|
US Extremity Non Vascular Right
|
Facility
OP
|
$347.00
|
|
|
Service Code
|
CPT 76882 RT
|
| Hospital Charge Code |
1169685
|
|
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 Fetal Biophysical Profile w/o N Str
|
Facility
OP
|
$439.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
1169689
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.88 |
| Max. Negotiated Rate |
$395.10 |
| Rate for Payer: Aetna of IA Commercial |
$395.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$395.10
|
| Rate for Payer: Aetna of IA Medicare |
$250.23
|
| Rate for Payer: Amerigroup Medicaid |
$221.56
|
| Rate for Payer: Amerigroup Medicare |
$221.70
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$329.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$219.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$219.41
|
| Rate for Payer: Medical Associates Commercial |
$329.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$219.50
|
| Rate for Payer: Midlands Choice Commercial |
$307.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$222.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$329.25
|
| Rate for Payer: United Healthcare Commercial |
$395.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$259.01
|
| Rate for Payer: Wellmark IA HMO |
$169.88
|
| Rate for Payer: Wellmark IA PPO |
$186.87
|
|
|
US Fetal Biophysical Profile w/o N Str
|
Facility
IP
|
$439.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
1169689
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$307.30 |
| Max. Negotiated Rate |
$395.10 |
| Rate for Payer: Aetna of IA Commercial |
$395.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$395.10
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$329.25
|
| Rate for Payer: Medical Associates Commercial |
$329.25
|
| Rate for Payer: Midlands Choice Commercial |
$307.30
|
| Rate for Payer: United Healthcare Commercial |
$395.10
|
|
|
US Head/Neck Soft Tissue
|
Facility
OP
|
$394.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
1169729
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$191.58 |
| Max. Negotiated Rate |
$354.60 |
| Rate for Payer: Aetna of IA Commercial |
$354.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$354.60
|
| Rate for Payer: Aetna of IA Medicare |
$224.58
|
| Rate for Payer: Amerigroup Medicaid |
$198.85
|
| Rate for Payer: Amerigroup Medicare |
$198.97
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$295.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$197.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$196.92
|
| Rate for Payer: Medical Associates Commercial |
$295.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$197.00
|
| Rate for Payer: Midlands Choice Commercial |
$275.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$199.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$295.50
|
| Rate for Payer: United Healthcare Commercial |
$354.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$232.46
|
| Rate for Payer: Wellmark IA HMO |
$191.58
|
| Rate for Payer: Wellmark IA PPO |
$210.74
|
|
|
US Head/Neck Soft Tissue
|
Facility
IP
|
$394.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
1169729
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$275.80 |
| Max. Negotiated Rate |
$354.60 |
| Rate for Payer: Aetna of IA Commercial |
$354.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$354.60
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$295.50
|
| Rate for Payer: Medical Associates Commercial |
$295.50
|
| Rate for Payer: Midlands Choice Commercial |
$275.80
|
| Rate for Payer: United Healthcare Commercial |
$354.60
|
|
|
US LE Arterial Duplex Bilateral
|
Facility
IP
|
$641.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
1169759
|
|
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 LE Arterial Duplex Bilateral
|
Facility
OP
|
$641.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
1169759
|
|
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 LE Arterial Duplex Left
|
Facility
IP
|
$518.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
1169761
|
|
Hospital Revenue Code
|
920
|
| 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 LE Arterial Duplex Left
|
Facility
OP
|
$518.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
1169761
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$191.58 |
| 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 |
$191.58
|
| Rate for Payer: Wellmark IA PPO |
$210.74
|
|
|
US LE Arterial Duplex Right
|
Facility
IP
|
$518.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
1169763
|
|
Hospital Revenue Code
|
921
|
| 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 LE Arterial Duplex Right
|
Facility
OP
|
$518.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
1169763
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$191.58 |
| 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 |
$191.58
|
| Rate for Payer: Wellmark IA PPO |
$210.74
|
|
|
US LE Venous Doppler Bilateral
|
Facility
IP
|
$826.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
1169767
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$578.20 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Aetna of IA Commercial |
$743.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$743.40
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$619.50
|
| Rate for Payer: Medical Associates Commercial |
$619.50
