|
US Pregnant > 14 Weeks
|
Facility
IP
|
$379.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
7960832
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$265.30 |
| 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: Cash Price |
$303.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$284.25
|
| Rate for Payer: Medical Associates Commercial |
$284.25
|
| Rate for Payer: Midlands Choice Commercial |
$265.30
|
| Rate for Payer: United Healthcare Commercial |
$341.10
|
|
|
US Pregnant < 14 Weeks Addl Gest
|
Facility
IP
|
$253.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
7960829
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$177.10 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Aetna of IA Commercial |
$227.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$227.70
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.75
|
| Rate for Payer: Medical Associates Commercial |
$189.75
|
| Rate for Payer: Midlands Choice Commercial |
$177.10
|
| Rate for Payer: United Healthcare Commercial |
$227.70
|
|
|
US Pregnant < 14 Weeks Addl Gest
|
Facility
OP
|
$253.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
7960829
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Aetna of IA Commercial |
$227.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$227.70
|
| Rate for Payer: Aetna of IA Medicare |
$144.21
|
| Rate for Payer: Amerigroup Medicaid |
$127.69
|
| Rate for Payer: Amerigroup Medicare |
$127.76
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$126.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.45
|
| Rate for Payer: Medical Associates Commercial |
$189.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$126.50
|
| Rate for Payer: Midlands Choice Commercial |
$177.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$189.75
|
| Rate for Payer: United Healthcare Commercial |
$227.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$149.27
|
| Rate for Payer: Wellmark IA HMO |
$169.88
|
| Rate for Payer: Wellmark IA PPO |
$186.87
|
|
|
US Pregnant > 14 Weeks Addl Gest
|
Facility
OP
|
$253.00
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
7960835
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Aetna of IA Commercial |
$227.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$227.70
|
| Rate for Payer: Aetna of IA Medicare |
$144.21
|
| Rate for Payer: Amerigroup Medicaid |
$127.69
|
| Rate for Payer: Amerigroup Medicare |
$127.76
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$126.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.45
|
| Rate for Payer: Medical Associates Commercial |
$189.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$126.50
|
| Rate for Payer: Midlands Choice Commercial |
$177.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$189.75
|
| Rate for Payer: United Healthcare Commercial |
$227.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$149.27
|
| Rate for Payer: Wellmark IA HMO |
$169.88
|
| Rate for Payer: Wellmark IA PPO |
$186.87
|
|
|
US Pregnant > 14 Weeks Addl Gest
|
Facility
IP
|
$253.00
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
7960835
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$177.10 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Aetna of IA Commercial |
$227.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$227.70
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.75
|
| Rate for Payer: Medical Associates Commercial |
$189.75
|
| Rate for Payer: Midlands Choice Commercial |
$177.10
|
| Rate for Payer: United Healthcare Commercial |
$227.70
|
|
|
US Retroperitoneal Complete
|
Facility
IP
|
$493.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
1169867
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$345.10 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Aetna of IA Commercial |
$443.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$443.70
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$369.75
|
| Rate for Payer: Medical Associates Commercial |
$369.75
|
| Rate for Payer: Midlands Choice Commercial |
$345.10
|
| Rate for Payer: United Healthcare Commercial |
$443.70
|
|
|
US Retroperitoneal Complete
|
Facility
OP
|
$493.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
1169867
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$246.40 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Aetna of IA Commercial |
$443.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$443.70
|
| Rate for Payer: Aetna of IA Medicare |
$281.01
|
| Rate for Payer: Amerigroup Medicaid |
$248.82
|
| Rate for Payer: Amerigroup Medicare |
$248.96
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$369.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$246.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$246.40
|
| Rate for Payer: Medical Associates Commercial |
$369.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$246.50
|
| Rate for Payer: Midlands Choice Commercial |
$345.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$250.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$369.75
|
| Rate for Payer: United Healthcare Commercial |
$443.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$290.87
|
| Rate for Payer: Wellmark IA HMO |
$302.56
|
| Rate for Payer: Wellmark IA PPO |
$332.82
|
|
|
US Retroperitoneal Limited
|
Facility
OP
|
$387.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
1169869
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$191.58 |
| Max. Negotiated Rate |
$348.30 |
| Rate for Payer: Aetna of IA Commercial |
$348.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$348.30
|
| Rate for Payer: Aetna of IA Medicare |
$220.59
|
| Rate for Payer: Amerigroup Medicaid |
$195.32
|
| Rate for Payer: Amerigroup Medicare |
$195.44
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$290.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$193.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$193.42
|
| Rate for Payer: Medical Associates Commercial |
$290.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$193.50
|
| Rate for Payer: Midlands Choice Commercial |
$270.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$196.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$290.25
|
| Rate for Payer: United Healthcare Commercial |
$348.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$228.33
|
| Rate for Payer: Wellmark IA HMO |
$191.58
|
| Rate for Payer: Wellmark IA PPO |
$210.74
|
|
|
US Retroperitoneal Limited
|
Facility
IP
|
$387.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
1169869
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$270.90 |
| Max. Negotiated Rate |
$348.30 |
| Rate for Payer: Aetna of IA Commercial |
$348.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$348.30
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$290.25
|
| Rate for Payer: Medical Associates Commercial |
$290.25
|
| Rate for Payer: Midlands Choice Commercial |
$270.90
|
| Rate for Payer: United Healthcare Commercial |
$348.30
|
|
|
US Scrotum (Contents)
|
Facility
IP
|
$459.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
1169877
|
|
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 Scrotum (Contents)
