|
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
|
|
|
CT Angiography Upper Extremity Right
|
Facility
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 73206 RT
|
| Hospital Charge Code |
1167887
|
|
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 Upper Extremity Right
|
Facility
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 73206 RT
|
| Hospital Charge Code |
1167887
|
|
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
|
|
|
CT Ankle w/ Contrast Left
|
Facility
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
1167897
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$717.71 |
| Max. Negotiated Rate |
$1,292.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,292.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,292.40
|
| Rate for Payer: Aetna of IA Medicare |
$818.52
|
| Rate for Payer: Amerigroup Medicaid |
$724.75
|
| Rate for Payer: Amerigroup Medicare |
$725.18
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,077.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$718.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$717.71
|
| Rate for Payer: Medical Associates Commercial |
$1,077.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$718.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,005.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$728.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,077.00
|
| Rate for Payer: United Healthcare Commercial |
$1,292.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$847.24
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
CT Ankle w/ Contrast Left
|
Facility
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
1167897
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,005.20 |
| Max. Negotiated Rate |
$1,292.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,292.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,077.00
|
| Rate for Payer: Medical Associates Commercial |
$1,077.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,005.20
|
| Rate for Payer: United Healthcare Commercial |
$1,292.40
|
|
|
CT Ankle w/ Contrast Right
|
Facility
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
1167899
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,005.20 |
| Max. Negotiated Rate |
$1,292.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,292.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,077.00
|
| Rate for Payer: Medical Associates Commercial |
$1,077.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,005.20
|
| Rate for Payer: United Healthcare Commercial |
$1,292.40
|
|
|
CT Ankle w/ Contrast Right
|
Facility
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
1167899
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$717.71 |
| Max. Negotiated Rate |
$1,292.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,292.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,292.40
|
| Rate for Payer: Aetna of IA Medicare |
$818.52
|
| Rate for Payer: Amerigroup Medicaid |
$724.75
|
| Rate for Payer: Amerigroup Medicare |
$725.18
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,077.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$718.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$717.71
|
| Rate for Payer: Medical Associates Commercial |
$1,077.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$718.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,005.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$728.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,077.00
|
| Rate for Payer: United Healthcare Commercial |
$1,292.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$847.24
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
CT Ankle w/o Contrast Left
|
Facility
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
1167903
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$784.70 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,008.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,008.90
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$840.75
|
| Rate for Payer: Medical Associates Commercial |
$840.75
|
| Rate for Payer: Midlands Choice Commercial |
$784.70
|
| Rate for Payer: United Healthcare Commercial |
$1,008.90
|
|
|
CT Ankle w/o Contrast Left
|
Facility
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
1167903
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,008.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,008.90
|
| Rate for Payer: Aetna of IA Medicare |
$638.97
|
| Rate for Payer: Amerigroup Medicaid |
$565.77
|
| Rate for Payer: Amerigroup Medicare |
$566.10
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$840.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$560.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$560.28
|
| Rate for Payer: Medical Associates Commercial |
$840.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$560.50
|
| Rate for Payer: Midlands Choice Commercial |
$784.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$568.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$840.75
|
| Rate for Payer: United Healthcare Commercial |
$1,008.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$661.39
|
| Rate for Payer: Wellmark IA HMO |
$480.50
|
| Rate for Payer: Wellmark IA PPO |
$528.55
|
|
|
CT Ankle w/o Contrast Right
|
Facility
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
1167905
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: United Healthcare Commercial |
$1,008.90
|
| Rate for Payer: Aetna of IA Commercial |
$1,008.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,008.90
|
| Rate for Payer: Aetna of IA Medicare |
$638.97
|
| Rate for Payer: Amerigroup Medicaid |
$565.77
|
| Rate for Payer: Amerigroup Medicare |
$566.10
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$840.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$560.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$560.28
|
| Rate for Payer: Medical Associates Commercial |
$840.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$560.50
|
| Rate for Payer: Midlands Choice Commercial |
$784.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$568.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$840.75
|
| Rate for Payer: United Healthcare Managed Medicare |
$661.39
|
| Rate for Payer: Wellmark IA HMO |
$480.50
|
| Rate for Payer: Wellmark IA PPO |
$528.55
|
|
|
CT Ankle w/o Contrast Right
|
Facility
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
1167905
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$784.70 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,008.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,008.90
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$840.75
|
| Rate for Payer: Medical Associates Commercial |
$840.75
|
| Rate for Payer: Midlands Choice Commercial |
$784.70
|
| Rate for Payer: United Healthcare Commercial |
$1,008.90
|
|
|
CT Ankle w/ + w/o Contrast Left
|
Facility
IP
|
$1,592.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
1167891
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,114.40 |
| Max. Negotiated Rate |
$1,432.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,432.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,432.80
|
| Rate for Payer: Cash Price |
$1,273.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,194.00
|
| Rate for Payer: Medical Associates Commercial |
$1,194.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,114.40
