|
Cryptosporidium Antigen DMCL
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 87272
|
| Hospital Charge Code |
8037702
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.03 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$65.76
|
| Rate for Payer: Amerigroup Medicare |
$51.81
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.12
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.30
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$59.00
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
|
Cryptosporidium Antigen DMCL
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 87272
|
| Hospital Charge Code |
8037702
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
CT Abdomen + Pelvis w/ Contrast
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
4500785
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$832.37 |
| 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 |
$1,395.86
|
| Rate for Payer: Amerigroup Medicare |
$1,099.89
|
| 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 |
$1,089.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,382.30
|
| Rate for Payer: Medical Associates Commercial |
$1,815.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,089.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,694.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,402.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,252.35
|
| 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 WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
CT Abdomen + Pelvis w/ Contrast
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
4500785
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,694.00 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,178.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,178.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,815.00
|
| Rate for Payer: Medical Associates Commercial |
$1,815.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,694.00
|
| Rate for Payer: United Healthcare Commercial |
$2,178.00
|
|
|
CT Abdomen + Pelvis w/o Contrast
|
Facility
|
IP
|
$1,860.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
4500788
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,302.00 |
| Max. Negotiated Rate |
$1,674.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,674.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,674.00
|
| Rate for Payer: Cash Price |
$1,488.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,395.00
|
| Rate for Payer: Medical Associates Commercial |
$1,395.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,302.00
|
| Rate for Payer: United Healthcare Commercial |
$1,674.00
|
|
|
CT Abdomen + Pelvis w/o Contrast
|
Facility
|
OP
|
$1,860.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
4500788
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$832.37 |
| Max. Negotiated Rate |
$1,674.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,674.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,674.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,060.20
|
| Rate for Payer: Amerigroup Medicaid |
$1,072.85
|
| Rate for Payer: Amerigroup Medicare |
$845.37
|
| Rate for Payer: Cash Price |
$1,488.00
|
| Rate for Payer: Cash Price |
$1,488.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,395.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$837.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,062.43
|
| Rate for Payer: Medical Associates Commercial |
$1,395.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$837.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,302.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,078.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$962.55
|
| Rate for Payer: United Healthcare Commercial |
$1,674.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,097.40
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
CT Abdomen + Pelvis w/ + w/o Contrast
|
Facility
|
OP
|
$3,176.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
4500782
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$832.37 |
| Max. Negotiated Rate |
$2,858.40 |
| Rate for Payer: Aetna of IA Commercial |
$2,858.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,858.40
|
| Rate for Payer: Aetna of IA Medicare |
$1,810.32
|
| Rate for Payer: Amerigroup Medicaid |
$1,831.92
|
| Rate for Payer: Amerigroup Medicare |
$1,443.49
|
| Rate for Payer: Cash Price |
$2,540.80
|
| Rate for Payer: Cash Price |
$2,540.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,382.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,429.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,814.13
|
| Rate for Payer: Medical Associates Commercial |
$2,382.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,429.20
|
| Rate for Payer: Midlands Choice Commercial |
$2,223.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,840.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,643.58
|
| Rate for Payer: United Healthcare Commercial |
$2,858.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,873.84
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
CT Abdomen + Pelvis w/ + w/o Contrast
|
Facility
|
IP
|
$3,176.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
4500782
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,223.20 |
| Max. Negotiated Rate |
$2,858.40 |
| Rate for Payer: Aetna of IA Commercial |
$2,858.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,858.40
|
| Rate for Payer: Cash Price |
$2,540.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,382.00
|
| Rate for Payer: Medical Associates Commercial |
$2,382.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,223.20
|
| Rate for Payer: United Healthcare Commercial |
$2,858.40
|
|
|
CT Abdomen w/ Contrast
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
8148964
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$847.00 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,089.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,089.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$907.50
|
| Rate for Payer: Medical Associates Commercial |
$907.50
|
| Rate for Payer: Midlands Choice Commercial |
$847.00
|
| Rate for Payer: United Healthcare Commercial |
$1,089.00
|
|
|
CT Abdomen w/ Contrast
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
1167847
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$847.00 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,089.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,089.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$907.50
|
| Rate for Payer: Medical Associates Commercial |
$907.50
|
| Rate for Payer: Midlands Choice Commercial |
$847.00
|
| Rate for Payer: United Healthcare Commercial |
$1,089.00
|
|
|
CT Abdomen w/ Contrast
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
1167847
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$544.50 |
