|
CT Ankle w/ + w/o Contrast Right
|
Facility
|
OP
|
$1,592.00
|
|
|
Service Code
|
CPT 73702 RT
|
| Hospital Charge Code |
1167893
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$716.40 |
| 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: Aetna of IA Medicare |
$907.44
|
| Rate for Payer: Amerigroup Medicaid |
$918.27
|
| Rate for Payer: Amerigroup Medicare |
$723.56
|
| 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 |
$716.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$909.35
|
| Rate for Payer: Medical Associates Commercial |
$1,194.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$716.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,114.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$922.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$823.86
|
| Rate for Payer: United Healthcare Commercial |
$1,432.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$939.28
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
CT Ankle w/ + w/o Contrast Right
|
Facility
|
IP
|
$1,592.00
|
|
|
Service Code
|
CPT 73702 RT
|
| 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
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
8773538
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$344.42 |
| 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 |
$57.68
|
| Rate for Payer: Amerigroup Medicare |
$45.45
|
| 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 |
$45.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.12
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$45.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.75
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
| Rate for Payer: Wellmark IA HMO WHPI |
$312.67
|
| Rate for Payer: Wellmark IA PPO |
$344.42
|
|
|
CT Cardiac Calcium Scoring
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
8773538
|
|
Hospital Revenue Code
|
921
|
| 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 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/ Contrast
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
4500796
|
|
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 Chest w/o Contrast
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
4500799
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$312.67 |
| 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 |
$655.82
|
| Rate for Payer: Amerigroup Medicare |
$516.77
|
| 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 |
$511.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$649.45
|
| Rate for Payer: Medical Associates Commercial |
$852.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$511.65
|
| Rate for Payer: Midlands Choice Commercial |
$795.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$659.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$588.40
|
| Rate for Payer: United Healthcare Commercial |
$1,023.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$670.83
|
| Rate for Payer: Wellmark IA HMO WHPI |
$312.67
|
| Rate for Payer: Wellmark IA PPO |
$344.42
|
|
|
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
|
OP
|
$1,672.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
4500793
|
|
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 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 Elbow w/ Contrast Left
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 73201 LT
|
| Hospital Charge Code |
1167996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$646.20 |
| 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: Aetna of IA Medicare |
$818.52
|
| Rate for Payer: Amerigroup Medicaid |
$828.28
|
| Rate for Payer: Amerigroup Medicare |
$652.66
|
| 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 |
$646.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$820.24
|
| Rate for Payer: Medical Associates Commercial |
$1,077.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$646.20
|
| Rate for Payer: Midlands Choice Commercial |
$1,005.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$832.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$743.13
|
| Rate for Payer: United Healthcare Commercial |
$1,292.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$847.24
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
CT Elbow w/ Contrast Left
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 73201 LT
|
| 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 Right
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 73201 RT
|
| Hospital Charge Code |
1167998
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$646.20 |
| 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: Aetna of IA Medicare |
$818.52
|
| Rate for Payer: Amerigroup Medicaid |
$828.28
|
| Rate for Payer: Amerigroup Medicare |
$652.66
|
| 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 |
$646.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$820.24
|
| Rate for Payer: Medical Associates Commercial |
$1,077.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$646.20
|
| Rate for Payer: Midlands Choice Commercial |
$1,005.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$832.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$743.13
|
| Rate for Payer: United Healthcare Commercial |
$1,292.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$847.24
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
CT Elbow w/ Contrast Right
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 73201 RT
|
| Hospital Charge Code |
1167998
|
|
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/o Contrast Left
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 73200 LT
|
| Hospital Charge Code |
1168002
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$312.67 |
| 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 |
$646.59
|
| Rate for Payer: Amerigroup Medicare |
$509.49
|
| 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 |
$504.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$640.32
|
| Rate for Payer: Medical Associates Commercial |
$840.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$504.45
