|
US LE Venous Duplex Right
|
Facility
OP
|
$582.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
1169773
|
|
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
OP
|
$582.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
1998323
|
|
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 Venouse Duplex Left
|
Facility
IP
|
$582.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
8654295
|
|
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 Venouse Duplex Left
|
Facility
OP
|
$582.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
8654295
|
|
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 Lower Extremity Non Vascular Left
|
Facility
IP
|
$394.00
|
|
|
Service Code
|
CPT 76881 LT
|
| Hospital Charge Code |
1169784
|
|
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 Lower Extremity Non Vascular Left
|
Facility
OP
|
$394.00
|
|
|
Service Code
|
CPT 76881 LT
|
| Hospital Charge Code |
1169784
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$196.92 |
| 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: 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
|
|
|
US Lower Extremity Non Vascular Right
|
Facility
IP
|
$394.00
|
|
|
Service Code
|
CPT 76881 RT
|
| Hospital Charge Code |
1169787
|
|
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 Lower Extremity Non Vascular Right
|
Facility
OP
|
$394.00
|
|
|
Service Code
|
CPT 76881 RT
|
| Hospital Charge Code |
1169787
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$196.92 |
| 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: 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
|
|
|
US Pelvis Non OB Complete
|
Facility
IP
|
$459.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
1169844
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$321.30 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna of IA Commercial |
$413.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$413.10
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$344.25
|
| Rate for Payer: Medical Associates Commercial |
$344.25
|
| Rate for Payer: Midlands Choice Commercial |
$321.30
|
| Rate for Payer: United Healthcare Commercial |
$413.10
|
|
|
US Pelvis Non OB Complete
|
Facility
OP
|
$459.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
1169844
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$229.41 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna of IA Commercial |
$413.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$413.10
|
| Rate for Payer: Aetna of IA Medicare |
$261.63
|
| Rate for Payer: Amerigroup Medicaid |
$231.66
|
| Rate for Payer: Amerigroup Medicare |
$231.80
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$344.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$229.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$229.41
|
| Rate for Payer: Medical Associates Commercial |
$344.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$229.50
|
| Rate for Payer: Midlands Choice Commercial |
$321.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$232.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$344.25
|
| Rate for Payer: United Healthcare Commercial |
$413.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$270.81
|
| Rate for Payer: Wellmark IA HMO |
$302.56
|
| Rate for Payer: Wellmark IA PPO |
$332.82
|
|
|
US Pelvis Non OB Complete +Transvaginal
|
Facility
OP
|
$459.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
7840664
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$229.41 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna of IA Commercial |
$413.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$413.10
|
| Rate for Payer: Aetna of IA Medicare |
$261.63
|
| Rate for Payer: Amerigroup Medicaid |
$231.66
|
| Rate for Payer: Amerigroup Medicare |
$231.80
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$344.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$229.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$229.41
|
| Rate for Payer: Medical Associates Commercial |
$344.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$229.50
|
| Rate for Payer: Midlands Choice Commercial |
$321.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$232.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$344.25
|
| Rate for Payer: United Healthcare Commercial |
$413.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$270.81
|
| Rate for Payer: Wellmark IA HMO |
$302.56
|
| Rate for Payer: Wellmark IA PPO |
$332.82
|
|
|
US Pelvis Non OB Complete +Transvaginal
|
Facility
IP
|
$459.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
7840664
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$321.30 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna of IA Commercial |
$413.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$413.10
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$344.25
|
| Rate for Payer: Medical Associates Commercial |
$344.25
|
| Rate for Payer: Midlands Choice Commercial |
$321.30
|
| Rate for Payer: United Healthcare Commercial |
$413.10
|
|
|
US Pelvis Non OB Limited
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
1169846
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$148.44 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Aetna of IA Commercial |
$267.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$267.30
|
| Rate for Payer: Aetna of IA Medicare |
$169.29
|
| Rate for Payer: Amerigroup Medicaid |
$149.90
|
| Rate for Payer: Amerigroup Medicare |
$149.98
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$148.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$148.44
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$150.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$222.75
|
| Rate for Payer: United Healthcare Commercial |
$267.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$175.23
|
| Rate for Payer: Wellmark IA HMO |
$191.58
|
| Rate for Payer: Wellmark IA PPO |
$210.74
|
|
|
US Pelvis Non OB Limited
|
Facility
IP
|
$297.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
1169846
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Aetna of IA Commercial |
$267.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$267.30
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.75
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: United Healthcare Commercial |
$267.30
|
|
|
US Pelvis Non OB Transvaginal
|
Facility
OP
|
$349.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
7960823
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$174.43 |
| Max. Negotiated Rate |
$314.10 |
| Rate for Payer: Aetna of IA Commercial |
$314.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$314.10
|
| Rate for Payer: Aetna of IA Medicare |
$198.93
|
| Rate for Payer: Amerigroup Medicaid |
$176.14
|
| Rate for Payer: Amerigroup Medicare |
$176.24
