|
CT Forearm w/ + w/o Contrast Left
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
1168046
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$660.24 |
| Max. Negotiated Rate |
$1,188.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,188.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,188.90
|
| Rate for Payer: Aetna of IA Medicare |
$752.97
|
| Rate for Payer: Amerigroup Medicaid |
$666.71
|
| Rate for Payer: Amerigroup Medicare |
$667.10
|
| Rate for Payer: Cash Price |
$1,056.80
|
| Rate for Payer: Cash Price |
$1,056.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$990.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$660.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$660.24
|
| Rate for Payer: Medical Associates Commercial |
$990.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$660.50
|
| Rate for Payer: Midlands Choice Commercial |
$924.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$670.41
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$670.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$990.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$990.75
|
| Rate for Payer: United Healthcare Commercial |
$1,188.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$779.39
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
CT Forearm w/ + w/o Contrast Right
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
1168048
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$924.70 |
| Max. Negotiated Rate |
$1,188.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,188.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,188.90
|
| Rate for Payer: Cash Price |
$1,056.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$990.75
|
| Rate for Payer: Medical Associates Commercial |
$990.75
|
| Rate for Payer: Midlands Choice Commercial |
$924.70
|
| Rate for Payer: United Healthcare Commercial |
$1,188.90
|
|
|
CT Forearm w/ + w/o Contrast Right
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
1168048
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$660.24 |
| Max. Negotiated Rate |
$1,188.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,188.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,188.90
|
| Rate for Payer: Aetna of IA Medicare |
$752.97
|
| Rate for Payer: Amerigroup Medicaid |
$666.71
|
| Rate for Payer: Amerigroup Medicare |
$667.10
|
| Rate for Payer: Cash Price |
$1,056.80
|
| Rate for Payer: Cash Price |
$1,056.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$990.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$660.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$660.24
|
| Rate for Payer: Medical Associates Commercial |
$990.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$660.50
|
| Rate for Payer: Midlands Choice Commercial |
$924.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$670.41
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$670.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$990.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$990.75
|
| Rate for Payer: United Healthcare Commercial |
$1,188.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$779.39
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
CT Hand w/ Contrast Left
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
1168080
|
|
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 Hand w/ Contrast Left
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
1168080
|
|
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: Molina Healthcare Managed Medicare |
$728.34
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,077.00
|
| 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 Hand w/ Contrast Right
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
1168082
|
|
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: Molina Healthcare Managed Medicare |
$728.34
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,077.00
|
| 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 Hand w/ Contrast Right
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
1168082
|
|
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 Hand w/o Contrast Left
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
1168086
|
|
Hospital Revenue Code
|
350
|
| 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 Hand w/o Contrast Left
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
1168086
|
|
Hospital Revenue Code
|
350
|
| 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: Molina Healthcare Managed Medicare |
$568.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$840.75
|
| 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 Hand w/o Contrast Right
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
1168088
|
|
Hospital Revenue Code
|
350
|
| 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: Molina Healthcare Managed Medicare |
$568.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$840.75
|
| 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 Hand w/o Contrast Right
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
1168088
|
|
Hospital Revenue Code
|
350
|
| 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 Hand w/ + w/o Contrast Left
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
1168074
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$924.70 |
| Max. Negotiated Rate |
$1,188.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,188.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,188.90
|
| Rate for Payer: Cash Price |
$1,056.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$990.75
|
| Rate for Payer: Medical Associates Commercial |
$990.75
|
| Rate for Payer: Midlands Choice Commercial |
$924.70
|
| Rate for Payer: United Healthcare Commercial |
$1,188.90
|
|
|
CT Hand w/ + w/o Contrast Left
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
1168074
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$660.24 |
| Max. Negotiated Rate |
$1,188.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,188.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,188.90
|
| Rate for Payer: Aetna of IA Medicare |
$752.97
|
| Rate for Payer: Amerigroup Medicaid |
$666.71
|
| Rate for Payer: Amerigroup Medicare |
$667.10
|
| Rate for Payer: Cash Price |
$1,056.80
|
| Rate for Payer: Cash Price |
$1,056.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$990.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$660.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$660.24
|
| Rate for Payer: Medical Associates Commercial |
$990.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$660.50
|
| Rate for Payer: Midlands Choice Commercial |
$924.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$670.41
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$670.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$990.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$990.75
|
| Rate for Payer: United Healthcare Commercial |
$1,188.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$779.39
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
CT Hand w/ + w/o Contrast Right
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
1168076
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$660.24 |
| Max. Negotiated Rate |
$1,188.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,188.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,188.90
|
| Rate for Payer: Aetna of IA Medicare |
$752.97
|
| Rate for Payer: Amerigroup Medicaid |
$666.71
|
| Rate for Payer: Amerigroup Medicare |
$667.10
|
| Rate for Payer: Cash Price |
$1,056.80
|
| Rate for Payer: Cash Price |
