|
VDMC CT Angiography Head w/ Contrast
|
Facility
|
IP
|
$1,445.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
8027200
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,011.50 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,300.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,300.50
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,083.75
|
| Rate for Payer: Medical Associates Commercial |
$1,083.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,011.50
|
| Rate for Payer: United Healthcare Commercial |
$1,300.50
|
|
|
VDMC CT Angiography Head w/ Contrast
|
Facility
|
OP
|
$1,445.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
8027200
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$650.25 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,300.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,300.50
|
| Rate for Payer: Aetna of IA Medicare |
$823.65
|
| Rate for Payer: Amerigroup Medicaid |
$833.48
|
| Rate for Payer: Amerigroup Medicare |
$656.75
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,083.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$650.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$825.38
|
| Rate for Payer: Medical Associates Commercial |
$1,083.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$650.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,011.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$837.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$747.79
|
| Rate for Payer: United Healthcare Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$852.55
|
| Rate for Payer: Wellmark IA HMO WHPI |
$684.19
|
| Rate for Payer: Wellmark IA PPO |
$753.67
|
|
|
VDMC CT Angiography Neck w/ Contrast
|
Facility
|
IP
|
$1,445.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
8027201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,011.50 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,300.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,300.50
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,083.75
|
| Rate for Payer: Medical Associates Commercial |
$1,083.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,011.50
|
| Rate for Payer: United Healthcare Commercial |
$1,300.50
|
|
|
VDMC CT Angiography Neck w/ Contrast
|
Facility
|
OP
|
$1,445.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
8027201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$650.25 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,300.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,300.50
|
| Rate for Payer: Aetna of IA Medicare |
$823.65
|
| Rate for Payer: Amerigroup Medicaid |
$833.48
|
| Rate for Payer: Amerigroup Medicare |
$656.75
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,083.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$650.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$825.38
|
| Rate for Payer: Medical Associates Commercial |
$1,083.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$650.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,011.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$837.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$747.79
|
| Rate for Payer: United Healthcare Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$852.55
|
| Rate for Payer: Wellmark IA HMO WHPI |
$684.19
|
| Rate for Payer: Wellmark IA PPO |
$753.67
|
|
|
VDMC CT Anigo Chest w/ Contrast
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
8148971
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$544.50 |
| 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 |
$697.93
|
| Rate for Payer: Amerigroup Medicare |
$549.94
|
| 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 |
$544.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$691.15
|
| Rate for Payer: Medical Associates Commercial |
$907.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$544.50
|
| Rate for Payer: Midlands Choice Commercial |
$847.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$701.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$626.18
|
| Rate for Payer: United Healthcare Commercial |
$1,089.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$713.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$684.19
|
| Rate for Payer: Wellmark IA PPO |
$753.67
|
|
|
VDMC CT Anigo Chest w/ Contrast
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
8148971
|
|
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 Chest w/ Cont
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
8148972
|
|
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 Chest w/ Cont
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
8148972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$544.50 |
| 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 |
$697.93
|
| Rate for Payer: Amerigroup Medicare |
$549.94
|
| 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 |
$544.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$691.15
|
| Rate for Payer: Medical Associates Commercial |
$907.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$544.50
|
| Rate for Payer: Midlands Choice Commercial |
$847.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$701.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$626.18
|
| Rate for Payer: United Healthcare Commercial |
$1,089.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$713.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
VDMC CT Chest w/ Contrast
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
8027203
|
|
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 Chest w/ Contrast
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
8027203
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$544.50 |
| 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 |
$697.93
|
| Rate for Payer: Amerigroup Medicare |
$549.94
|
| 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 |
$544.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$691.15
|
| Rate for Payer: Medical Associates Commercial |
$907.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$544.50
|
| Rate for Payer: Midlands Choice Commercial |
$847.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$701.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$626.18
|
| Rate for Payer: United Healthcare Commercial |
$1,089.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$713.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
VDMC CT Chest w/o Cont
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
8148973
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$795.90 |
