|
VANCOMYCIN LEVEL
|
Facility
IP
|
$129.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
1634896
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
|
|
VANICREAM, topical - Cre
|
Facility
IP
|
$27.52
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
43700453
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$24.77 |
| Rate for Payer: Aetna of IA Commercial |
$24.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.77
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.64
|
| Rate for Payer: Medical Associates Commercial |
$20.64
|
| Rate for Payer: Midlands Choice Commercial |
$19.26
|
| Rate for Payer: United Healthcare Commercial |
$24.77
|
|
|
VANICREAM, topical - Cre
|
Facility
OP
|
$27.52
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
43700453
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$228.47 |
| Rate for Payer: Aetna of IA Commercial |
$24.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.77
|
| Rate for Payer: Aetna of IA Medicare |
$15.69
|
| Rate for Payer: Amerigroup Medicaid |
$13.89
|
| Rate for Payer: Amerigroup Medicare |
$13.90
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.75
|
| Rate for Payer: Medical Associates Commercial |
$20.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.76
|
| Rate for Payer: Midlands Choice Commercial |
$19.26
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.64
|
| Rate for Payer: United Healthcare Commercial |
$24.77
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.24
|
| Rate for Payer: Wellmark IA HMO |
$207.70
|
| Rate for Payer: Wellmark IA PPO |
$228.47
|
|
|
varicella virus vaccine - Pow
|
Facility
IP
|
$324.06
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43706041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$226.84 |
| Max. Negotiated Rate |
$291.65 |
| Rate for Payer: Aetna of IA Commercial |
$291.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$291.65
|
| Rate for Payer: Cash Price |
$259.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$243.04
|
| Rate for Payer: Medical Associates Commercial |
$243.04
|
| Rate for Payer: Midlands Choice Commercial |
$226.84
|
| Rate for Payer: United Healthcare Commercial |
$291.65
|
|
|
varicella virus vaccine - Pow
|
Facility
OP
|
$324.06
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43706041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.97 |
| Max. Negotiated Rate |
$291.65 |
| Rate for Payer: Aetna of IA Commercial |
$291.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$291.65
|
| Rate for Payer: Aetna of IA Medicare |
$184.71
|
| Rate for Payer: Amerigroup Medicaid |
$163.55
|
| Rate for Payer: Amerigroup Medicare |
$163.65
|
| Rate for Payer: Cash Price |
$259.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$243.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$162.03
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$161.97
|
| Rate for Payer: Medical Associates Commercial |
$243.04
|
| Rate for Payer: Medical Associates Managed Medicare |
$162.03
|
| Rate for Payer: Midlands Choice Commercial |
$226.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$164.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$243.04
|
| Rate for Payer: United Healthcare Commercial |
$291.65
|
| Rate for Payer: United Healthcare Managed Medicare |
$191.20
|
|
|
Varicella Zoster Virus IgG Antibody DMCL
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
8037822
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna of IA Commercial |
$94.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$94.50
|
| Rate for Payer: Aetna of IA Medicare |
$59.85
|
| Rate for Payer: Amerigroup Medicaid |
$52.99
|
| Rate for Payer: Amerigroup Medicare |
$53.02
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$52.48
|
| Rate for Payer: Medical Associates Commercial |
$78.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.50
|
| Rate for Payer: Midlands Choice Commercial |
$73.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$53.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.75
|
| Rate for Payer: United Healthcare Commercial |
$94.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.95
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Varicella Zoster Virus IgG Antibody DMCL
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
8037822
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna of IA Commercial |
$94.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$94.50
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.75
|
| Rate for Payer: Medical Associates Commercial |
$78.75
|
| Rate for Payer: Midlands Choice Commercial |
$73.50
|
| Rate for Payer: United Healthcare Commercial |
$94.50
|
|
|
Varicella Zoster Virus IgM Antibody DMCL
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
8037823
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna of IA Commercial |
$94.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$94.50
|
| Rate for Payer: Aetna of IA Medicare |
$59.85
|
| Rate for Payer: Amerigroup Medicaid |
$52.99
|
| Rate for Payer: Amerigroup Medicare |
$53.02
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$52.48
|
| Rate for Payer: Medical Associates Commercial |
$78.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.50
|
| Rate for Payer: Midlands Choice Commercial |
$73.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$53.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.75
|
| Rate for Payer: United Healthcare Commercial |
$94.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.95
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Varicella Zoster Virus IgM Antibody DMCL
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
8037823
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna of IA Commercial |
$94.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$94.50
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.75
|
| Rate for Payer: Medical Associates Commercial |
$78.75
|
| Rate for Payer: Midlands Choice Commercial |
$73.50
|
| Rate for Payer: United Healthcare Commercial |
$94.50
|
|
|
VASECTOMY UNIL OR BILAT
|
Professional
|
$1,285.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
8068962
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$210.80 |
| Max. Negotiated Rate |
$899.50 |
| Rate for Payer: Aetna of IA Medicare |
$210.80
