|
US Breast Limited Left.
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT 76642 LT
|
| Hospital Charge Code |
5052788
|
|
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 |
5052788
|
|
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 Limited Right
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT 76642 RT
|
| Hospital Charge Code |
6800936
|
|
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 Limited Right
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT 76642 RT
|
| Hospital Charge Code |
6800936
|
|
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 Right.
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT 76642 RT
|
| Hospital Charge Code |
5052791
|
|
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 Right.
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT 76642 RT
|
| Hospital Charge Code |
5052791
|
|
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 Right
|
Facility
IP
|
$360.00
|
|
|
Service Code
|
CPT 76641 RT
|
| Hospital Charge Code |
6800939
|
|
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 Right
|
Facility
OP
|
$360.00
|
|
|
Service Code
|
CPT 76641 RT
|
| Hospital Charge Code |
6800939
|
|
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 Right.
|
Facility
OP
|
$360.00
|
|
|
Service Code
|
CPT 76641 RT
|
| Hospital Charge Code |
1169625
|
|
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 Right.
|
Facility
IP
|
$360.00
|
|
|
Service Code
|
CPT 76641 RT
|
| Hospital Charge Code |
1169625
|
|
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 Carotid Doppler Bilateral
|
Facility
IP
|
$716.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
1169627
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$644.40 |
| Rate for Payer: Aetna of IA Commercial |
$644.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$644.40
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$537.00
|
| Rate for Payer: Medical Associates Commercial |
$537.00
|
| Rate for Payer: Midlands Choice Commercial |
$501.20
|
| Rate for Payer: United Healthcare Commercial |
$644.40
|
|
|
US Carotid Doppler Bilateral
|
Facility
OP
|
$716.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
1169627
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$191.58 |
| Max. Negotiated Rate |
$644.40 |
| Rate for Payer: Aetna of IA Commercial |
$644.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$644.40
|
| Rate for Payer: Aetna of IA Medicare |
$408.12
|
| Rate for Payer: Amerigroup Medicaid |
$361.37
|
| Rate for Payer: Amerigroup Medicare |
$361.58
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$537.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$358.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$357.86
|
| Rate for Payer: Medical Associates Commercial |
$537.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$358.00
|
| Rate for Payer: Midlands Choice Commercial |
$501.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$363.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$537.00
|
| Rate for Payer: United Healthcare Commercial |
$644.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$422.44
|
| Rate for Payer: Wellmark IA HMO |
$191.58
|
| Rate for Payer: Wellmark IA PPO |
$210.74
|
|
|
US Carotid Duplex Bilateral
|
Facility
OP
|
$716.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
1169629
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$191.58 |
| Max. Negotiated Rate |
$644.40 |
| Rate for Payer: Aetna of IA Commercial |
$644.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$644.40
|
| Rate for Payer: Aetna of IA Medicare |
$408.12
|
| Rate for Payer: Amerigroup Medicaid |
$361.37
|
| Rate for Payer: Amerigroup Medicare |
$361.58
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$537.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$358.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$357.86
|
| Rate for Payer: Medical Associates Commercial |
$537.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$358.00
|
| Rate for Payer: Midlands Choice Commercial |
$501.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$363.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$537.00
|
| Rate for Payer: United Healthcare Commercial |
$644.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$422.44
|
| Rate for Payer: Wellmark IA HMO |
$191.58
|
| Rate for Payer: Wellmark IA PPO |
$210.74
|
|
|
US Carotid Duplex Bilateral
|
Facility
IP
|
$716.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
1169629
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$644.40 |
| Rate for Payer: Aetna of IA Commercial |
$644.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$644.40
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$537.00
|
| Rate for Payer: Medical Associates Commercial |
$537.00
|
| Rate for Payer: Midlands Choice Commercial |
$501.20
|
| Rate for Payer: United Healthcare Commercial |
$644.40
|
|
|
US CHEST
|
Facility
OP
|
$360.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
1169635
|
|
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: 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
|
| Rate for Payer: Wellmark IA HMO |
$191.58
|
| Rate for Payer: Wellmark IA PPO |
$210.74
|
|
|
US CHEST
|
Facility
IP
|
$360.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
1169635
|
|
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 Drainage Abscess or Cyst
|
Facility
OP
|
$897.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1169645
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$448.32 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: Aetna of IA Commercial |
$807.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$807.30
|
| Rate for Payer: Aetna of IA Medicare |
$511.29
|
| Rate for Payer: Amerigroup Medicaid |
$452.72
|
| Rate for Payer: Amerigroup Medicare |
$452.98
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$672.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$448.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$448.32
|
| Rate for Payer: Medical Associates Commercial |
$672.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$448.50
|
| Rate for Payer: Midlands Choice Commercial |
$627.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$455.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$672.75