|
| Rate for Payer: United Healthcare Commercial |
$1,432.80
|
|
|
CT Ankle w/ + w/o Contrast Left
|
Facility
OP
|
$1,592.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
1167891
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$795.68 |
| Max. Negotiated Rate |
$1,432.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,432.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,432.80
|
| Rate for Payer: Aetna of IA Medicare |
$907.44
|
| Rate for Payer: Amerigroup Medicaid |
$803.48
|
| Rate for Payer: Amerigroup Medicare |
$803.96
|
| Rate for Payer: Cash Price |
$1,273.60
|
| Rate for Payer: Cash Price |
$1,273.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,194.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$796.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$795.68
|
| Rate for Payer: Medical Associates Commercial |
$1,194.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$796.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,114.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$807.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,194.00
|
| Rate for Payer: United Healthcare Commercial |
$1,432.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$939.28
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
CT Ankle w/ + w/o Contrast Right
|
Facility
OP
|
$1,592.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
1167893
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$795.68 |
| Max. Negotiated Rate |
$1,432.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,432.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,432.80
|
| Rate for Payer: Aetna of IA Medicare |
$907.44
|
| Rate for Payer: Amerigroup Medicaid |
$803.48
|
| Rate for Payer: Amerigroup Medicare |
$803.96
|
| Rate for Payer: Cash Price |
$1,273.60
|
| Rate for Payer: Cash Price |
$1,273.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,194.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$796.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$795.68
|
| Rate for Payer: Medical Associates Commercial |
$1,194.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$796.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,114.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$807.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,194.00
|
| Rate for Payer: United Healthcare Commercial |
$1,432.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$939.28
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
CT Ankle w/ + w/o Contrast Right
|
Facility
IP
|
$1,592.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
1167893
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,114.40 |
| Max. Negotiated Rate |
$1,432.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,432.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,432.80
|
| Rate for Payer: Cash Price |
$1,273.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,194.00
|
| Rate for Payer: Medical Associates Commercial |
$1,194.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,114.40
|
| Rate for Payer: United Healthcare Commercial |
$1,432.80
|
|
|
CT Cardiac Calcium Scoring
|
Facility
IP
|
$100.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
8773538
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
|
|
CT Cardiac Calcium Scoring
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
8773538
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$528.55 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Aetna of IA Medicare |
$57.00
|
| Rate for Payer: Amerigroup Medicaid |
$50.47
|
| Rate for Payer: Amerigroup Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$50.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.98
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
| Rate for Payer: Wellmark IA HMO |
$480.50
|
| Rate for Payer: Wellmark IA PPO |
$528.55
|
|
|
CT Chest w/ Contrast
|
Facility
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
4500796
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$604.76 |
| Max. Negotiated Rate |
$1,146.44 |
| Rate for Payer: United Healthcare Commercial |
$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 Managed Medicare |
$713.90
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
CT Chest w/ Contrast
|
Facility
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
4500796
|
|
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 Chest w/o Contrast
|
Facility
OP
|
$1,137.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
4500799
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$480.50 |
| 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 |
$573.84
|
| Rate for Payer: Amerigroup Medicare |
$574.18
|
| 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 |
$568.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$568.27
|
| Rate for Payer: Medical Associates Commercial |
$852.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$568.50
|
| Rate for Payer: Midlands Choice Commercial |
$795.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$577.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$852.75
|
| Rate for Payer: United Healthcare Commercial |
$1,023.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$670.83
|
| Rate for Payer: Wellmark IA HMO |
$480.50
|
| Rate for Payer: Wellmark IA PPO |
$528.55
|
|
|
CT Chest w/o Contrast
|
Facility
IP
|
$1,137.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
4500799
|
|
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
|
|
|
CT Chest w/ + w/o Contrast
|
Facility
IP
|
$1,672.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
4500793
|
|
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 Chest w/ + w/o Contrast
|
Facility
OP
|
$1,672.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
4500793
|
|
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 Elbow w/ Contrast Left
|
Facility
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
1167996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,005.20 |
| Max. Negotiated Rate |
$1,292.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,292.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,077.00
|
| Rate for Payer: Medical Associates Commercial |
$1,077.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,005.20
|
| Rate for Payer: United Healthcare Commercial |
$1,292.40
|
|
|
CT Elbow w/ Contrast Left
|
Facility
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
1167996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$717.71 |
| Max. Negotiated Rate |
$1,292.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,292.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,292.40
|
| Rate for Payer: Aetna of IA Medicare |
$818.52
|
| Rate for Payer: Amerigroup Medicaid |
$724.75
|
| Rate for Payer: Amerigroup Medicare |
$725.18
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,077.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$718.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$717.71
|
| Rate for Payer: Medical Associates Commercial |
$1,077.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$718.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,005.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$728.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,077.00
|
| Rate for Payer: United Healthcare Commercial |
$1,292.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$847.24
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