|
| Rate for Payer: Amerigroup Medicaid |
$217.97
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$252.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$215.02
|
| Rate for Payer: Medical Associates Commercial |
$400.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$210.80
|
| Rate for Payer: Midlands Choice Commercial |
$899.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$316.20
|
| Rate for Payer: Wellmark IA HMO |
$433.00
|
| Rate for Payer: Wellmark IA PPO |
$509.00
|
|
|
vasopressin 20 units/mL Inj Sol
|
Facility
IP
|
$204.26
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43705874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.98 |
| Max. Negotiated Rate |
$183.83 |
| Rate for Payer: Aetna of IA Commercial |
$183.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$183.83
|
| Rate for Payer: Cash Price |
$163.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$153.20
|
| Rate for Payer: Medical Associates Commercial |
$153.20
|
| Rate for Payer: Midlands Choice Commercial |
$142.98
|
| Rate for Payer: United Healthcare Commercial |
$183.83
|
|
|
vasopressin 20 units/mL Inj Sol
|
Facility
OP
|
$204.26
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43705874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.09 |
| Max. Negotiated Rate |
$183.83 |
| Rate for Payer: Aetna of IA Commercial |
$183.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$183.83
|
| Rate for Payer: Aetna of IA Medicare |
$116.43
|
| Rate for Payer: Amerigroup Medicaid |
$103.09
|
| Rate for Payer: Amerigroup Medicare |
$103.15
|
| Rate for Payer: Cash Price |
$163.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$153.20
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$102.13
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$102.09
|
| Rate for Payer: Medical Associates Commercial |
$153.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$102.13
|
| Rate for Payer: Midlands Choice Commercial |
$142.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$103.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$153.20
|
| Rate for Payer: United Healthcare Commercial |
$183.83
|
| Rate for Payer: United Healthcare Managed Medicare |
$120.51
|
|
|
VDMC Chest-Cad
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT 0174T
|
| Hospital Charge Code |
7922825
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of IA Commercial |
$27.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.50
|
| Rate for Payer: Medical Associates Commercial |
$22.50
|
| Rate for Payer: Midlands Choice Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$27.00
|
|
|
VDMC Chest-Cad
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 0174T
|
| Hospital Charge Code |
7922825
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of IA Commercial |
$27.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.00
|
| Rate for Payer: Aetna of IA Medicare |
$17.10
|
| Rate for Payer: Amerigroup Medicaid |
$15.14
|
| Rate for Payer: Amerigroup Medicare |
$15.15
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.99
|
| Rate for Payer: Medical Associates Commercial |
$22.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.00
|
| Rate for Payer: Midlands Choice Commercial |
$21.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.50
|
| Rate for Payer: United Healthcare Commercial |
$27.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$17.70
|
|
|
VDMC CT Abdomen + Pelvis w/ Contrast
|
Facility
OP
|
$2,420.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
8027196
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,042.22 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,178.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,178.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,379.40
|
| Rate for Payer: Amerigroup Medicaid |
$1,221.37
|
| Rate for Payer: Amerigroup Medicare |
$1,222.10
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,815.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,210.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,209.52
|
| Rate for Payer: Medical Associates Commercial |
$1,815.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,210.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,694.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,228.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,815.00
|
| Rate for Payer: United Healthcare Commercial |
$2,178.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,427.80
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
VDMC CT Abdomen + Pelvis w/ Contrast
|
Facility
IP
|
$2,420.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
8027196
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,694.00 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,178.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,178.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,815.00
|
| Rate for Payer: Medical Associates Commercial |
$1,815.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,694.00
|
| Rate for Payer: United Healthcare Commercial |
$2,178.00
|
|
|
VDMC CT Abdomen + Pelvis w/o Contrast
|
Facility
OP
|
$1,860.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
8027197
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$929.63 |
| Max. Negotiated Rate |
$1,674.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,674.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,674.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,060.20
|
| Rate for Payer: Amerigroup Medicaid |
$938.74
|
| Rate for Payer: Amerigroup Medicare |
$939.30
|
| Rate for Payer: Cash Price |
$1,488.00
|
| Rate for Payer: Cash Price |
$1,488.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,395.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$930.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$929.63
|
| Rate for Payer: Medical Associates Commercial |
$1,395.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$930.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,302.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$943.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,395.00
|
| Rate for Payer: United Healthcare Commercial |
$1,674.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,097.40
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
VDMC CT Abdomen + Pelvis w/o Contrast