|
| Rate for Payer: Midlands Choice Commercial |
$578.20
|
| Rate for Payer: United Healthcare Commercial |
$743.40
|
|
|
US LE Venous Doppler Bilateral
|
Facility
OP
|
$826.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
1169767
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$302.56 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Aetna of IA Commercial |
$743.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$743.40
|
| Rate for Payer: Aetna of IA Medicare |
$470.82
|
| Rate for Payer: Amerigroup Medicaid |
$416.88
|
| Rate for Payer: Amerigroup Medicare |
$417.13
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$619.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$413.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$412.83
|
| Rate for Payer: Medical Associates Commercial |
$619.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$413.00
|
| Rate for Payer: Midlands Choice Commercial |
$578.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$419.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$619.50
|
| Rate for Payer: United Healthcare Commercial |
$743.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$487.34
|
| Rate for Payer: Wellmark IA HMO |
$302.56
|
| Rate for Payer: Wellmark IA PPO |
$332.82
|
|
|
US LE Venous Doppler Right
|
Facility
IP
|
$582.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
8654298
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$407.40 |
| Max. Negotiated Rate |
$523.80 |
| Rate for Payer: Aetna of IA Commercial |
$523.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$523.80
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$436.50
|
| Rate for Payer: Medical Associates Commercial |
$436.50
|
| Rate for Payer: Midlands Choice Commercial |
$407.40
|
| Rate for Payer: United Healthcare Commercial |
$523.80
|
|
|
US LE Venous Doppler Right
|
Facility
OP
|
$582.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
8654298
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$290.88 |
| Max. Negotiated Rate |
$523.80 |
| Rate for Payer: Aetna of IA Commercial |
$523.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$523.80
|
| Rate for Payer: Aetna of IA Medicare |
$331.74
|
| Rate for Payer: Amerigroup Medicaid |
$293.74
|
| Rate for Payer: Amerigroup Medicare |
$293.91
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$436.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$291.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$290.88
|
| Rate for Payer: Medical Associates Commercial |
$436.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$291.00
|
| Rate for Payer: Midlands Choice Commercial |
$407.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$295.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$436.50
|
| Rate for Payer: United Healthcare Commercial |
$523.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$343.38
|
|
|
US LE Venous Duplex Bilateral
|
Facility
OP
|
$826.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
1998322
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$302.56 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Wellmark IA HMO |
$302.56
|
| Rate for Payer: Aetna of IA Commercial |
$743.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$743.40
|
| Rate for Payer: Aetna of IA Medicare |
$470.82
|
| Rate for Payer: Amerigroup Medicaid |
$416.88
|
| Rate for Payer: Amerigroup Medicare |
$417.13
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$619.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$413.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$412.83
|
| Rate for Payer: Medical Associates Commercial |
$619.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$413.00
|
| Rate for Payer: Midlands Choice Commercial |
$578.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$419.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$619.50
|
| Rate for Payer: United Healthcare Commercial |
$743.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$487.34
|
| Rate for Payer: Wellmark IA PPO |
$332.82
|
|
|
US LE Venous Duplex Bilateral
|
Facility
IP
|
$826.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
1169769
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$578.20 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Aetna of IA Commercial |
$743.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$743.40
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$619.50
|
| Rate for Payer: Medical Associates Commercial |
$619.50
|
| Rate for Payer: Midlands Choice Commercial |
$578.20
|
| Rate for Payer: United Healthcare Commercial |
$743.40
|
|
|
US LE Venous Duplex Bilateral
|
Facility
IP
|
$826.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
1998322
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$578.20 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Aetna of IA Commercial |
$743.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$743.40
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$619.50
|
| Rate for Payer: Medical Associates Commercial |
$619.50
|
| Rate for Payer: Midlands Choice Commercial |
$578.20
|
| Rate for Payer: United Healthcare Commercial |
$743.40
|
|
|
US LE Venous Duplex Bilateral
|
Facility
OP
|
$826.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
1169769
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$302.56 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Aetna of IA Commercial |