| Max. Negotiated Rate |
$1,023.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,023.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,023.30
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$852.75
|
| Rate for Payer: Medical Associates Commercial |
$852.75
|
| Rate for Payer: Midlands Choice Commercial |
$795.90
|
| Rate for Payer: United Healthcare Commercial |
$1,023.30
|
|
|
VDMC CT Chest w/o Cont
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
8148973
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$312.67 |
| Max. Negotiated Rate |
$1,023.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,023.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,023.30
|
| Rate for Payer: Aetna of IA Medicare |
$648.09
|
| Rate for Payer: Amerigroup Medicaid |
$655.82
|
| Rate for Payer: Amerigroup Medicare |
$516.77
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$852.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$511.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$649.45
|
| Rate for Payer: Medical Associates Commercial |
$852.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$511.65
|
| Rate for Payer: Midlands Choice Commercial |
$795.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$659.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$588.40
|
| Rate for Payer: United Healthcare Commercial |
$1,023.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$670.83
|
| Rate for Payer: Wellmark IA HMO WHPI |
$312.67
|
| Rate for Payer: Wellmark IA PPO |
$344.42
|
|
|
VDMC CT Chest w/o Contrast
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
8027204
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$795.90 |
| Max. Negotiated Rate |
$1,023.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,023.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,023.30
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$852.75
|
| Rate for Payer: Medical Associates Commercial |
$852.75
|
| Rate for Payer: Midlands Choice Commercial |
$795.90
|
| Rate for Payer: United Healthcare Commercial |
$1,023.30
|
|
|
VDMC CT Chest w/o Contrast
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
8027204
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$312.67 |
| Max. Negotiated Rate |
$1,023.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,023.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,023.30
|
| Rate for Payer: Aetna of IA Medicare |
$648.09
|
| Rate for Payer: Amerigroup Medicaid |
$655.82
|
| Rate for Payer: Amerigroup Medicare |
$516.77
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$852.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$511.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$649.45
|
| Rate for Payer: Medical Associates Commercial |
$852.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$511.65
|
| Rate for Payer: Midlands Choice Commercial |
$795.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$659.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$588.40
|
| Rate for Payer: United Healthcare Commercial |
$1,023.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$670.83
|
| Rate for Payer: Wellmark IA HMO WHPI |
$312.67
|
| Rate for Payer: Wellmark IA PPO |
$344.42
|
|
|
VDMC CT Chest w/ + w/o Cont
|
Facility
|
IP
|
$1,672.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
8148970
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,170.40 |
| Max. Negotiated Rate |
$1,504.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,504.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,504.80
|
| Rate for Payer: Cash Price |
$1,337.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,254.00
|
| Rate for Payer: Medical Associates Commercial |
$1,254.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,170.40
|
| Rate for Payer: United Healthcare Commercial |
$1,504.80
|
|
|
VDMC CT Chest w/ + w/o Cont
|
Facility
|
OP
|
$1,672.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
8148970
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$752.40 |
| Max. Negotiated Rate |
$1,504.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,504.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,504.80
|
| Rate for Payer: Aetna of IA Medicare |
$953.04
|
| Rate for Payer: Amerigroup Medicaid |
$964.41
|
| Rate for Payer: Amerigroup Medicare |
$759.92
|
| Rate for Payer: Cash Price |
$1,337.60
|
| Rate for Payer: Cash Price |
$1,337.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,254.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$752.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$955.05
|
| Rate for Payer: Medical Associates Commercial |
$1,254.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$752.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,170.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$969.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$865.26
|
| Rate for Payer: United Healthcare Commercial |
$1,504.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$986.48
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
VDMC CT Chest w/ + w/o Contrast
|
Facility
|
IP
|
$1,672.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
8027202
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,170.40 |
| Max. Negotiated Rate |
$1,504.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,504.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,504.80
|
| Rate for Payer: Cash Price |
$1,337.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,254.00
|
| Rate for Payer: Medical Associates Commercial |
$1,254.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,170.40
|
| Rate for Payer: United Healthcare Commercial |
$1,504.80
|
|
|
VDMC CT Chest w/ + w/o Contrast
|
Facility
|
OP
|
$1,672.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
8027202
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$752.40 |
| Max. Negotiated Rate |
$1,504.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,504.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,504.80
|
| Rate for Payer: Aetna of IA Medicare |
$953.04
|
| Rate for Payer: Amerigroup Medicaid |
$964.41
|
| Rate for Payer: Amerigroup Medicare |
$759.92
|
| Rate for Payer: Cash Price |
$1,337.60
|
| Rate for Payer: Cash Price |
$1,337.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,254.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$752.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$955.05
|
| Rate for Payer: Medical Associates Commercial |