|
Facility
IP
|
$1,860.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
8027197
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,302.00 |
| Max. Negotiated Rate |
$1,674.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,674.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,674.00
|
| Rate for Payer: Cash Price |
$1,488.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,395.00
|
| Rate for Payer: Medical Associates Commercial |
$1,395.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,302.00
|
| Rate for Payer: United Healthcare Commercial |
$1,674.00
|
|
|
VDMC CT Abdomen + Pelvis w/ + w/o Contrast
|
Facility
OP
|
$3,176.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
8027195
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,042.22 |
| Max. Negotiated Rate |
$2,858.40 |
| Rate for Payer: Aetna of IA Commercial |
$2,858.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,858.40
|
| Rate for Payer: Aetna of IA Medicare |
$1,810.32
|
| Rate for Payer: Amerigroup Medicaid |
$1,602.93
|
| Rate for Payer: Amerigroup Medicare |
$1,603.88
|
| Rate for Payer: Cash Price |
$2,540.80
|
| Rate for Payer: Cash Price |
$2,540.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,382.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,588.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,587.36
|
| Rate for Payer: Medical Associates Commercial |
$2,382.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,588.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,223.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,611.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,382.00
|
| Rate for Payer: United Healthcare Commercial |
$2,858.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,873.84
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
VDMC CT Abdomen + Pelvis w/ + w/o Contrast
|
Facility
IP
|
$3,176.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
8027195
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,223.20 |
| Max. Negotiated Rate |
$2,858.40 |
| Rate for Payer: Aetna of IA Commercial |
$2,858.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,858.40
|
| Rate for Payer: Cash Price |
$2,540.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,382.00
|
| Rate for Payer: Medical Associates Commercial |
$2,382.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,223.20
|
| Rate for Payer: United Healthcare Commercial |
$2,858.40
|
|
|
VDMC CT Angio Chest w/ Cont
|
Facility
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
8208787
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$604.76 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,089.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,089.00
|
| Rate for Payer: Aetna of IA Medicare |
$689.70
|
| Rate for Payer: Amerigroup Medicaid |
$610.69
|
| Rate for Payer: Amerigroup Medicare |
$611.05
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$907.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$605.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$604.76
|
| Rate for Payer: Medical Associates Commercial |
$907.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$605.00
|
| Rate for Payer: Midlands Choice Commercial |
$847.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$614.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$907.50
|
| Rate for Payer: United Healthcare Commercial |
$1,089.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$713.90
|
| Rate for Payer: Wellmark IA HMO |
$709.28
|
| Rate for Payer: Wellmark IA PPO |
$780.21
|
|
|
VDMC CT Angio Chest w/ Cont
|
Facility
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
8208787
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$847.00 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,089.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,089.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$907.50
|
| Rate for Payer: Medical Associates Commercial |
$907.50
|
| Rate for Payer: Midlands Choice Commercial |
$847.00
|
| Rate for Payer: United Healthcare Commercial |
$1,089.00
|
|
|
VDMC CT Angiography Abdomen + Pelvis
|
Facility
IP
|
$2,420.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
8027198
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,694.00 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,178.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,178.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,815.00
|
| Rate for Payer: Medical Associates Commercial |
$1,815.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,694.00
|
| Rate for Payer: United Healthcare Commercial |
$2,178.00
|
|
|
VDMC CT Angiography Abdomen + Pelvis
|
Facility
OP
|
$2,420.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
8027198
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$709.28 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,178.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,178.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,379.40
|
| Rate for Payer: Amerigroup Medicaid |
$1,221.37
|
| Rate for Payer: Amerigroup Medicare |
$1,222.10
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,815.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,210.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,209.52
|
| Rate for Payer: Medical Associates Commercial |
$1,815.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,210.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,694.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,228.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,815.00
|
| Rate for Payer: United Healthcare Commercial |
$2,178.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,427.80
|
| Rate for Payer: Wellmark IA HMO |
$709.28
|
| Rate for Payer: Wellmark IA PPO |
$780.21
|
|
|
VDMC CT Angiography Chest w/ Contrast
|
Facility
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
8027199
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$847.00 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,089.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,089.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$907.50
|
| Rate for Payer: Medical Associates Commercial |
$907.50
|
| Rate for Payer: Midlands Choice Commercial |
$847.00
|
| Rate for Payer: United Healthcare Commercial |
$1,089.00
|
|
