|
CT Forearm w/o Contrast Left
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 73200 LT
|
| Hospital Charge Code |
1168058
|
|
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 Forearm w/o Contrast Left
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 73200 LT
|
| Hospital Charge Code |
1168058
|
|
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 Forearm w/o Contrast Right
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 73200 RT
|
| Hospital Charge Code |
1168060
|
|
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 Forearm w/o Contrast Right
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 73200 RT
|
| Hospital Charge Code |
1168060
|
|
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 Forearm w/ + w/o Contrast Left
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
CPT 73202 LT
|
| Hospital Charge Code |
1168046
|
|
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 Left
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
CPT 73202 LT
|
| Hospital Charge Code |
1168046
|
|
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 Forearm w/ + w/o Contrast Right
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
CPT 73202 RT
|
| 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 RT
|
| Hospital Charge Code |
1168048
|
|
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 Hand w/ Contrast Left
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 73201 LT
|
| Hospital Charge Code |
1168080
|
|
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 Hand w/ Contrast Left
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 73201 LT
|
| 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 Right
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 73201 RT
|
| 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/ Contrast Right
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 73201 RT
|
| Hospital Charge Code |
1168082
|
|
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 Hand w/o Contrast Left
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 73200 LT
|
| 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 LT
|
| Hospital Charge Code |
1168086
|
|
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 Hand w/o Contrast Right
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 73200 RT
|
| Hospital Charge Code |
1168088
|
|
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 Hand w/o Contrast Right
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 73200 RT
|
| 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 LT
|
| 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 LT
|
| Hospital Charge Code |
1168074
|
|
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 Hand w/ + w/o Contrast Right
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
CPT 73202 RT
|
| Hospital Charge Code |
1168076
|
|
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 Hand w/ + w/o Contrast Right
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
CPT 73202 RT
|
| 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 |
$524.25 |
| 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: Aetna of IA Medicare |
$664.05
|
| Rate for Payer: Amerigroup Medicaid |
$671.97
|
| Rate for Payer: Amerigroup Medicare |
$529.49
|
| 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 |
$524.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$665.45
|
| Rate for Payer: Medical Associates Commercial |
$873.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$524.25
|
| Rate for Payer: Midlands Choice Commercial |
$815.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$675.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$602.89
|
| Rate for Payer: United Healthcare Commercial |
$1,048.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$687.35
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
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 |
$409.05 |
| Max. Negotiated Rate |
$916.89 |
| 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 |
$524.31
|
| Rate for Payer: Amerigroup Medicare |
$413.14
|
| 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 |
$409.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$519.22
|
| Rate for Payer: Medical Associates Commercial |
$681.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$409.05
|
| Rate for Payer: Midlands Choice Commercial |
$636.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$526.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$470.41
|
| Rate for Payer: United Healthcare Commercial |
$818.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$536.31
|
| Rate for Payer: Wellmark IA HMO WHPI |
$832.37
|
| Rate for Payer: Wellmark IA PPO |
$916.89
|
|
|
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
|
|