|
| Rate for Payer: Midlands Choice Commercial |
$784.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$649.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$580.12
|
| Rate for Payer: United Healthcare Commercial |
$1,008.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$661.39
|
| Rate for Payer: Wellmark IA HMO WHPI |
$312.67
|
| Rate for Payer: Wellmark IA PPO |
$344.42
|
|
|
CT Elbow w/o Contrast Left
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 73200 LT
|
| Hospital Charge Code |
1168002
|
|
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 Elbow w/o Contrast Right
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 73200 RT
|
| Hospital Charge Code |
1168004
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$312.67 |
| 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 |
$646.59
|
| Rate for Payer: Amerigroup Medicare |
$509.49
|
| 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 |
$504.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$640.32
|
| Rate for Payer: Medical Associates Commercial |
$840.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$504.45
|
| Rate for Payer: Midlands Choice Commercial |
$784.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$649.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$580.12
|
| Rate for Payer: United Healthcare Commercial |
$1,008.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$661.39
|
| Rate for Payer: Wellmark IA HMO WHPI |
$312.67
|
| Rate for Payer: Wellmark IA PPO |
$344.42
|
|
|
CT Elbow w/o Contrast Right
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 73200 RT
|
| Hospital Charge Code |
1168004
|
|
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 Elbow w/ + w/o Contrast Left
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
CPT 73202 LT
|
| Hospital Charge Code |
1167990
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$594.45 |
| 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 |
$761.95
|
| Rate for Payer: Amerigroup Medicare |
$600.39
|
| 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 |
$594.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$754.56
|
| Rate for Payer: Medical Associates Commercial |
$990.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$594.45
|
| Rate for Payer: Midlands Choice Commercial |
$924.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$765.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$683.62
|
| Rate for Payer: United Healthcare Commercial |
$1,188.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$779.39
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
CT Elbow w/ + w/o Contrast Left
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
CPT 73202 LT
|
| Hospital Charge Code |
1167990
|
|
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 Elbow w/ + w/o Contrast Right
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
CPT 73202 RT
|
| Hospital Charge Code |
1167992
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$594.45 |
| 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 |
$761.95
|
| Rate for Payer: Amerigroup Medicare |
$600.39
|
| 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 |
$594.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$754.56
|
| Rate for Payer: Medical Associates Commercial |
$990.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$594.45
|
| Rate for Payer: Midlands Choice Commercial |
$924.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$765.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$683.62
|
| Rate for Payer: United Healthcare Commercial |
$1,188.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$779.39
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
CT Elbow w/ + w/o Contrast Right
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
CPT 73202 RT
|
| Hospital Charge Code |
1167992
|
|
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 Femur w/ Contrast Left
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701 LT
|
| Hospital Charge Code |
1168014
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$646.20 |
| 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: Aetna of IA Medicare |
$818.52
|
| Rate for Payer: Amerigroup Medicaid |
$828.28
|
| Rate for Payer: Amerigroup Medicare |
$652.66
|
| 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 |
$646.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$820.24
|
| Rate for Payer: Medical Associates Commercial |
$1,077.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$646.20
|
| Rate for Payer: Midlands Choice Commercial |
$1,005.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$832.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$743.13
|
| Rate for Payer: United Healthcare Commercial |
$1,292.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$847.24
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
CT Femur w/ Contrast Left
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701 LT
|
| Hospital Charge Code |
1168014
|
|
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 Femur w/ Contrast Right
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 73701 RT
|
| Hospital Charge Code |
1168016
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$646.20 |
| 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: Aetna of IA Medicare |
$818.52
|
| Rate for Payer: Amerigroup Medicaid |
$828.28
|
| Rate for Payer: Amerigroup Medicare |
$652.66
|
| 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 |
$646.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$820.24
|
| Rate for Payer: Medical Associates Commercial |
$1,077.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$646.20
|
| Rate for Payer: Midlands Choice Commercial |
$1,005.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$832.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$743.13
|
| Rate for Payer: United Healthcare Commercial |
$1,292.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$847.24
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
