62
|
| Rate for Payer: Amerigroup Medicare |
$1,517.52
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,253.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,502.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,501.90
|
| Rate for Payer: Medical Associates Commercial |
$2,253.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,502.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,103.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,525.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,253.75
|
| Rate for Payer: United Healthcare Commercial |
$2,704.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,772.95
|
| Rate for Payer: Wellmark IA HMO |
$1,657.26
|
| Rate for Payer: Wellmark IA PPO |
$1,822.99
|
|
|
NM Parathyroid Study
|
Facility
OP
|
$1,236.00
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
1169316
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$617.75 |
| Max. Negotiated Rate |
$1,112.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,112.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,112.40
|
| Rate for Payer: Aetna of IA Medicare |
$704.52
|
| Rate for Payer: Amerigroup Medicaid |
$623.81
|
| Rate for Payer: Amerigroup Medicare |
$624.18
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$927.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$618.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$617.75
|
| Rate for Payer: Medical Associates Commercial |
$927.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$618.00
|
| Rate for Payer: Midlands Choice Commercial |
$865.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$627.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$927.00
|
| Rate for Payer: United Healthcare Commercial |
$1,112.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$729.24
|
| Rate for Payer: Wellmark IA HMO |
$879.16
|
| Rate for Payer: Wellmark IA PPO |
$967.08
|
|
|
NM Parathyroid Study
|
Facility
IP
|
$1,236.00
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
1169316
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$865.20 |
| Max. Negotiated Rate |
$1,112.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,112.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,112.40
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$927.00
|
| Rate for Payer: Medical Associates Commercial |
$927.00
|
| Rate for Payer: Midlands Choice Commercial |
$865.20
|
| Rate for Payer: United Healthcare Commercial |
$1,112.40
|
|
|
NM Pulmonary Perfusion Imaging
|
Facility
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
1169328
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$564.77 |
| Max. Negotiated Rate |
$1,822.99 |
| Rate for Payer: Aetna of IA Commercial |
$1,017.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,017.00
|
| Rate for Payer: Aetna of IA Medicare |
$644.10
|
| Rate for Payer: Amerigroup Medicaid |
$570.31
|
| Rate for Payer: Amerigroup Medicare |
$570.65
|
| Rate for Payer: Cash Price |
$904.00
|
| Rate for Payer: Cash Price |
$904.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$847.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$565.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$564.77
|
| Rate for Payer: Medical Associates Commercial |
$847.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$565.00
|
| Rate for Payer: Midlands Choice Commercial |
$791.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$573.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$847.50
|
| Rate for Payer: United Healthcare Commercial |
$1,017.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$666.70
|
| Rate for Payer: Wellmark IA HMO |
$1,657.26
|
| Rate for Payer: Wellmark IA PPO |
$1,822.99
|
|
