|
CT Abdomen w/o Contrast
|
Facility
OP
|
$1,146.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
1167849
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$1,031.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,031.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,031.40
|
| Rate for Payer: Aetna of IA Medicare |
$653.22
|
| Rate for Payer: Amerigroup Medicaid |
$578.39
|
| Rate for Payer: Amerigroup Medicare |
$578.73
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$859.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$573.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$572.77
|
| Rate for Payer: Medical Associates Commercial |
$859.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$573.00
|
| Rate for Payer: Midlands Choice Commercial |
$802.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$581.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$859.50
|
| Rate for Payer: United Healthcare Commercial |
$1,031.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$676.14
|
| Rate for Payer: Wellmark IA HMO |
$480.50
|
| Rate for Payer: Wellmark IA PPO |
$528.55
|
|
|
CT Abdomen w/o Contrast
|
Facility
IP
|
$1,146.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
1167849
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$802.20 |
| Max. Negotiated Rate |
$1,031.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,031.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,031.40
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$859.50
|
| Rate for Payer: Medical Associates Commercial |
$859.50
|
| Rate for Payer: Midlands Choice Commercial |
$802.20
|
| Rate for Payer: United Healthcare Commercial |
$1,031.40
|
|
|
CT Abdomen w/o Contrast
|
Facility
IP
|
$1,146.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
8148967
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$802.20 |
| Max. Negotiated Rate |
$1,031.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,031.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,031.40
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$859.50
|
| Rate for Payer: Medical Associates Commercial |
$859.50
|
| Rate for Payer: Midlands Choice Commercial |
$802.20
|
| Rate for Payer: United Healthcare Commercial |
$1,031.40
|
|
|
CT Abdomen w/o Contrast
|
Facility
OP
|
$1,146.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
8148967
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$1,031.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,031.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,031.40
|
| Rate for Payer: Aetna of IA Medicare |
$653.22
|
| Rate for Payer: Amerigroup Medicaid |
$578.39
|
| Rate for Payer: Amerigroup Medicare |
$578.73
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$859.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$573.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$572.77
|
| Rate for Payer: Medical Associates Commercial |
$859.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$573.00
|
| Rate for Payer: Midlands Choice Commercial |
$802.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$581.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$859.50
|
| Rate for Payer: United Healthcare Commercial |
$1,031.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$676.14
|
| Rate for Payer: Wellmark IA HMO |
$480.50
|
| Rate for Payer: Wellmark IA PPO |
$528.55
|
|
|
CT Abdomen w/ + w/o Contrast
|
Facility
OP
|
$1,672.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
1167845
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$835.67 |
| 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 |
$843.86
|
| Rate for Payer: Amerigroup Medicare |
$844.36
|
| 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 |
$836.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$835.67
|
| Rate for Payer: Medical Associates Commercial |
$1,254.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$836.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,170.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$848.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,254.00
|
| Rate for Payer: United Healthcare Commercial |
$1,504.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$986.48
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
CT Abdomen w/ + w/o Contrast
|
Facility
IP
|
$1,672.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
1167845
|
|
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
|
|
|
CT Abdomen w/ + w/o Contrast
|
Facility
IP
|
$1,672.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
8148961
|
|
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
|
|
|
CT Abdomen w/ + w/o Contrast
|
Facility
OP
|
$1,672.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
8148961
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$835.67 |
| 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 |
$843.86
|
| Rate for Payer: Amerigroup Medicare |
$844.36
|
| 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 |
$836.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$835.67
|
| Rate for Payer: Medical Associates Commercial |
$1,254.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$836.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,170.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$848.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,254.00
|
| Rate for Payer: United Healthcare Commercial |
$1,504.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$986.48
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
CT Angiography Abd Aorta + Iliofemoral
|
Facility
IP
|
$2,420.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
1167851
|
|
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 Angiography Abd Aorta + Iliofemoral
|
Facility
OP
|
$2,420.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
1167851
|
|
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
|
|
|
CT Angiography Abdomen
|
Facility
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
1167853
|
|
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
|
|
|
CT Angiography Abdomen
|
Facility
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
1167853
|
|
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 Angiography Abdomen
|
Facility
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
8148958
|
|
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 Angiography Abdomen
|
Facility
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
8148958
|
|
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
|
|
|
CT Angiography Chest w/ Contrast
|
Facility
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
7960796
|
|
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
|
|
|
CT Angiography Chest w/ Contrast
|
Facility
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
7960796
|
|
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 Angiography Head w/ Contrast
|
Facility
OP
|
$1,445.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
7960805
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$709.28 |
| 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 |
$729.29
|
| Rate for Payer: Amerigroup Medicare |
$729.72
|
| 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 |
$722.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$722.21
|
| Rate for Payer: Medical Associates Commercial |
$1,083.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$722.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,011.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$733.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,083.75
|
| Rate for Payer: United Healthcare Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$852.55
|
| Rate for Payer: Wellmark IA HMO |
$709.28
|
| Rate for Payer: Wellmark IA PPO |
$780.21
|
|
|
CT Angiography Head w/ Contrast
|
Facility
IP
|
$1,445.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
7960805
|
|
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
|
|
|
CT Angiography Neck w/ Contrast
|
Facility
IP
|
$1,445.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
7960808
|
|
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
|
|
|
CT Angiography Neck w/ Contrast
|
Facility
OP
|
$1,445.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
7960808
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$709.28 |
| 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 |
$729.29
|
| Rate for Payer: Amerigroup Medicare |
$729.72
|
| 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 |
$722.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$722.21
|
| Rate for Payer: Medical Associates Commercial |
$1,083.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$722.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,011.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$733.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,083.75
|
| Rate for Payer: United Healthcare Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$852.55
|
| Rate for Payer: Wellmark IA HMO |
$709.28
|
| Rate for Payer: Wellmark IA PPO |
$780.21
|
|
|
CT Angiography of Abdomen + Pelvis
|
Facility
IP
|
$2,420.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
2410305
|
|
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 Angiography of Abdomen + Pelvis
|
Facility
OP
|
$2,420.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
2410305
|
|
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
|
|
|
CT Angiography Pelvis w/ Contrast
|
Facility
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
7960811
|
|
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 Angiography Pelvis w/ Contrast
|
Facility
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
7960811
|
|
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
|
|
|
CT Angiography Upper Extremity Left
|
Facility
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 73206 RT
|
| Hospital Charge Code |
1167885
|
|
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: 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
|
|
