|
CT IAC w/ + w/o Contrast
|
Facility
|
OP
|
$1,623.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
1168138
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$811.18 |
| Max. Negotiated Rate |
$1,460.70 |
| Rate for Payer: Aetna of IA Commercial |
$1,460.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,460.70
|
| Rate for Payer: Aetna of IA Medicare |
$925.11
|
| Rate for Payer: Amerigroup Medicaid |
$819.13
|
| Rate for Payer: Amerigroup Medicare |
$819.62
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,217.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$811.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$811.18
|
| Rate for Payer: Medical Associates Commercial |
$1,217.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$811.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,136.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$823.67
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$823.19
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,217.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,217.25
|
| Rate for Payer: United Healthcare Commercial |
$1,460.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$957.57
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
CT Knee w/ Contrast Left
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
1168152
|
|
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 Knee w/ Contrast Left
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
1168152
|
|
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 Knee w/ Contrast Right
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
1168154
|
|
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 Knee w/ Contrast Right
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
1168154
|
|
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 Knee w/o Contrast Left
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
1168158
|
|
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 Knee w/o Contrast Left
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
1168158
|
|
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: 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 Knee w/o Contrast Right
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
1168160
|
|
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: 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 Knee w/o Contrast Right
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
1168160
|
|
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 Knee w/ + w/o Contrast Left
|
Facility
|
OP
|
$1,592.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
1168146
|
|
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: Molina Healthcare Managed Medicare |
$807.46
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,194.00
|
| 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 Knee w/ + w/o Contrast Left
|
Facility
|
IP
|
$1,592.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
1168146
|
|
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 Knee w/ + w/o Contrast Right
|
Facility
|
IP
|
$1,592.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
1168148
|
|
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 Knee w/ + w/o Contrast Right
|
Facility
|
OP
|
$1,592.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
1168148
|
|
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: Molina Healthcare Managed Medicare |
$807.46
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,194.00
|
| 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 Limited or Localized F/U Study
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
1168162
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$313.37 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Aetna of IA Commercial |
$564.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$564.30
|
| Rate for Payer: Aetna of IA Medicare |
$357.39
|
| Rate for Payer: Amerigroup Medicaid |
$316.45
|
| Rate for Payer: Amerigroup Medicare |
$316.64
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$470.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$313.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$313.37
|
| Rate for Payer: Medical Associates Commercial |
$470.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$313.50
|
| Rate for Payer: Midlands Choice Commercial |
$438.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$318.20
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$318.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$470.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$470.25
|
| Rate for Payer: United Healthcare Commercial |
$564.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$369.93
|
| Rate for Payer: Wellmark IA HMO |
$480.50
|
| Rate for Payer: Wellmark IA PPO |
$528.55
|
|
|
CT Limited or Localized F/U Study
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
1168162
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$438.90 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Aetna of IA Commercial |
$564.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$564.30
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$470.25
|
| Rate for Payer: Medical Associates Commercial |
$470.25
|
| Rate for Payer: Midlands Choice Commercial |
$438.90
|
| Rate for Payer: United Healthcare Commercial |
$564.30
|
|
|
CT Lower Extremity w/ Contrast Left
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701 LT
|
| Hospital Charge Code |
1168166
|
|
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 Lower Extremity w/ Contrast Left
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701 LT
|
| Hospital Charge Code |
1168166
|
|
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: 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
|
|
|
CT Lower Extremity w/ Contrast Right
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
1168168
|
|
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 Lower Extremity w/ Contrast Right
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
1168168
|
|
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 Lower Extremity w/o Contrast Left
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
1168178
|
|
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: 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 Lower Extremity w/o Contrast Left
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
1168178
|
|
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 Lower Extremity w/o Contrast Right
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
1168180
|
|
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 Lower Extremity w/o Contrast Right
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
1168180
|
|
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: 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 Lower Extremity w/+w/o Contrast Left
|
Facility
|
IP
|
$1,592.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
1168172
|
|
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 Lower Extremity w/+w/o Contrast Left
|
Facility
|
OP
|
$1,592.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
1168172
|
|
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: Molina Healthcare Managed Medicare |
$807.46
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,194.00
|
| 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
|
|