|
| Rate for Payer: United Healthcare Commercial |
$807.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$529.23
|
| Rate for Payer: Wellmark IA HMO |
$655.34
|
| Rate for Payer: Wellmark IA PPO |
$720.87
|
|
|
US Drainage Abscess or Cyst
|
Facility
IP
|
$897.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1169645
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$627.90 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: Aetna of IA Commercial |
$807.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$807.30
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$672.75
|
| Rate for Payer: Medical Associates Commercial |
$672.75
|
| Rate for Payer: Midlands Choice Commercial |
$627.90
|
| Rate for Payer: United Healthcare Commercial |
$807.30
|
|
|
US Echocardiogram
|
Facility
IP
|
$1,338.00
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
1844784
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$936.60 |
| Max. Negotiated Rate |
$1,204.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,204.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,003.50
|
| Rate for Payer: Medical Associates Commercial |
$1,003.50
|
| Rate for Payer: Midlands Choice Commercial |
$936.60
|
| Rate for Payer: United Healthcare Commercial |
$1,204.20
|
|
|
US Echocardiogram
|
Facility
OP
|
$1,338.00
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
1844784
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$668.73 |
| Max. Negotiated Rate |
$1,204.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,204.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,204.20
|
| Rate for Payer: Aetna of IA Medicare |
$762.66
|
| Rate for Payer: Amerigroup Medicaid |
$675.29
|
| Rate for Payer: Amerigroup Medicare |
$675.69
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,003.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$669.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$668.73
|
| Rate for Payer: Medical Associates Commercial |
$1,003.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$669.00
|
| Rate for Payer: Midlands Choice Commercial |
$936.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$679.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,003.50
|
| Rate for Payer: United Healthcare Commercial |
$1,204.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$789.42
|
|
|
US Echocardiogram Limited
|
Facility
IP
|
$518.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
7960820
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$362.60 |
| Max. Negotiated Rate |
$466.20 |
| Rate for Payer: Aetna of IA Commercial |
$466.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$466.20
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$388.50
|
| Rate for Payer: Medical Associates Commercial |
$388.50
|
| Rate for Payer: Midlands Choice Commercial |
$362.60
|
| Rate for Payer: United Healthcare Commercial |
$466.20
|
|
|
US Echocardiogram Limited
|
Facility
OP
|
$518.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
7960820
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$258.90 |
| Max. Negotiated Rate |
$466.20 |
| Rate for Payer: Aetna of IA Commercial |
$466.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$466.20
|
| Rate for Payer: Aetna of IA Medicare |
$295.26
|
| Rate for Payer: Amerigroup Medicaid |
$261.43
|
| Rate for Payer: Amerigroup Medicare |
$261.59
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$388.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$259.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$258.90
|
| Rate for Payer: Medical Associates Commercial |
$388.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$259.00
|
| Rate for Payer: Midlands Choice Commercial |
$362.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$262.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$388.50
|
| Rate for Payer: United Healthcare Commercial |
$466.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$305.62
|
| Rate for Payer: Wellmark IA HMO |
$415.40
|
| Rate for Payer: Wellmark IA PPO |
$456.94
|
|
|
US Extremity Non Vascular Left
|
Facility
IP
|
$347.00
|
|
|
Service Code
|
CPT 76882 LT
|
| Hospital Charge Code |
1169683
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$242.90 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Aetna of IA Commercial |
$312.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$312.30
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$260.25
|
| Rate for Payer: Medical Associates Commercial |
$260.25
|
| Rate for Payer: Midlands Choice Commercial |
$242.90
|
| Rate for Payer: United Healthcare Commercial |
$312.30
|
|
|
US Extremity Non Vascular Left
|
Facility
OP
|
$347.00
|
|
|
Service Code
|
CPT 76882 LT
|
| Hospital Charge Code |
1169683
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$173.43 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Aetna of IA Commercial |
$312.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$312.30
|
| Rate for Payer: Aetna of IA Medicare |
$197.79
|
| Rate for Payer: Amerigroup Medicaid |
$175.13
|
| Rate for Payer: Amerigroup Medicare |
$175.24
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$260.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$173.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$173.43
|
| Rate for Payer: Medical Associates Commercial |
$260.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$173.50
|
| Rate for Payer: Midlands Choice Commercial |
$242.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$176.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$260.25
|
| Rate for Payer: United Healthcare Commercial |
$312.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$204.73
|
|
|
US Extremity Non Vascular Right
|
Facility
IP
|
$347.00
|
|
|
Service Code
|
CPT 76882 RT
|
| Hospital Charge Code |
1169685
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$242.90 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Aetna of IA Commercial |
$312.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$312.30
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$260.25
|
| Rate for Payer: Medical Associates Commercial |
$260.25
|
| Rate for Payer: Midlands Choice Commercial |
$242.90
|
| Rate for Payer: United Healthcare Commercial |
$312.30
|
|