$743.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$743.40
|
| Rate for Payer: Aetna of IA Medicare |
$470.82
|
| Rate for Payer: Amerigroup Medicaid |
$416.88
|
| Rate for Payer: Amerigroup Medicare |
$417.13
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$619.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$413.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$412.83
|
| Rate for Payer: Medical Associates Commercial |
$619.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$413.00
|
| Rate for Payer: Midlands Choice Commercial |
$578.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$419.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$619.50
|
| Rate for Payer: United Healthcare Commercial |
$743.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$487.34
|
| Rate for Payer: Wellmark IA HMO |
$302.56
|
| Rate for Payer: Wellmark IA PPO |
$332.82
|
|
|
US LE Venous Duplex Left
|
Facility
IP
|
$582.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
1169771
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$407.40 |
| Max. Negotiated Rate |
$523.80 |
| Rate for Payer: Aetna of IA Commercial |
$523.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$523.80
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$436.50
|
| Rate for Payer: Medical Associates Commercial |
$436.50
|
| Rate for Payer: Midlands Choice Commercial |
$407.40
|
| Rate for Payer: United Healthcare Commercial |
$523.80
|
|
|
US LE Venous Duplex Left
|
Facility
IP
|
$582.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
1998324
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$407.40 |
| Max. Negotiated Rate |
$523.80 |
| Rate for Payer: Aetna of IA Commercial |
$523.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$523.80
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$436.50
|
| Rate for Payer: Medical Associates Commercial |
$436.50
|
| Rate for Payer: Midlands Choice Commercial |
$407.40
|
| Rate for Payer: United Healthcare Commercial |
$523.80
|
|
|
US LE Venous Duplex Left
|
Facility
OP
|
$582.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
1998324
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$191.58 |
| Max. Negotiated Rate |
$523.80 |
| Rate for Payer: Aetna of IA Commercial |
$523.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$523.80
|
| Rate for Payer: Aetna of IA Medicare |
$331.74
|
| Rate for Payer: Amerigroup Medicaid |
$293.74
|
| Rate for Payer: Amerigroup Medicare |
$293.91
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$436.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$291.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$290.88
|
| Rate for Payer: Medical Associates Commercial |
$436.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$291.00
|
| Rate for Payer: Midlands Choice Commercial |
$407.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$295.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$436.50
|
| Rate for Payer: United Healthcare Commercial |
$523.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$343.38
|
| Rate for Payer: Wellmark IA HMO |
$191.58
|
| Rate for Payer: Wellmark IA PPO |
$210.74
|
|
|
US LE Venous Duplex Left
|
Facility
OP
|
$582.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
1169771
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$290.88 |
| Max. Negotiated Rate |
$523.80 |
| Rate for Payer: Aetna of IA Commercial |
$523.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$523.80
|
| Rate for Payer: Aetna of IA Medicare |
$331.74
|
| Rate for Payer: Amerigroup Medicaid |
$293.74
|
| Rate for Payer: Amerigroup Medicare |
$293.91
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$436.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$291.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$290.88
|
| Rate for Payer: Medical Associates Commercial |
$436.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$291.00
|
| Rate for Payer: Midlands Choice Commercial |
$407.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$295.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$436.50
|
| Rate for Payer: United Healthcare Commercial |
$523.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$343.38
|
|
|
US LE Venous Duplex Right
|
Facility
IP
|
$582.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
1998323
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$407.40 |
| Max. Negotiated Rate |
$523.80 |
| Rate for Payer: Aetna of IA Commercial |
$523.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$523.80
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$436.50
|
| Rate for Payer: Medical Associates Commercial |
$436.50
|
| Rate for Payer: Midlands Choice Commercial |
$407.40
|
| Rate for Payer: United Healthcare Commercial |
$523.80
|
|
|
US LE Venous Duplex Right
|
Facility
IP
|
$582.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
1169773
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$407.40 |
| Max. Negotiated Rate |
$523.80 |
| Rate for Payer: Aetna of IA Commercial |
$523.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$523.80
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$436.50
|
| Rate for Payer: Medical Associates Commercial |
$436.50
|
| Rate for Payer: Midlands Choice Commercial |
$407.40
|
| Rate for Payer: United Healthcare Commercial |
$523.80
|
|
