|
XR Clavicle Left
|
Facility
OP
|
$151.00
|
|
|
Service Code
|
CPT 73000 LT
|
| Hospital Charge Code |
1170075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.47 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Aetna of IA Medicare |
$86.07
|
| Rate for Payer: Amerigroup Medicaid |
$76.21
|
| Rate for Payer: Amerigroup Medicare |
$76.26
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$75.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$75.47
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.50
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$76.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.25
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$89.09
|
|
|
XR Clavicle Right
|
Facility
OP
|
$151.00
|
|
|
Service Code
|
CPT 73000 RT
|
| Hospital Charge Code |
1170077
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.47 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Aetna of IA Medicare |
$86.07
|
| Rate for Payer: Amerigroup Medicaid |
$76.21
|
| Rate for Payer: Amerigroup Medicare |
$76.26
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$75.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$75.47
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.50
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$76.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.25
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$89.09
|
|
|
XR Clavicle Right
|
Facility
IP
|
$151.00
|
|
|
Service Code
|
CPT 73000 RT
|
| Hospital Charge Code |
1170077
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
|
|
XR Cystography
|
Facility
OP
|
$347.00
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
1170083
|
|
Hospital Revenue Code
|
320
|
| 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: 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
|
| Rate for Payer: Wellmark IA HMO |
$178.56
|
| Rate for Payer: Wellmark IA PPO |
$196.42
|
|
|
XR Cystography
|
Facility
IP
|
$347.00
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
1170083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.90 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Aetna of IA Commercial |
$312.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$312.30
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$260.25
|
| Rate for Payer: Medical Associates Commercial |
$260.25
|
| Rate for Payer: Midlands Choice Commercial |
$242.90
|
| Rate for Payer: United Healthcare Commercial |
$312.30
|
|
|
XR Elbow 2 Views Left
|
Facility
IP
|
$145.00
|
|
|
Service Code
|
CPT 73070 LT
|
| Hospital Charge Code |
1170121
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Aetna of IA Commercial |
$130.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$130.50
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.75
|
| Rate for Payer: Medical Associates Commercial |
$108.75
|
| Rate for Payer: Midlands Choice Commercial |
$101.50
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
|
|
XR Elbow 2 Views Left
|
Facility
OP
|
$145.00
|
|
|
Service Code
|
CPT 73070 LT
|
| Hospital Charge Code |
1170121
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.47 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Aetna of IA Commercial |
$130.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$130.50
|
| Rate for Payer: Aetna of IA Medicare |
$82.65
|
| Rate for Payer: Amerigroup Medicaid |
$73.18
|
| Rate for Payer: Amerigroup Medicare |
$73.22
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$72.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$72.47
|
| Rate for Payer: Medical Associates Commercial |
$108.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.50
|
| Rate for Payer: Midlands Choice Commercial |
$101.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$73.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$108.75
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$85.55
|
|
|
XR Elbow 2 Views Right
|
Facility
OP
|
$145.00
|
|
|
Service Code
|
CPT 73070 RT
|
| Hospital Charge Code |
1170123
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.47 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Aetna of IA Commercial |
$130.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$130.50
|
| Rate for Payer: Aetna of IA Medicare |
$82.65
|
| Rate for Payer: Amerigroup Medicaid |
$73.18
|
| Rate for Payer: Amerigroup Medicare |
$73.22
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$72.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$72.47
|
| Rate for Payer: Medical Associates Commercial |
$108.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.50
|
| Rate for Payer: Midlands Choice Commercial |
$101.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$73.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$108.75
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$85.55
|
|
|
XR Elbow 2 Views Right
|
Facility
IP
|
$145.00
|
|
|
Service Code
|
CPT 73070 RT
|
| Hospital Charge Code |
1170123
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Aetna of IA Commercial |
$130.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$130.50
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.75
|
| Rate for Payer: Medical Associates Commercial |
$108.75
|
| Rate for Payer: Midlands Choice Commercial |
$101.50
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
|
|
XR Elbow Complete Left
|
Facility
OP
|
$151.00
|
|
|
Service Code
|
CPT 73080 LT
|
| Hospital Charge Code |
1170127
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.47 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Aetna of IA Medicare |
$86.07
|
| Rate for Payer: Amerigroup Medicaid |
$76.21
|
| Rate for Payer: Amerigroup Medicare |
$76.26
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$75.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$75.47
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.50
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$76.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.25
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$89.09
|
|
|
XR Elbow Complete Left
|
Facility
IP
|
$151.00
|
|
|
Service Code
|
CPT 73080 LT
|
| Hospital Charge Code |
1170127
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
|
|
XR Elbow Complete Right
|
Facility
OP
|
$151.00
|
|
|
Service Code
|
CPT 73080 RT
|
| Hospital Charge Code |
1170129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.47 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Aetna of IA Medicare |
$86.07
|
| Rate for Payer: Amerigroup Medicaid |
$76.21
|
| Rate for Payer: Amerigroup Medicare |
$76.26
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$75.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$75.47
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.50
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$76.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.25
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$89.09
|
|
|
XR Elbow Complete Right
|
Facility
IP
|
$151.00
|
|
|
Service Code
|
CPT 73080 RT
|
| Hospital Charge Code |
1170129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
|
|
XR Esophagus
|
Facility
IP
|
$279.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1170137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna of IA Commercial |
$251.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$251.10
