|
XR Femur Min 2 Views Rt
|
Facility
IP
|
$147.00
|
|
|
Service Code
|
CPT 73552 RT
|
| Hospital Charge Code |
8025367
|
|
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 Rt
|
Facility
OP
|
$147.00
|
|
|
Service Code
|
CPT 73552 RT
|
| Hospital Charge Code |
8025367
|
|
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 Finger 2nd Digit Left
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT 73140 F1
|
| Hospital Charge Code |
1170151
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
|
|
XR Finger 2nd Digit Left
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT 73140 F1
|
| Hospital Charge Code |
1170151
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Aetna of IA Medicare |
$67.83
|
| Rate for Payer: Amerigroup Medicaid |
$60.06
|
| Rate for Payer: Amerigroup Medicare |
$60.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$59.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.48
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.50
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$70.21
|
|
|
XR Finger 2nd Digit Right
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT 73140 F6
|
| Hospital Charge Code |
1170153
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Aetna of IA Medicare |
$67.83
|
| Rate for Payer: Amerigroup Medicaid |
$60.06
|
| Rate for Payer: Amerigroup Medicare |
$60.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$59.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.48
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.50
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$70.21
|
|
|
XR Finger 2nd Digit Right
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT 73140 F6
|
| Hospital Charge Code |
1170153
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
|
|
XR Finger 3rd Digit Left
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT 73140 F2
|
| Hospital Charge Code |
1170155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
|
|
XR Finger 3rd Digit Left
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT 73140 F2
|
| Hospital Charge Code |
1170155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Aetna of IA Medicare |
$67.83
|
| Rate for Payer: Amerigroup Medicaid |
$60.06
|
| Rate for Payer: Amerigroup Medicare |
$60.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$59.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.48
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.50
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$70.21
|
|
|
XR Finger 3rd Digit Right
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT 73140 F7
|
| Hospital Charge Code |
1170157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Aetna of IA Medicare |
$67.83
|
| Rate for Payer: Amerigroup Medicaid |
$60.06
|
| Rate for Payer: Amerigroup Medicare |
$60.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$59.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.48
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.50
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$70.21
|
|
|
XR Finger 3rd Digit Right
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT 73140 F7
|
| Hospital Charge Code |
1170157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
|
|
XR Finger 4th Digit Left
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT 73140 F3
|
| Hospital Charge Code |
1170159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Aetna of IA Medicare |
$67.83
|
| Rate for Payer: Amerigroup Medicaid |
$60.06
|
| Rate for Payer: Amerigroup Medicare |
$60.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$59.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.48
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.50
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$70.21
|
|
|
XR Finger 4th Digit Left
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT 73140 F3
|
| Hospital Charge Code |
1170159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
|
|
XR Finger 4th Digit Right
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT 73140 F8
|
| Hospital Charge Code |
1170161
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
|
|
XR Finger 4th Digit Right
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT 73140 F8
|
| Hospital Charge Code |
1170161
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Aetna of IA Medicare |
$67.83
|
| Rate for Payer: Amerigroup Medicaid |
$60.06
|
| Rate for Payer: Amerigroup Medicare |
$60.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$59.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.48
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.50
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$70.21
|
|
|
XR Finger 5th Digit Left
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT 73140 F4
|
| Hospital Charge Code |
1170163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
|
|
XR Finger 5th Digit Left
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT 73140 F4
|
| Hospital Charge Code |
1170163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Aetna of IA Medicare |
$67.83
|
| Rate for Payer: Amerigroup Medicaid |
$60.06
|
| Rate for Payer: Amerigroup Medicare |
$60.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$59.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.48
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.50
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$70.21
|
|
|
XR Finger 5th Digit Right
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT 73140 F9
|
| Hospital Charge Code |
1170165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
|
|
XR Finger 5th Digit Right
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT 73140 F9
|
| Hospital Charge Code |
1170165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Aetna of IA Medicare |
$67.83
|
| Rate for Payer: Amerigroup Medicaid |
$60.06
|
| Rate for Payer: Amerigroup Medicare |
$60.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$59.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.48
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.50
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$70.21
|
|
|
XR Finger Thumb Left
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT 73140 FA
|
| Hospital Charge Code |
1170167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
|
|
XR Finger Thumb Left
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT 73140 FA
|
| Hospital Charge Code |
1170167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Aetna of IA Medicare |
$67.83
|
| Rate for Payer: Amerigroup Medicaid |
$60.06
|
| Rate for Payer: Amerigroup Medicare |
$60.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$59.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.48
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.50
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$70.21
|
|
|
XR Finger Thumb Right
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT 73140 F5
|
| Hospital Charge Code |
1170169
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Aetna of IA Medicare |
$67.83
|
| Rate for Payer: Amerigroup Medicaid |
$60.06
|
| Rate for Payer: Amerigroup Medicare |
$60.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$59.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.48
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.50
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$70.21
|
|
|
XR Finger Thumb Right
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT 73140 F5
|
| Hospital Charge Code |
1170169
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
|
|
XR Fistula or Sinus Tract Abscess Study
|
Facility
OP
|
$830.00
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
1170171
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.56 |
| Max. Negotiated Rate |
$747.00 |
| Rate for Payer: Aetna of IA Commercial |
$747.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$747.00
|
| Rate for Payer: Aetna of IA Medicare |
$473.10
|
| Rate for Payer: Amerigroup Medicaid |
$418.90
|
| Rate for Payer: Amerigroup Medicare |
$419.15
|
| Rate for Payer: Cash Price |
$664.00
|
| Rate for Payer: Cash Price |
$664.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$622.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$415.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$414.83
|
| Rate for Payer: Medical Associates Commercial |
$622.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$415.00
|
| Rate for Payer: Midlands Choice Commercial |
$581.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$421.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$622.50
|
| Rate for Payer: United Healthcare Commercial |
$747.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$489.70
|
| Rate for Payer: Wellmark IA HMO |
$178.56
|
| Rate for Payer: Wellmark IA PPO |
$196.42
|
|
|
XR Fistula or Sinus Tract Abscess Study
|
Facility
IP
|
$830.00
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
1170171
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$581.00 |
| Max. Negotiated Rate |
$747.00 |
| Rate for Payer: Aetna of IA Commercial |
$747.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$747.00
|
| Rate for Payer: Cash Price |
$664.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$622.50
|
| Rate for Payer: Medical Associates Commercial |
$622.50
|
| Rate for Payer: Midlands Choice Commercial |
$581.00
|
| Rate for Payer: United Healthcare Commercial |
$747.00
|
|
|
XR Fluoro Cath Placement
|
Facility
OP
|
$549.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
7960838
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$274.39 |
| Max. Negotiated Rate |
$720.87 |
| Rate for Payer: Aetna of IA Commercial |
$494.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$494.10
|
| Rate for Payer: Aetna of IA Medicare |
$312.93
|
| Rate for Payer: Amerigroup Medicaid |
$277.08
|
| Rate for Payer: Amerigroup Medicare |
$277.24
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$411.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$274.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$274.39
|
| Rate for Payer: Medical Associates Commercial |
$411.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$274.50
|
| Rate for Payer: Midlands Choice Commercial |
$384.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$278.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$411.75
|
| Rate for Payer: United Healthcare Commercial |
$494.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$323.91
|
| Rate for Payer: Wellmark IA HMO |
$655.34
|
| Rate for Payer: Wellmark IA PPO |
$720.87
|
|
