|
XR Arthrogram Knee Right
|
Facility
|
OP
|
$723.00
|
|
|
Service Code
|
CPT 73580 RT
|
| Hospital Charge Code |
1169972
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$325.35 |
| Max. Negotiated Rate |
$650.70 |
| Rate for Payer: Aetna of IA Commercial |
$650.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$650.70
|
| Rate for Payer: Aetna of IA Medicare |
$412.11
|
| Rate for Payer: Amerigroup Medicaid |
$417.03
|
| Rate for Payer: Amerigroup Medicare |
$328.60
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$542.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$325.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$412.98
|
| Rate for Payer: Medical Associates Commercial |
$542.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$325.35
|
| Rate for Payer: Midlands Choice Commercial |
$506.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$419.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$374.15
|
| Rate for Payer: United Healthcare Commercial |
$650.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$426.57
|
|
|
XR Arthrogram Knee Right
|
Facility
|
IP
|
$723.00
|
|
|
Service Code
|
CPT 73580 RT
|
| Hospital Charge Code |
1169972
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$506.10 |
| Max. Negotiated Rate |
$650.70 |
| Rate for Payer: Aetna of IA Commercial |
$650.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$650.70
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$542.25
|
| Rate for Payer: Medical Associates Commercial |
$542.25
|
| Rate for Payer: Midlands Choice Commercial |
$506.10
|
| Rate for Payer: United Healthcare Commercial |
$650.70
|
|
|
XR Arthrogram Shoulder Left
|
Facility
|
IP
|
$772.00
|
|
|
Service Code
|
CPT 73040 LT
|
| Hospital Charge Code |
1169984
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$540.40 |
| Max. Negotiated Rate |
$694.80 |
| Rate for Payer: Aetna of IA Commercial |
$694.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$694.80
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$579.00
|
| Rate for Payer: Medical Associates Commercial |
$579.00
|
| Rate for Payer: Midlands Choice Commercial |
$540.40
|
| Rate for Payer: United Healthcare Commercial |
$694.80
|
|
|
XR Arthrogram Shoulder Left
|
Facility
|
OP
|
$772.00
|
|
|
Service Code
|
CPT 73040 LT
|
| Hospital Charge Code |
1169984
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$347.40 |
| Max. Negotiated Rate |
$694.80 |
| Rate for Payer: Aetna of IA Commercial |
$694.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$694.80
|
| Rate for Payer: Aetna of IA Medicare |
$440.04
|
| Rate for Payer: Amerigroup Medicaid |
$445.29
|
| Rate for Payer: Amerigroup Medicare |
$350.87
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$579.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$347.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$440.97
|
| Rate for Payer: Medical Associates Commercial |
$579.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$347.40
|
| Rate for Payer: Midlands Choice Commercial |
$540.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$447.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$399.51
|
| Rate for Payer: United Healthcare Commercial |
$694.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$455.48
|
|
|
XR Arthrogram Shoulder Right
|
Facility
|
OP
|
$772.00
|
|
|
Service Code
|
CPT 73040 RT
|
| Hospital Charge Code |
1169986
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$347.40 |
| Max. Negotiated Rate |
$694.80 |
| Rate for Payer: Aetna of IA Commercial |
$694.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$694.80
|
| Rate for Payer: Aetna of IA Medicare |
$440.04
|
| Rate for Payer: Amerigroup Medicaid |
$445.29
|
| Rate for Payer: Amerigroup Medicare |
$350.87
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$579.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$347.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$440.97
|
| Rate for Payer: Medical Associates Commercial |
$579.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$347.40
|
| Rate for Payer: Midlands Choice Commercial |
$540.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$447.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$399.51
|
| Rate for Payer: United Healthcare Commercial |
$694.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$455.48
|
|
|
XR Arthrogram Shoulder Right
|
Facility
|
IP
|
$772.00
|
|
|
Service Code
|
CPT 73040 RT
|
| Hospital Charge Code |
1169986
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$540.40 |
| Max. Negotiated Rate |
$694.80 |
| Rate for Payer: Aetna of IA Commercial |
$694.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$694.80
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$579.00
|
| Rate for Payer: Medical Associates Commercial |
$579.00
|
| Rate for Payer: Midlands Choice Commercial |
$540.40
|
| Rate for Payer: United Healthcare Commercial |
$694.80
|
|
|
XR Arthrogram Wrist Left
|
Facility
|
OP
|
$759.00
|
|
|
Service Code
|
CPT 73115 LT
|
| Hospital Charge Code |
1169996
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$341.55 |
| Max. Negotiated Rate |
$683.10 |
| Rate for Payer: Aetna of IA Commercial |
$683.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$683.10
|
| Rate for Payer: Aetna of IA Medicare |
$432.63
|
| Rate for Payer: Amerigroup Medicaid |
$437.79
|
| Rate for Payer: Amerigroup Medicare |
$344.97
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$569.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$341.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$433.54
|
| Rate for Payer: Medical Associates Commercial |
$569.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$341.55
|
| Rate for Payer: Midlands Choice Commercial |
$531.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$439.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$392.78
|
| Rate for Payer: United Healthcare Commercial |
$683.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$447.81
|
|
|
XR Arthrogram Wrist Left
|
Facility
|
IP
|
$759.00
|
|
|
Service Code
|
CPT 73115 LT
|
| Hospital Charge Code |
1169996
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$531.30 |
| Max. Negotiated Rate |
$683.10 |
| Rate for Payer: Aetna of IA Commercial |
$683.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$683.10
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$569.25
|
| Rate for Payer: Medical Associates Commercial |
$569.25
|
| Rate for Payer: Midlands Choice Commercial |