$1,056.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$990.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$660.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$660.24
|
| Rate for Payer: Medical Associates Commercial |
$990.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$660.50
|
| Rate for Payer: Midlands Choice Commercial |
$924.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$670.41
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$670.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$990.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$990.75
|
| Rate for Payer: United Healthcare Commercial |
$1,188.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$779.39
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
CT Hand w/ + w/o Contrast Right
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
1168076
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$924.70 |
| Max. Negotiated Rate |
$1,188.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,188.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,188.90
|
| Rate for Payer: Cash Price |
$1,056.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$990.75
|
| Rate for Payer: Medical Associates Commercial |
$990.75
|
| Rate for Payer: Midlands Choice Commercial |
$924.70
|
| Rate for Payer: United Healthcare Commercial |
$1,188.90
|
|
|
CT Head or Brain w/ Contrast
|
Facility
|
OP
|
$1,165.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
1168092
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$582.27 |
| Max. Negotiated Rate |
$1,146.44 |
| Rate for Payer: Aetna of IA Commercial |
$1,048.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,048.50
|
| Rate for Payer: Aetna of IA Medicare |
$664.05
|
| Rate for Payer: Amerigroup Medicaid |
$587.98
|
| Rate for Payer: Amerigroup Medicare |
$588.32
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$873.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$582.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$582.27
|
| Rate for Payer: Medical Associates Commercial |
$873.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$582.50
|
| Rate for Payer: Midlands Choice Commercial |
$815.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$591.24
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$590.89
|
| Rate for Payer: Oscar Health of IA Commercial |
$873.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$873.75
|
| Rate for Payer: United Healthcare Commercial |
$1,048.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$687.35
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
CT Head or Brain w/ Contrast
|
Facility
|
IP
|
$1,165.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
1168092
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$815.50 |
| Max. Negotiated Rate |
$1,048.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,048.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,048.50
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$873.75
|
| Rate for Payer: Medical Associates Commercial |
$873.75
|
| Rate for Payer: Midlands Choice Commercial |
$815.50
|
| Rate for Payer: United Healthcare Commercial |
$1,048.50
|
|
|
CT Head or Brain w/o Contrast
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
1168094
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$636.30 |
| Max. Negotiated Rate |
$818.10 |
| Rate for Payer: Aetna of IA Commercial |
$818.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$818.10
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$681.75
|
| Rate for Payer: Medical Associates Commercial |
$681.75
|
| Rate for Payer: Midlands Choice Commercial |
$636.30
|
| Rate for Payer: United Healthcare Commercial |
$818.10
|
|
|
CT Head or Brain w/o Contrast
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
1168094
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$454.32 |
| Max. Negotiated Rate |
$1,146.44 |
| Rate for Payer: Aetna of IA Commercial |
$818.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$818.10
|
| Rate for Payer: Aetna of IA Medicare |
$518.13
|
| Rate for Payer: Amerigroup Medicaid |
$458.77
|
| Rate for Payer: Amerigroup Medicare |
$459.04
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$681.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$454.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$454.32
|
| Rate for Payer: Medical Associates Commercial |
$681.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$454.50
|
| Rate for Payer: Midlands Choice Commercial |
$636.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$461.32
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$461.04
|
| Rate for Payer: Oscar Health of IA Commercial |
$681.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$681.75
|
| Rate for Payer: United Healthcare Commercial |
$818.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$536.31
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
CT Head or Brain w/ + w/o Contrast
|
Facility
|
IP
|
$1,629.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
1168090
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,140.30 |
| Max. Negotiated Rate |
$1,466.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,466.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,466.10
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,221.75
|
| Rate for Payer: Medical Associates Commercial |
$1,221.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,140.30
|
| Rate for Payer: United Healthcare Commercial |
$1,466.10
|
|
|
CT Head or Brain w/ + w/o Contrast
|
Facility
|
OP
|
$1,629.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
1168090
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$814.17 |
| Max. Negotiated Rate |
$1,466.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,466.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,466.10
|
| Rate for Payer: Aetna of IA Medicare |
$928.53
|
| Rate for Payer: Amerigroup Medicaid |
$822.16
|
| Rate for Payer: Amerigroup Medicare |
$822.64
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,221.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$814.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$814.17
|
| Rate for Payer: Medical Associates Commercial |
$1,221.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$814.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,140.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$826.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$826.23
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,221.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,221.75
|
| Rate for Payer: United Healthcare Commercial |
$1,466.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$961.11
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
CT Hip w/ Contrast Left
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
1168110
|
|
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: Molina Healthcare Managed Medicare |
$728.34
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,077.00
|
| 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 Hip w/ Contrast Left
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
1168110
|
|
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 Hip w/ Contrast Right
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
1168112
|
|
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 Hip w/ Contrast Right
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
1168112
|
|
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: Molina Healthcare Managed Medicare |
$728.34
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,077.00
|
| 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
|
|