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$261.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$174.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$174.43
|
| Rate for Payer: Medical Associates Commercial |
$261.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$174.50
|
| Rate for Payer: Midlands Choice Commercial |
$244.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$177.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$261.75
|
| Rate for Payer: United Healthcare Commercial |
$314.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$205.91
|
| Rate for Payer: Wellmark IA HMO |
$191.58
|
| Rate for Payer: Wellmark IA PPO |
$210.74
|
|
|
US Pelvis Non OB Transvaginal
|
Facility
IP
|
$349.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
7960823
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$244.30 |
| Max. Negotiated Rate |
$314.10 |
| Rate for Payer: Aetna of IA Commercial |
$314.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$314.10
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$261.75
|
| Rate for Payer: Medical Associates Commercial |
$261.75
|
| Rate for Payer: Midlands Choice Commercial |
$244.30
|
| Rate for Payer: United Healthcare Commercial |
$314.10
|
|
|
US Pregnancy Follow Up
|
Facility
OP
|
$296.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
1169854
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$147.94 |
| Max. Negotiated Rate |
$266.40 |
| Rate for Payer: Aetna of IA Commercial |
$266.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$266.40
|
| Rate for Payer: Aetna of IA Medicare |
$168.72
|
| Rate for Payer: Amerigroup Medicaid |
$149.39
|
| Rate for Payer: Amerigroup Medicare |
$149.48
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$148.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$147.94
|
| Rate for Payer: Medical Associates Commercial |
$222.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$148.00
|
| Rate for Payer: Midlands Choice Commercial |
$207.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$150.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$222.00
|
| Rate for Payer: United Healthcare Commercial |
$266.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$174.64
|
| Rate for Payer: Wellmark IA HMO |
$169.88
|
| Rate for Payer: Wellmark IA PPO |
$186.87
|
|
|
US Pregnancy Follow Up
|
Facility
IP
|
$296.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
1169854
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$207.20 |
| Max. Negotiated Rate |
$266.40 |
| Rate for Payer: Aetna of IA Commercial |
$266.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$266.40
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.00
|
| Rate for Payer: Medical Associates Commercial |
$222.00
|
| Rate for Payer: Midlands Choice Commercial |
$207.20
|
| Rate for Payer: United Healthcare Commercial |
$266.40
|
|
|
US Pregnancy Limited
|
Facility
IP
|
$394.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
1169856
|
|
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 Pregnancy Limited
|
Facility
OP
|
$394.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
1169856
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.88 |
| 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 |
$169.88
|
| Rate for Payer: Wellmark IA PPO |
$186.87
|
|
|
US Pregnancy Transvaginal
|
Facility
IP
|
$394.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
1169861
|
|
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 Pregnancy Transvaginal
|
Facility
OP
|
$394.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
1169861
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.88 |
| Max. Negotiated Rate |
$354.60 |
| Rate for Payer: Amerigroup Medicaid |
$198.85
|
| 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 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 |
$169.88
|
| Rate for Payer: Wellmark IA PPO |
$186.87
|
|
|
US Pregnant < 14 Weeks
|
Facility
OP
|
$524.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
7960826
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.88 |
| Max. Negotiated Rate |
$471.60 |
| Rate for Payer: Aetna of IA Commercial |
$471.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$471.60
|
| Rate for Payer: Aetna of IA Medicare |
$298.68
|
| Rate for Payer: Amerigroup Medicaid |
$264.46
|
| Rate for Payer: Amerigroup Medicare |
$264.62
|
| Rate for Payer: Cash Price |
$419.20
|
| Rate for Payer: Cash Price |
$419.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$393.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$262.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$261.90
|
| Rate for Payer: Medical Associates Commercial |
$393.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$262.00
|
| Rate for Payer: Midlands Choice Commercial |
$366.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$265.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$393.00
|
| Rate for Payer: United Healthcare Commercial |
$471.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$309.16
|
| Rate for Payer: Wellmark IA HMO |
$169.88
|
| Rate for Payer: Wellmark IA PPO |
$186.87
|
|
|
US Pregnant < 14 Weeks
|
Facility
IP
|
$524.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
7960826
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$366.80 |
| Max. Negotiated Rate |
$471.60 |
| Rate for Payer: Aetna of IA Commercial |
$471.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$471.60
|
| Rate for Payer: Cash Price |
$419.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$393.00
|
| Rate for Payer: Medical Associates Commercial |
$393.00
|
| Rate for Payer: Midlands Choice Commercial |
$366.80
|
| Rate for Payer: United Healthcare Commercial |
$471.60
|
|
|
US Pregnant > 14 Weeks
|
Facility
OP
|
$379.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
7960832
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.88 |
| Max. Negotiated Rate |
$341.10 |
| Rate for Payer: Aetna of IA Commercial |
$341.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$341.10
|
| Rate for Payer: Aetna of IA Medicare |
$216.03
|
| Rate for Payer: Amerigroup Medicaid |
$191.28
|
| Rate for Payer: Amerigroup Medicare |
$191.40
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$284.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$189.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$189.42
|
| Rate for Payer: Medical Associates Commercial |
$284.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$189.50
|
| Rate for Payer: Midlands Choice Commercial |
$265.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$192.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$284.25
|
| Rate for Payer: United Healthcare Commercial |
$341.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$223.61
|
| Rate for Payer: Wellmark IA HMO |
$169.88
|
| Rate for Payer: Wellmark IA PPO |
$186.87
|
|