| 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 |
$697.93
|
| Rate for Payer: Amerigroup Medicare |
$549.94
|
| 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 |
$544.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$691.15
|
| Rate for Payer: Medical Associates Commercial |
$907.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$544.50
|
| Rate for Payer: Midlands Choice Commercial |
$847.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$701.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$626.18
|
| Rate for Payer: United Healthcare Commercial |
$1,089.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$713.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
CT Abdomen w/ Contrast
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
8148964
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$544.50 |
| 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 |
$697.93
|
| Rate for Payer: Amerigroup Medicare |
$549.94
|
| 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 |
$544.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$691.15
|
| Rate for Payer: Medical Associates Commercial |
$907.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$544.50
|
| Rate for Payer: Midlands Choice Commercial |
$847.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$701.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$626.18
|
| Rate for Payer: United Healthcare Commercial |
$1,089.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$713.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
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
|
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
|
OP
|
$1,146.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
8148967
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$312.67 |
| 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 |
$661.01
|
| Rate for Payer: Amerigroup Medicare |
$520.86
|
| 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 |
$515.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$654.60
|
| Rate for Payer: Medical Associates Commercial |
$859.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$515.70
|
| Rate for Payer: Midlands Choice Commercial |
$802.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$664.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$593.06
|
| Rate for Payer: United Healthcare Commercial |
$1,031.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$676.14
|
| Rate for Payer: Wellmark IA HMO WHPI |
$312.67
|
| Rate for Payer: Wellmark IA PPO |
$344.42
|
|
|
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 |
$312.67 |
| 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 |
$661.01
|
| Rate for Payer: Amerigroup Medicare |
$520.86
|
| 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 |
$515.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$654.60
|
| Rate for Payer: Medical Associates Commercial |
$859.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$515.70
|
| Rate for Payer: Midlands Choice Commercial |
$802.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$664.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$593.06
|
| Rate for Payer: United Healthcare Commercial |
$1,031.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$676.14
|
| Rate for Payer: Wellmark IA HMO WHPI |
$312.67
|
| Rate for Payer: Wellmark IA PPO |
$344.42
|
|
|
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 |
$752.40 |
| 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: Aetna of IA Medicare |
$953.04
|
| Rate for Payer: Amerigroup Medicaid |
$964.41
|
| Rate for Payer: Amerigroup Medicare |
$759.92
|
| 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 |
$752.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$955.05
|
| Rate for Payer: Medical Associates Commercial |
$1,254.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$752.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,170.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$969.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$865.26
|
| Rate for Payer: United Healthcare Commercial |
$1,504.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$986.48
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
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 |
$752.40 |
| 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: Aetna of IA Medicare |
$953.04
|
| Rate for Payer: Amerigroup Medicaid |
$964.41
|
| Rate for Payer: Amerigroup Medicare |
$759.92
|
| 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 |
$752.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$955.05
|
| Rate for Payer: Medical Associates Commercial |
$1,254.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$752.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,170.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$969.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$865.26
|
| Rate for Payer: United Healthcare Commercial |
$1,504.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$986.48
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
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 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 |
$684.19 |
| 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 |
$1,395.86
|
| Rate for Payer: Amerigroup Medicare |
$1,099.89
|
| 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 |
$1,089.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,382.30
|
| Rate for Payer: Medical Associates Commercial |
$1,815.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,089.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,694.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,402.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,252.35
|
| 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 WHPI |
$684.19
|
| Rate for Payer: Wellmark IA PPO |
$753.67
|
|
|
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
|
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
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
1167853
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$544.50 |
| 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 |
$697.93
|
| Rate for Payer: Amerigroup Medicare |
$549.94
|
| 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 |
$544.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$691.15
|
| Rate for Payer: Medical Associates Commercial |
$907.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$544.50
|
| Rate for Payer: Midlands Choice Commercial |
$847.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$701.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$626.18
|
| Rate for Payer: United Healthcare Commercial |
$1,089.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$713.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$684.19
|
| Rate for Payer: Wellmark IA PPO |
$753.67
|
|