|
Facility
OP
|
$459.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
1169877
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$191.58 |
| 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 |
$191.58
|
| Rate for Payer: Wellmark IA PPO |
$210.74
|
|
|
US Thyroid
|
Facility
OP
|
$394.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
1169883
|
|
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 Thyroid
|
Facility
IP
|
$394.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
1169883
|
|
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 UE Arterial Duplex Bilateral
|
Facility
OP
|
$639.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
1169895
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$191.58 |
| Max. Negotiated Rate |
$575.10 |
| Rate for Payer: Aetna of IA Commercial |
$575.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$575.10
|
| Rate for Payer: Aetna of IA Medicare |
$364.23
|
| Rate for Payer: Amerigroup Medicaid |
$322.50
|
| Rate for Payer: Amerigroup Medicare |
$322.70
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$479.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$319.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$319.37
|
| Rate for Payer: Medical Associates Commercial |
$479.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$319.50
|
| Rate for Payer: Midlands Choice Commercial |
$447.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$324.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$479.25
|
| Rate for Payer: United Healthcare Commercial |
$575.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$377.01
|
| Rate for Payer: Wellmark IA HMO |
$191.58
|
| Rate for Payer: Wellmark IA PPO |
$210.74
|
|
|
US UE Arterial Duplex Bilateral
|
Facility
IP
|
$639.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
1169895
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$447.30 |
| Max. Negotiated Rate |
$575.10 |
| Rate for Payer: Aetna of IA Commercial |
$575.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$575.10
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$479.25
|
| Rate for Payer: Medical Associates Commercial |
$479.25
|
| Rate for Payer: Midlands Choice Commercial |
$447.30
|
| Rate for Payer: United Healthcare Commercial |
$575.10
|
|
|
US UE Arterial Duplex Left
|
Facility
IP
|
$521.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
1169897
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$364.70 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Aetna of IA Commercial |
$468.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$468.90
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$390.75
|
| Rate for Payer: Medical Associates Commercial |
$390.75
|
| Rate for Payer: Midlands Choice Commercial |
$364.70
|
| Rate for Payer: United Healthcare Commercial |
$468.90
|
|
|
US UE Arterial Duplex Left
|
Facility
OP
|
$521.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
1169897
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$191.58 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Aetna of IA Commercial |
$468.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$468.90
|
| Rate for Payer: Aetna of IA Medicare |
$296.97
|
| Rate for Payer: Amerigroup Medicaid |
$262.95
|
| Rate for Payer: Amerigroup Medicare |
$263.10
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$390.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$260.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$260.40
|
| Rate for Payer: Medical Associates Commercial |
$390.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$260.50
|
| Rate for Payer: Midlands Choice Commercial |
$364.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$264.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$390.75
|
| Rate for Payer: United Healthcare Commercial |
$468.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$307.39
|
| Rate for Payer: Wellmark IA HMO |
$191.58
|
| Rate for Payer: Wellmark IA PPO |
$210.74
|
|
|
US UE Arterial Duplex Right
|
Facility
OP
|
$521.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
1169899
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$191.58 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Aetna of IA Commercial |
$468.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$468.90
|
| Rate for Payer: Aetna of IA Medicare |
$296.97
|
| Rate for Payer: Amerigroup Medicaid |
$262.95
|
| Rate for Payer: Amerigroup Medicare |
$263.10
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$390.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$260.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$260.40
|
| Rate for Payer: Medical Associates Commercial |
$390.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$260.50
|
| Rate for Payer: Midlands Choice Commercial |
$364.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$264.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$390.75
|
| Rate for Payer: United Healthcare Commercial |
$468.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$307.39
|
| Rate for Payer: Wellmark IA HMO |
$191.58
|
| Rate for Payer: Wellmark IA PPO |
$210.74
|
|
|
US UE Arterial Duplex Right
|
Facility
IP
|
$521.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
1169899
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$364.70 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Aetna of IA Commercial |
$468.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$468.90
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$390.75
|
| Rate for Payer: Medical Associates Commercial |
$390.75
|
| Rate for Payer: Midlands Choice Commercial |
$364.70
|
| Rate for Payer: United Healthcare Commercial |
$468.90
|
|
|
US UE Venous Duplex Left
|
Facility
IP
|
$582.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
1169903
|
|
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 UE Venous Duplex Left
|
Facility
OP
|
$582.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
1169903
|
|
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 UE Venous Duplex Right
|
Facility
OP
|
$582.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
1169905
|
|
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 UE Venous Duplex Right
|
Facility
IP
|
$582.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
1169905
|
|
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
|
|
|
Uterine and Adnexa Procedures for Non-malignancy With CC/MCC
|
Facility
IP
|
$11,262.67
|
|
|
Service Code
|
MS-DRG 742
|
| Hospital Charge Code |
503
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$11,262.67 |
| Rate for Payer: Amerigroup Medicaid |
$11,208.26
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11,099.45
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11,262.67
|
|
|
Uterine and Adnexa Procedures for Non-malignancy Without CC/MCC
|
Facility
IP
|
$8,709.56
|
|
|
Service Code
|
MS-DRG 743
|
| Hospital Charge Code |
504
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,709.56 |
| Rate for Payer: Amerigroup Medicaid |
$8,667.48
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,583.33
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,709.56
|
|
