|
US Abdomen Limited
|
Facility
IP
|
$377.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
625610
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$263.90 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Aetna of IA Commercial |
$339.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$339.30
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$282.75
|
| Rate for Payer: Medical Associates Commercial |
$282.75
|
| Rate for Payer: Midlands Choice Commercial |
$263.90
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
|
|
US Abdomen Limited
|
Facility
OP
|
$377.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
625610
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$188.42 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Aetna of IA Commercial |
$339.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$339.30
|
| Rate for Payer: Aetna of IA Medicare |
$214.89
|
| Rate for Payer: Amerigroup Medicaid |
$190.27
|
| Rate for Payer: Amerigroup Medicare |
$190.38
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$282.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$188.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$188.42
|
| Rate for Payer: Medical Associates Commercial |
$282.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$188.50
|
| Rate for Payer: Midlands Choice Commercial |
$263.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$191.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$282.75
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$222.43
|
| Rate for Payer: Wellmark IA HMO |
$191.58
|
| Rate for Payer: Wellmark IA PPO |
$210.74
|
|
|
US Abdomen Limited
|
Facility
IP
|
$377.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
1169569
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$263.90 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Aetna of IA Commercial |
$339.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$339.30
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$282.75
|
| Rate for Payer: Medical Associates Commercial |
$282.75
|
| Rate for Payer: Midlands Choice Commercial |
$263.90
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
|
|
US Aorta IVC Iliac Duplex Complete
|
Facility
OP
|
$641.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
1169577
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$302.56 |
| Max. Negotiated Rate |
$576.90 |
| Rate for Payer: Aetna of IA Commercial |
$576.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$576.90
|
| Rate for Payer: Aetna of IA Medicare |
$365.37
|
| Rate for Payer: Amerigroup Medicaid |
$323.51
|
| Rate for Payer: Amerigroup Medicare |
$323.70
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$480.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$320.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$320.37
|
| Rate for Payer: Medical Associates Commercial |
$480.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$320.50
|
| Rate for Payer: Midlands Choice Commercial |
$448.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$325.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$480.75
|
| Rate for Payer: United Healthcare Commercial |
$576.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$378.19
|
| Rate for Payer: Wellmark IA HMO |
$302.56
|
| Rate for Payer: Wellmark IA PPO |
$332.82
|
|
|
US Aorta IVC Iliac Duplex Complete
|
Facility
IP
|
$641.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
1169577
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$448.70 |
| Max. Negotiated Rate |
$576.90 |
| Rate for Payer: Aetna of IA Commercial |
$576.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$576.90
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$480.75
|
| Rate for Payer: Medical Associates Commercial |
$480.75
|
| Rate for Payer: Midlands Choice Commercial |
$448.70
|
| Rate for Payer: United Healthcare Commercial |
$576.90
|
|
|
US Art/Vein Abd/Pelvis/Scrotal Complete
|
Facility
OP
|
$508.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
1169581
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$253.90 |
| Max. Negotiated Rate |
$457.20 |
| Rate for Payer: Aetna of IA Commercial |
$457.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$457.20
|
| Rate for Payer: Aetna of IA Medicare |
$289.56
|
| Rate for Payer: Amerigroup Medicaid |
$256.39
|
| Rate for Payer: Amerigroup Medicare |
$256.54
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$381.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$254.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$253.90
|
| Rate for Payer: Medical Associates Commercial |
$381.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$254.00
|
| Rate for Payer: Midlands Choice Commercial |
$355.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$257.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$381.00
|
| Rate for Payer: United Healthcare Commercial |
$457.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$299.72
|
| Rate for Payer: Wellmark IA HMO |
$302.56
|
| Rate for Payer: Wellmark IA PPO |
$332.82
|
|
|
US Art/Vein Abd/Pelvis/Scrotal Complete
|
Facility
IP
|
$508.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
1169581
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$355.60 |
| Max. Negotiated Rate |
$457.20 |
| Rate for Payer: Aetna of IA Commercial |
$457.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$457.20
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$381.00
|
| Rate for Payer: Medical Associates Commercial |
$381.00
|
| Rate for Payer: Midlands Choice Commercial |
$355.60
|
| Rate for Payer: United Healthcare Commercial |
$457.20
|
|
|
US Art/Vein Abd/Pelvis/Scrotal Limited
|
Facility
OP
|
$361.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
1169583
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$180.43 |
| Max. Negotiated Rate |
$332.82 |
| Rate for Payer: Aetna of IA Commercial |
$324.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$324.90
|
| Rate for Payer: Aetna of IA Medicare |
$205.77
|
| Rate for Payer: Amerigroup Medicaid |
$182.20
|
| Rate for Payer: Amerigroup Medicare |
$182.30
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$270.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$180.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$180.43
|
| Rate for Payer: Medical Associates Commercial |
$270.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$180.50
|
| Rate for Payer: Midlands Choice Commercial |
$252.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$183.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$270.75
|
| Rate for Payer: United Healthcare Commercial |
$324.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$212.99
|
| Rate for Payer: Wellmark IA HMO |
$302.56
|
| Rate for Payer: Wellmark IA PPO |
$332.82
|
|
|
US Art/Vein Abd/Pelvis/Scrotal Limited
|
Facility
IP
|
$361.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
1169583