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$209.25
|
| Rate for Payer: Medical Associates Commercial |
$209.25
|
| Rate for Payer: Midlands Choice Commercial |
$195.30
|
| Rate for Payer: United Healthcare Commercial |
$251.10
|
|
|
XR Esophagus
|
Facility
OP
|
$279.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1170137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.52 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna of IA Commercial |
$251.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$251.10
|
| Rate for Payer: Aetna of IA Medicare |
$159.03
|
| Rate for Payer: Amerigroup Medicaid |
$140.81
|
| Rate for Payer: Amerigroup Medicare |
$140.90
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$209.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$139.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$139.44
|
| Rate for Payer: Medical Associates Commercial |
$209.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$139.50
|
| Rate for Payer: Midlands Choice Commercial |
$195.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$141.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$209.25
|
| Rate for Payer: United Healthcare Commercial |
$251.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$164.61
|
| Rate for Payer: Wellmark IA HMO |
$59.52
|
| Rate for Payer: Wellmark IA PPO |
$65.47
|
|
|
XR Facial Bones < 3 Views
|
Facility
OP
|
$151.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
1170139
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.52 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Aetna of IA Medicare |
$86.07
|
| Rate for Payer: Amerigroup Medicaid |
$76.21
|
| Rate for Payer: Amerigroup Medicare |
$76.26
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$75.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$75.47
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.50
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$76.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.25
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$89.09
|
| Rate for Payer: Wellmark IA HMO |
$59.52
|
| Rate for Payer: Wellmark IA PPO |
$65.47
|
|
|
XR Facial Bones < 3 Views
|
Facility
IP
|
$151.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
1170139
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
|
|
XR Facial Bones Minimum 3 Views
|
Facility
IP
|
$180.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
1170141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
|
|
XR Facial Bones Minimum 3 Views
|
Facility
OP
|
$180.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
1170141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.52 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Aetna of IA Medicare |
$102.60
|
| Rate for Payer: Amerigroup Medicaid |
$90.85
|
| Rate for Payer: Amerigroup Medicare |
$90.90
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.96
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.20
|
| Rate for Payer: Wellmark IA HMO |
$59.52
|
| Rate for Payer: Wellmark IA PPO |
$65.47
|
|
|
XR Femur 1 View Lt
|
Facility
OP
|
$147.00
|
|
|
Service Code
|
CPT 73551 LT
|
| Hospital Charge Code |
8025358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.47 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna of IA Commercial |
$132.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$132.30
|
| Rate for Payer: Aetna of IA Medicare |
$83.79
|
| Rate for Payer: Amerigroup Medicaid |
$74.19
|
| Rate for Payer: Amerigroup Medicare |
$74.24
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$110.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.47
|
| Rate for Payer: Medical Associates Commercial |
$110.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.50
|
| Rate for Payer: Midlands Choice Commercial |
$102.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$110.25
|
| Rate for Payer: United Healthcare Commercial |
$132.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.73
|
|
|
XR Femur 1 View Lt
|
Facility
IP
|
$147.00
|
|
|
Service Code
|
CPT 73551 LT
|
| Hospital Charge Code |
8025358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna of IA Commercial |
$132.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$132.30
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$110.25
|
| Rate for Payer: Medical Associates Commercial |
$110.25
|
| Rate for Payer: Midlands Choice Commercial |
$102.90
|
| Rate for Payer: United Healthcare Commercial |
$132.30
|
|
|
XR Femur 1 View Rt
|
Facility
OP
|
$147.00
|
|
|
Service Code
|
CPT 73551 RT
|
| Hospital Charge Code |
8025361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.47 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna of IA Commercial |
$132.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$132.30
|
| Rate for Payer: Aetna of IA Medicare |
$83.79
|
| Rate for Payer: Amerigroup Medicaid |
$74.19
|
| Rate for Payer: Amerigroup Medicare |
$74.24
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$110.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.47
|
| Rate for Payer: Medical Associates Commercial |
$110.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.50
|
| Rate for Payer: Midlands Choice Commercial |
$102.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$110.25
|
| Rate for Payer: United Healthcare Commercial |
$132.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.73
|
|
|
XR Femur 1 View Rt
|
Facility
IP
|
$147.00
|
|
|
Service Code
|
CPT 73551 RT
|
| Hospital Charge Code |
8025361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna of IA Commercial |
$132.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$132.30
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$110.25
|
| Rate for Payer: Medical Associates Commercial |
$110.25
|
| Rate for Payer: Midlands Choice Commercial |
$102.90
|
| Rate for Payer: United Healthcare Commercial |
$132.30
|
|
|
XR Femur Min 2 Views Lt
|
Facility
IP
|
$147.00
|
|
|
Service Code
|
CPT 73552 LT
|
| Hospital Charge Code |
8025364
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna of IA Commercial |
$132.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$132.30
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$110.25
|
| Rate for Payer: Medical Associates Commercial |
$110.25
|
| Rate for Payer: Midlands Choice Commercial |
$102.90
|
| Rate for Payer: United Healthcare Commercial |
$132.30
|
|
|
XR Femur Min 2 Views Lt
|
Facility
OP
|
$147.00
|
|
|
Service Code
|
CPT 73552 LT
|
| Hospital Charge Code |
8025364
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.47 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna of IA Commercial |
$132.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$132.30
|
| Rate for Payer: Aetna of IA Medicare |
$83.79
|
| Rate for Payer: Amerigroup Medicaid |
$74.19
|
| Rate for Payer: Amerigroup Medicare |
$74.24
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$110.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.47
|
| Rate for Payer: Medical Associates Commercial |
$110.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.50
|
| Rate for Payer: Midlands Choice Commercial |
$102.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$110.25
|
| Rate for Payer: United Healthcare Commercial |
$132.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.73
|
|