$531.30
|
| Rate for Payer: United Healthcare Commercial |
$683.10
|
|
|
XR Arthrogram Wrist Right
|
Facility
|
OP
|
$759.00
|
|
|
Service Code
|
CPT 73115 RT
|
| Hospital Charge Code |
1169998
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$341.55 |
| Max. Negotiated Rate |
$683.10 |
| Rate for Payer: Aetna of IA Commercial |
$683.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$683.10
|
| Rate for Payer: Aetna of IA Medicare |
$432.63
|
| Rate for Payer: Amerigroup Medicaid |
$437.79
|
| Rate for Payer: Amerigroup Medicare |
$344.97
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$569.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$341.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$433.54
|
| Rate for Payer: Medical Associates Commercial |
$569.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$341.55
|
| Rate for Payer: Midlands Choice Commercial |
$531.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$439.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$392.78
|
| Rate for Payer: United Healthcare Commercial |
$683.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$447.81
|
|
|
XR Arthrogram Wrist Right
|
Facility
|
IP
|
$759.00
|
|
|
Service Code
|
CPT 73115 RT
|
| Hospital Charge Code |
1169998
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$531.30 |
| Max. Negotiated Rate |
$683.10 |
| Rate for Payer: Aetna of IA Commercial |
$683.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$683.10
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$569.25
|
| Rate for Payer: Medical Associates Commercial |
$569.25
|
| Rate for Payer: Midlands Choice Commercial |
$531.30
|
| Rate for Payer: United Healthcare Commercial |
$683.10
|
|
|
XR Barium Enema Complete
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1170002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.30 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Aetna of IA Commercial |
$426.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$426.60
|
| Rate for Payer: Aetna of IA Medicare |
$270.18
|
| Rate for Payer: Amerigroup Medicaid |
$273.40
|
| Rate for Payer: Amerigroup Medicare |
$215.43
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$355.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$213.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$270.75
|
| Rate for Payer: Medical Associates Commercial |
$355.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$213.30
|
| Rate for Payer: Midlands Choice Commercial |
$331.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$274.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$245.29
|
| Rate for Payer: United Healthcare Commercial |
$426.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$279.66
|
|
|
XR Barium Enema Complete
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1170002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$331.80 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Aetna of IA Commercial |
$426.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$426.60
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$355.50
|
| Rate for Payer: Medical Associates Commercial |
$355.50
|
| Rate for Payer: Midlands Choice Commercial |
$331.80
|
| Rate for Payer: United Healthcare Commercial |
$426.60
|
|
|
XR Barium Enema w/ Air Complete
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
1170006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$382.90 |
| Max. Negotiated Rate |
$492.30 |
| Rate for Payer: Aetna of IA Commercial |
$492.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$492.30
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$410.25
|
| Rate for Payer: Medical Associates Commercial |
$410.25
|
| Rate for Payer: Midlands Choice Commercial |
$382.90
|
| Rate for Payer: United Healthcare Commercial |
$492.30
|
|
|
XR Barium Enema w/ Air Complete
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
1170006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.15 |
| Max. Negotiated Rate |
$492.30 |
| Rate for Payer: Aetna of IA Commercial |
$492.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$492.30
|
| Rate for Payer: Aetna of IA Medicare |
$311.79
|
| Rate for Payer: Amerigroup Medicaid |
$315.51
|
| Rate for Payer: Amerigroup Medicare |
$248.61
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$410.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$246.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$312.45
|
| Rate for Payer: Medical Associates Commercial |
$410.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$246.15
|
| Rate for Payer: Midlands Choice Commercial |
$382.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$317.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$283.07
|
| Rate for Payer: United Healthcare Commercial |
$492.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$322.73
|
|
|
XR Bone Age Studies
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
1170014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna of IA Commercial |
$120.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.60
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.50
|
| Rate for Payer: Medical Associates Commercial |
$100.50
|
| Rate for Payer: Midlands Choice Commercial |
$93.80
|
| Rate for Payer: United Healthcare Commercial |
$120.60
|
|
|
XR Bone Age Studies
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
1170014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$60.30 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna of IA Commercial |
$120.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.60
|
| Rate for Payer: Aetna of IA Medicare |
$76.38
|
| Rate for Payer: Amerigroup Medicaid |
$77.29
|
| Rate for Payer: Amerigroup Medicare |
$60.90
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$60.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$76.54
|
| Rate for Payer: Medical Associates Commercial |
$100.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$60.30
|
| Rate for Payer: Midlands Choice Commercial |
$93.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$77.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$69.34
|
| Rate for Payer: United Healthcare Commercial |
$120.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.06
|
|
|
XR Bone Survey Complete (Mets)
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
1170018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$386.40 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Aetna of IA Commercial |