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$252.70 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Aetna of IA Commercial |
$324.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$324.90
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$270.75
|
| Rate for Payer: Medical Associates Commercial |
$270.75
|
| Rate for Payer: Midlands Choice Commercial |
$252.70
|
| Rate for Payer: United Healthcare Commercial |
$324.90
|
|
|
US Aspiration/Inject/Biopsy Bilateral
|
Facility
OP
|
$511.00
|
|
|
Service Code
|
CPT 76942 50
|
| Hospital Charge Code |
1169585
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.40 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna of IA Commercial |
$459.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$459.90
|
| Rate for Payer: Aetna of IA Medicare |
$291.27
|
| Rate for Payer: Amerigroup Medicaid |
$257.90
|
| Rate for Payer: Amerigroup Medicare |
$258.06
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$383.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$255.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$255.40
|
| Rate for Payer: Medical Associates Commercial |
$383.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$255.50
|
| Rate for Payer: Midlands Choice Commercial |
$357.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$259.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$383.25
|
| Rate for Payer: United Healthcare Commercial |
$459.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$301.49
|
|
|
US Aspiration/Inject/Biopsy Bilateral
|
Facility
IP
|
$511.00
|
|
|
Service Code
|
CPT 76942 50
|
| Hospital Charge Code |
1169585
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$357.70 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna of IA Commercial |
$459.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$459.90
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$383.25
|
| Rate for Payer: Medical Associates Commercial |
$383.25
|
| Rate for Payer: Midlands Choice Commercial |
$357.70
|
| Rate for Payer: United Healthcare Commercial |
$459.90
|
|
|
US Aspiration/Inject/Biopsy Left
|
Facility
IP
|
$511.00
|
|
|
Service Code
|
CPT 76942 LT
|
| Hospital Charge Code |
1169587
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$357.70 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna of IA Commercial |
$459.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$459.90
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$383.25
|
| Rate for Payer: Medical Associates Commercial |
$383.25
|
| Rate for Payer: Midlands Choice Commercial |
$357.70
|
| Rate for Payer: United Healthcare Commercial |
$459.90
|
|
|
US Aspiration/Inject/Biopsy Left
|
Facility
OP
|
$511.00
|
|
|
Service Code
|
CPT 76942 LT
|
| Hospital Charge Code |
1169587
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.40 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna of IA Commercial |
$459.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$459.90
|
| Rate for Payer: Aetna of IA Medicare |
$291.27
|
| Rate for Payer: Amerigroup Medicaid |
$257.90
|
| Rate for Payer: Amerigroup Medicare |
$258.06
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$383.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$255.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$255.40
|
| Rate for Payer: Medical Associates Commercial |
$383.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$255.50
|
| Rate for Payer: Midlands Choice Commercial |
$357.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$259.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$383.25
|
| Rate for Payer: United Healthcare Commercial |
$459.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$301.49
|
|
|
US Aspiration/Inject/Biopsy Right
|
Facility
IP
|
$511.00
|
|
|
Service Code
|
CPT 76942 RT
|
| Hospital Charge Code |
1169589
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$357.70 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna of IA Commercial |
$459.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$459.90
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$383.25
|
| Rate for Payer: Medical Associates Commercial |
$383.25
|
| Rate for Payer: Midlands Choice Commercial |
$357.70
|
| Rate for Payer: United Healthcare Commercial |
$459.90
|
|
|
US Aspiration/Inject/Biopsy Right
|
Facility
OP
|
$511.00
|
|
|
Service Code
|
CPT 76942 RT
|
| Hospital Charge Code |
1169589
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.40 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna of IA Commercial |
$459.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$459.90
|
| Rate for Payer: Aetna of IA Medicare |
$291.27
|
| Rate for Payer: Amerigroup Medicaid |
$257.90
|
| Rate for Payer: Amerigroup Medicare |
$258.06
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$383.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$255.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$255.40
|
| Rate for Payer: Medical Associates Commercial |
$383.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$255.50
|
| Rate for Payer: Midlands Choice Commercial |
$357.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$259.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$383.25
|
| Rate for Payer: United Healthcare Commercial |
$459.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$301.49
|
|
|
US Breast Bilateral
|
Facility
IP
|
$360.00
|
|
|
Service Code
|
CPT 76641 50
|
| Hospital Charge Code |
6800927
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna of IA Commercial |
$324.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$324.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$270.00
|
| Rate for Payer: Medical Associates Commercial |
$270.00
|
| Rate for Payer: Midlands Choice Commercial |
$252.00
|
| Rate for Payer: United Healthcare Commercial |
$324.00
|
|
|
US Breast Bilateral
|
Facility
OP
|
$360.00
|
|
|
Service Code
|
CPT 76641 50
|
| Hospital Charge Code |
6800927
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$179.93 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna of IA Commercial |
$324.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$324.00
|
| Rate for Payer: Aetna of IA Medicare |
$205.20
|
| Rate for Payer: Amerigroup Medicaid |
$181.69
|
| Rate for Payer: Amerigroup Medicare |
$181.80
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$270.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$180.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$179.93
|
| Rate for Payer: Medical Associates Commercial |
$270.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$180.00
|
| Rate for Payer: Midlands Choice Commercial |
$252.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$182.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$270.00
|
| Rate for Payer: United Healthcare Commercial |
$324.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$212.40
|
|
|
US Breast Bilateral.