$1,254.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$752.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,170.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$969.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$865.26
|
| Rate for Payer: United Healthcare Commercial |
$1,504.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$986.48
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
VDMC CT Soft Tissue Neck w/ Contrast
|
Facility
|
IP
|
$1,445.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
8027206
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,011.50 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,300.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,300.50
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,083.75
|
| Rate for Payer: Medical Associates Commercial |
$1,083.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,011.50
|
| Rate for Payer: United Healthcare Commercial |
$1,300.50
|
|
|
VDMC CT Soft Tissue Neck w/ Contrast
|
Facility
|
OP
|
$1,445.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
8027206
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$650.25 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,300.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,300.50
|
| Rate for Payer: Aetna of IA Medicare |
$823.65
|
| Rate for Payer: Amerigroup Medicaid |
$833.48
|
| Rate for Payer: Amerigroup Medicare |
$656.75
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,083.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$650.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$825.38
|
| Rate for Payer: Medical Associates Commercial |
$1,083.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$650.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,011.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$837.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$747.79
|
| Rate for Payer: United Healthcare Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$852.55
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
VDMC CT Soft Tissue Neck w/o Contrast
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
8027207
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$826.00 |
| Max. Negotiated Rate |
$1,062.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,062.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,062.00
|
| Rate for Payer: Cash Price |
$944.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$885.00
|
| Rate for Payer: Medical Associates Commercial |
$885.00
|
| Rate for Payer: Midlands Choice Commercial |
$826.00
|
| Rate for Payer: United Healthcare Commercial |
$1,062.00
|
|
|
VDMC CT Soft Tissue Neck w/o Contrast
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
8027207
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$312.67 |
| Max. Negotiated Rate |
$1,062.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,062.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,062.00
|
| Rate for Payer: Aetna of IA Medicare |
$672.60
|
| Rate for Payer: Amerigroup Medicaid |
$680.62
|
| Rate for Payer: Amerigroup Medicare |
$536.31
|
| Rate for Payer: Cash Price |
$944.00
|
| Rate for Payer: Cash Price |
$944.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$885.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$531.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$674.02
|
| Rate for Payer: Medical Associates Commercial |
$885.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$531.00
|
| Rate for Payer: Midlands Choice Commercial |
$826.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$683.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$610.65
|
| Rate for Payer: United Healthcare Commercial |
$1,062.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$696.20
|
| Rate for Payer: Wellmark IA HMO WHPI |
$312.67
|
| Rate for Payer: Wellmark IA PPO |
$344.42
|
|
|
VDMC CT Soft Tissue Neck w/ + w/o Contrast
|
Facility
|
OP
|
$1,656.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
8027205
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$745.20 |
| Max. Negotiated Rate |
$1,490.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,490.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,490.40
|
| Rate for Payer: Aetna of IA Medicare |
$943.92
|
| Rate for Payer: Amerigroup Medicaid |
$955.18
|
| Rate for Payer: Amerigroup Medicare |
$752.65
|
| Rate for Payer: Cash Price |
$1,324.80
|
| Rate for Payer: Cash Price |
$1,324.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,242.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$745.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$945.91
|
| Rate for Payer: Medical Associates Commercial |
$1,242.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$745.20
|
| Rate for Payer: Midlands Choice Commercial |
$1,159.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$959.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$856.98
|
| Rate for Payer: United Healthcare Commercial |
$1,490.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$977.04
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
VDMC CT Soft Tissue Neck w/ + w/o Contrast
|
Facility
|
IP
|
$1,656.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
8027205
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,159.20 |
| Max. Negotiated Rate |
$1,490.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,490.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,490.40
|
| Rate for Payer: Cash Price |
$1,324.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,242.00
|
| Rate for Payer: Medical Associates Commercial |
$1,242.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,159.20
|
| Rate for Payer: United Healthcare Commercial |
$1,490.40
|
|
|
VDMC DOT LAW ENFORCEMENT PHYSICAL
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
8015869
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of IA Commercial |
$112.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$112.50
|
| Rate for Payer: Aetna of IA Medicare |
$71.25
|
| Rate for Payer: Amerigroup Medicaid |
$72.10
|
| Rate for Payer: Amerigroup Medicare |
$56.81
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$56.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.40
|
| Rate for Payer: Medical Associates Commercial |
$93.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.25
|
| Rate for Payer: Midlands Choice Commercial |
$87.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$72.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.69
|
| Rate for Payer: United Healthcare Commercial |
$112.50
|
|