$496.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$496.80
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$414.00
|
| Rate for Payer: Medical Associates Commercial |
$414.00
|
| Rate for Payer: Midlands Choice Commercial |
$386.40
|
| Rate for Payer: United Healthcare Commercial |
$496.80
|
|
|
XR Bone Survey Complete (Mets)
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
1170018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Aetna of IA Commercial |
$496.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$496.80
|
| Rate for Payer: Aetna of IA Medicare |
$314.64
|
| Rate for Payer: Amerigroup Medicaid |
$318.39
|
| Rate for Payer: Amerigroup Medicare |
$250.88
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$414.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$248.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$315.30
|
| Rate for Payer: Medical Associates Commercial |
$414.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$248.40
|
| Rate for Payer: Midlands Choice Commercial |
$386.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$319.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$285.66
|
| Rate for Payer: United Healthcare Commercial |
$496.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$325.68
|
|
|
XR Bone Survey Infant
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
1170020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna of IA Commercial |
$158.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$158.40
|
| Rate for Payer: Aetna of IA Medicare |
$100.32
|
| Rate for Payer: Amerigroup Medicaid |
$101.52
|
| Rate for Payer: Amerigroup Medicare |
$79.99
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$79.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.53
|
| Rate for Payer: Medical Associates Commercial |
$132.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$79.20
|
| Rate for Payer: Midlands Choice Commercial |
$123.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$91.08
|
| Rate for Payer: United Healthcare Commercial |
$158.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.84
|
|
|
XR Bone Survey Infant
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
1170020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna of IA Commercial |
$158.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$158.40
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.00
|
| Rate for Payer: Medical Associates Commercial |
$132.00
|
| Rate for Payer: Midlands Choice Commercial |
$123.20
|
| Rate for Payer: United Healthcare Commercial |
$158.40
|
|
|
XR Calcaneous Left
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 73650 LT
|
| Hospital Charge Code |
1170032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.15 |
| Max. Negotiated Rate |
$114.30 |
| Rate for Payer: Aetna of IA Commercial |
$114.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$114.30
|
| Rate for Payer: Aetna of IA Medicare |
$72.39
|
| Rate for Payer: Amerigroup Medicaid |
$73.25
|
| Rate for Payer: Amerigroup Medicare |
$57.72
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$95.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$72.54
|
| Rate for Payer: Medical Associates Commercial |
$95.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.15
|
| Rate for Payer: Midlands Choice Commercial |
$88.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$73.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$65.72
|
| Rate for Payer: United Healthcare Commercial |
$114.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$74.93
|
|
|
XR Calcaneous Left
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 73650 LT
|
| Hospital Charge Code |
1170032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$114.30 |
| Rate for Payer: Aetna of IA Commercial |
$114.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$114.30
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$95.25
|
| Rate for Payer: Medical Associates Commercial |
$95.25
|
| Rate for Payer: Midlands Choice Commercial |
$88.90
|
| Rate for Payer: United Healthcare Commercial |
$114.30
|
|
|
XR Calcaneous Right
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 73650 RT
|
| Hospital Charge Code |
1170034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$114.30 |
| Rate for Payer: Aetna of IA Commercial |
$114.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$114.30
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$95.25
|
| Rate for Payer: Medical Associates Commercial |
$95.25
|
| Rate for Payer: Midlands Choice Commercial |
$88.90
|
| Rate for Payer: United Healthcare Commercial |
$114.30
|
|
|
XR Calcaneous Right
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 73650 RT
|
| Hospital Charge Code |
1170034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.15 |
| Max. Negotiated Rate |
$114.30 |
| Rate for Payer: Aetna of IA Commercial |
$114.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$114.30
|
| Rate for Payer: Aetna of IA Medicare |
$72.39
|
| Rate for Payer: Amerigroup Medicaid |
$73.25
|
| Rate for Payer: Amerigroup Medicare |
$57.72
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$95.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$72.54
|
| Rate for Payer: Medical Associates Commercial |
$95.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.15
|
| Rate for Payer: Midlands Choice Commercial |
$88.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$73.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$65.72
|
| Rate for Payer: United Healthcare Commercial |
$114.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$74.93
|
|
|
XR Chest 1 View
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
1345763
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$51.75 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna of IA Commercial |
$103.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$103.50
|
| Rate for Payer: Aetna of IA Medicare |
$65.55
|
| Rate for Payer: Amerigroup Medicaid |
$66.33
|
| Rate for Payer: Amerigroup Medicare |
$52.27
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$86.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.69
|
| Rate for Payer: Medical Associates Commercial |
$86.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.75
|
| Rate for Payer: Midlands Choice Commercial |
$80.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$59.51
|
| Rate for Payer: United Healthcare Commercial |
$103.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.85
|
|