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT 76642 50
|
| Hospital Charge Code |
1169621
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$125.95 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna of IA Commercial |
$226.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$226.80
|
| Rate for Payer: Aetna of IA Medicare |
$143.64
|
| Rate for Payer: Amerigroup Medicaid |
$127.18
|
| Rate for Payer: Amerigroup Medicare |
$127.26
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$126.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.95
|
| Rate for Payer: Medical Associates Commercial |
$189.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$126.00
|
| Rate for Payer: Midlands Choice Commercial |
$176.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$226.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$148.68
|
|
|
US Breast Bilateral.
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT 76642 50
|
| Hospital Charge Code |
1169621
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna of IA Commercial |
$226.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$226.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.00
|
| Rate for Payer: Medical Associates Commercial |
$189.00
|
| Rate for Payer: Midlands Choice Commercial |
$176.40
|
| Rate for Payer: United Healthcare Commercial |
$226.80
|
|
|
US Breast Left
|
Facility
IP
|
$360.00
|
|
|
Service Code
|
CPT 76641 LT
|
| Hospital Charge Code |
6800930
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna of IA Commercial |
$324.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$324.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$270.00
|
| Rate for Payer: Medical Associates Commercial |
$270.00
|
| Rate for Payer: Midlands Choice Commercial |
$252.00
|
| Rate for Payer: United Healthcare Commercial |
$324.00
|
|
|
US Breast Left
|
Facility
OP
|
$360.00
|
|
|
Service Code
|
CPT 76641 LT
|
| Hospital Charge Code |
6800930
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$179.93 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna of IA Commercial |
$324.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$324.00
|
| Rate for Payer: Aetna of IA Medicare |
$205.20
|
| Rate for Payer: Amerigroup Medicaid |
$181.69
|
| Rate for Payer: Amerigroup Medicare |
$181.80
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$270.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$180.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$179.93
|
| Rate for Payer: Medical Associates Commercial |
$270.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$180.00
|
| Rate for Payer: Midlands Choice Commercial |
$252.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$182.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$270.00
|
| Rate for Payer: United Healthcare Commercial |
$324.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$212.40
|
|
|
US Breast Left.
|
Facility
OP
|
$360.00
|
|
|
Service Code
|
CPT 76641 LT
|
| Hospital Charge Code |
1169623
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$179.93 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna of IA Commercial |
$324.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$324.00
|
| Rate for Payer: Aetna of IA Medicare |
$205.20
|
| Rate for Payer: Amerigroup Medicaid |
$181.69
|
| Rate for Payer: Amerigroup Medicare |
$181.80
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$270.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$180.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$179.93
|
| Rate for Payer: Medical Associates Commercial |
$270.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$180.00
|
| Rate for Payer: Midlands Choice Commercial |
$252.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$182.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$270.00
|
| Rate for Payer: United Healthcare Commercial |
$324.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$212.40
|
|
|
US Breast Left.
|
Facility
IP
|
$360.00
|
|
|
Service Code
|
CPT 76641 LT
|
| Hospital Charge Code |
1169623
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna of IA Commercial |
$324.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$324.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$270.00
|
| Rate for Payer: Medical Associates Commercial |
$270.00
|
| Rate for Payer: Midlands Choice Commercial |
$252.00
|
| Rate for Payer: United Healthcare Commercial |
$324.00
|
|
|
US Breast Limited Left
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT 76642 LT
|
| Hospital Charge Code |
6800933
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna of IA Commercial |
$226.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$226.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.00
|
| Rate for Payer: Medical Associates Commercial |
$189.00
|
| Rate for Payer: Midlands Choice Commercial |
$176.40
|
| Rate for Payer: United Healthcare Commercial |
$226.80
|
|
|
US Breast Limited Left
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT 76642 LT
|
| Hospital Charge Code |
6800933
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$125.95 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna of IA Commercial |
$226.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$226.80
|
| Rate for Payer: Aetna of IA Medicare |
$143.64
|
| Rate for Payer: Amerigroup Medicaid |
$127.18
|
| Rate for Payer: Amerigroup Medicare |
$127.26
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$126.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.95
|
| Rate for Payer: Medical Associates Commercial |
$189.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$126.00
|
| Rate for Payer: Midlands Choice Commercial |
$176.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$226.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$148.68
|
|
