|
Creatinine 24 Hour Urine
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
1634894
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$30.79
|
| Rate for Payer: Amerigroup Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.49
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.50
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
Creatinine Clearance 1
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
8788868
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of IA Commercial |
$81.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$67.50
|
| Rate for Payer: Medical Associates Commercial |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$63.00
|
| Rate for Payer: United Healthcare Commercial |
$81.00
|
|
|
Creatinine Clearance 1
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
8788868
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of IA Commercial |
$81.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.00
|
| Rate for Payer: Aetna of IA Medicare |
$51.30
|
| Rate for Payer: Amerigroup Medicaid |
$45.42
|
| Rate for Payer: Amerigroup Medicare |
$45.45
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$67.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$45.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$44.98
|
| Rate for Payer: Medical Associates Commercial |
$67.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$45.00
|
| Rate for Payer: Midlands Choice Commercial |
$63.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$45.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$67.50
|
| Rate for Payer: United Healthcare Commercial |
$81.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$53.10
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Creatinine Urine.
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
8435061
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
Creatinine Urine.
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
8435061
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$30.79
|
| Rate for Payer: Amerigroup Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.49
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.50
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
Creatinine Urine Random DMCL
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
8040998
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
Creatinine Urine Random DMCL
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
8040998
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$30.79
|
| Rate for Payer: Amerigroup Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.49
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.50
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
CRITICAL CARE 1ST 74 MINS
|
Professional
|
$679.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
7982749
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$195.19 |
| Max. Negotiated Rate |
$475.30 |
| Rate for Payer: Aetna of IA Medicare |
$195.19
|
| Rate for Payer: Amerigroup Medicaid |
$201.83
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$234.23
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$199.09
|
| Rate for Payer: Medical Associates Commercial |
$370.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$195.19
|
| Rate for Payer: Midlands Choice Commercial |
$475.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$292.78
|
| Rate for Payer: Wellmark IA HMO |
$331.00
|
| Rate for Payer: Wellmark IA PPO |
$331.00
|
|
|
CRITICAL CARE EA ADD'L 30 MINS
|
Professional
|
$341.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
7982747
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$98.04 |
| Max. Negotiated Rate |
$238.70 |
| Rate for Payer: Aetna of IA Medicare |
$98.04
|
| Rate for Payer: Amerigroup Medicaid |
$101.37
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.00
|
| Rate for Payer: Medical Associates Commercial |
$186.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$98.04
|
| Rate for Payer: Midlands Choice Commercial |
$238.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$147.06
|
| Rate for Payer: Wellmark IA HMO |
$166.00
|
| Rate for Payer: Wellmark IA PPO |
$166.00
|
|
|
Crypto Antigen
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
4022856
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
Crypto Antigen
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
8059690
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$57.54
|
| Rate for Payer: Amerigroup Medicare |
$57.57
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.98
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
Crypto Antigen
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
4022856
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$57.54
|
| Rate for Payer: Amerigroup Medicare |
$57.57
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.98
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
Crypto Antigen
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
8059690
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
Cryptosporidium Antigen DMCL
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 87272
|
| Hospital Charge Code |
8037702
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
Cryptosporidium Antigen DMCL
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 87272
|
| Hospital Charge Code |
8037702
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$57.54
|
| Rate for Payer: Amerigroup Medicare |
$57.57
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.98
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
CT Abdomen + Pelvis w/ Contrast
|
Facility
OP
|
$2,420.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
4500785
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,042.22 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Midlands Choice Commercial |
$1,694.00
|
| 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: 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
|
|
|
CT Abdomen + Pelvis w/ Contrast
|
Facility
IP
|
$2,420.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
4500785
|
|
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
|
|
|
CT Abdomen + Pelvis w/o Contrast
|
Facility
OP
|
$1,860.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
4500788
|
|
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
|
|
|
CT Abdomen + Pelvis w/o Contrast
|
Facility
IP
|
$1,860.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
4500788
|
|
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
|
|
|
CT Abdomen + Pelvis w/ + w/o Contrast
|
Facility
IP
|
$3,176.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
4500782
|
|
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
|
|
|
CT Abdomen + Pelvis w/ + w/o Contrast
|
Facility
OP
|
$3,176.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
4500782
|
|
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
|
|
|
CT Abdomen w/ Contrast
|
Facility
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
1167847
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$604.76 |
| Max. Negotiated Rate |
$1,146.44 |
| 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 |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
CT Abdomen w/ Contrast
|
Facility
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
8148964
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$604.76 |
| Max. Negotiated Rate |
$1,146.44 |
| 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 |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
CT Abdomen w/ Contrast
|
Facility
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
8148964
|
|
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
|
|
|
CT Abdomen w/ Contrast
|
Facility
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
1167847
|
|
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
|
|
