|
XR Hand 2 Views Left
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 73120 LT
|
| Hospital Charge Code |
1170215
|
|
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 Hand 2 Views Right
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 73120 RT
|
| Hospital Charge Code |
1170217
|
|
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 Hand 2 Views Right
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 73120 RT
|
| Hospital Charge Code |
1170217
|
|
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 Hand Complete Left
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 73130 LT
|
| Hospital Charge Code |
1170221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$140.70 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Aetna of IA Commercial |
$180.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$180.90
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$150.75
|
| Rate for Payer: Medical Associates Commercial |
$150.75
|
| Rate for Payer: Midlands Choice Commercial |
$140.70
|
| Rate for Payer: United Healthcare Commercial |
$180.90
|
|
|
XR Hand Complete Left
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 73130 LT
|
| Hospital Charge Code |
1170221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.45 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Aetna of IA Commercial |
$180.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$180.90
|
| Rate for Payer: Aetna of IA Medicare |
$114.57
|
| Rate for Payer: Amerigroup Medicaid |
$115.94
|
| Rate for Payer: Amerigroup Medicare |
$91.35
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$150.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$114.81
|
| Rate for Payer: Medical Associates Commercial |
$150.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.45
|
| Rate for Payer: Midlands Choice Commercial |
$140.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$116.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.02
|
| Rate for Payer: United Healthcare Commercial |
$180.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$118.59
|
|
|
XR Hand Complete Right
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 73130 RT
|
| Hospital Charge Code |
1170223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.45 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Aetna of IA Commercial |
$180.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$180.90
|
| Rate for Payer: Aetna of IA Medicare |
$114.57
|
| Rate for Payer: Amerigroup Medicaid |
$115.94
|
| Rate for Payer: Amerigroup Medicare |
$91.35
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$150.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$114.81
|
| Rate for Payer: Medical Associates Commercial |
$150.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.45
|
| Rate for Payer: Midlands Choice Commercial |
$140.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$116.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.02
|
| Rate for Payer: United Healthcare Commercial |
$180.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$118.59
|
|
|
XR Hand Complete Right
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 73130 RT
|
| Hospital Charge Code |
1170223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$140.70 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Aetna of IA Commercial |
$180.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$180.90
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$150.75
|
| Rate for Payer: Medical Associates Commercial |
$150.75
|
| Rate for Payer: Midlands Choice Commercial |
$140.70
|
| Rate for Payer: United Healthcare Commercial |
$180.90
|
|
|
XR Hip 1 View Left
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
1170225
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.35 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna of IA Commercial |
$146.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.70
|
| Rate for Payer: Aetna of IA Medicare |
$92.91
|
| Rate for Payer: Amerigroup Medicaid |
$94.02
|
| Rate for Payer: Amerigroup Medicare |
$74.08
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$122.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$93.11
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.35
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$94.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$84.35
|
| Rate for Payer: United Healthcare Commercial |
$146.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$96.17
|
|
|
XR Hip 1 View Left
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
1170225
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.10 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna of IA Commercial |
$146.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.70
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$122.25
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: United Healthcare Commercial |
$146.70
|
|
|
XR Hip 1 View Lt w/ Pelvis
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
8025370
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.35 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna of IA Commercial |
$146.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.70
|
| Rate for Payer: Aetna of IA Medicare |
$92.91
|
| Rate for Payer: Amerigroup Medicaid |
$94.02
|
| Rate for Payer: Amerigroup Medicare |
$74.08
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$122.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$93.11
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.35
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$94.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$84.35
|
| Rate for Payer: United Healthcare Commercial |
$146.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$96.17
|
|
|
XR Hip 1 View Lt w/ Pelvis
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
8025370
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.10 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna of IA Commercial |
$146.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.70
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$122.25
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: United Healthcare Commercial |
$146.70
|
|
|
XR Hip 1 View Right
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 73501 RT
|
| Hospital Charge Code |
1170227
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.35 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna of IA Commercial |
$146.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.70
|
| Rate for Payer: Aetna of IA Medicare |
$92.91
|
| Rate for Payer: Amerigroup Medicaid |
$94.02
|
| Rate for Payer: Amerigroup Medicare |
$74.08
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$122.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$93.11
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.35
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$94.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$84.35
|
| Rate for Payer: United Healthcare Commercial |
$146.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$96.17
|
|
|
XR Hip 1 View Right
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 73501 RT
|
| Hospital Charge Code |
1170227
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.10 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna of IA Commercial |
$146.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.70
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$122.25
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: United Healthcare Commercial |
$146.70
|
|
|
XR Hip 1 View Rt w/ Pelvis
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 73501 RT
|
| Hospital Charge Code |
8025373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.10 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna of IA Commercial |
$146.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.70
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$122.25
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: United Healthcare Commercial |
$146.70
|
|
|
XR Hip 1 View Rt w/ Pelvis
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 73501 RT
|
| Hospital Charge Code |
8025373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.35 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna of IA Commercial |
$146.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.70
|
| Rate for Payer: Aetna of IA Medicare |
$92.91
|
| Rate for Payer: Amerigroup Medicaid |
$94.02
|
| Rate for Payer: Amerigroup Medicare |
$74.08
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$122.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$93.11
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.35
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$94.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$84.35
|
| Rate for Payer: United Healthcare Commercial |
$146.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$96.17
|
|
|
XR Hip 2-3 Views Lt w/ Pelvis
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 73502 LT
|
| Hospital Charge Code |
8025376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.10 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna of IA Commercial |
$146.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.70
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$122.25
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: United Healthcare Commercial |
$146.70
|
|
|
XR Hip 2-3 Views Lt w/ Pelvis
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 73502 LT
|
| Hospital Charge Code |
8025376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.35 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna of IA Commercial |
$146.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.70
|
| Rate for Payer: Aetna of IA Medicare |
$92.91
|
| Rate for Payer: Amerigroup Medicaid |
$94.02
|
| Rate for Payer: Amerigroup Medicare |
$74.08
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$122.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$93.11
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.35
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$94.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$84.35
|
| Rate for Payer: United Healthcare Commercial |
$146.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$96.17
|
|
|
XR Hip 2-3 Views Rt w/ Pelvis
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 73502 RT
|
| Hospital Charge Code |
8025379
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.10 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna of IA Commercial |
$146.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.70
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$122.25
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: United Healthcare Commercial |
$146.70
|
|
|
XR Hip 2-3 Views Rt w/ Pelvis
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 73502 RT
|
| Hospital Charge Code |
8025379
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.35 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna of IA Commercial |
$146.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.70
|
| Rate for Payer: Aetna of IA Medicare |
$92.91
|
| Rate for Payer: Amerigroup Medicaid |
$94.02
|
| Rate for Payer: Amerigroup Medicare |
$74.08
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$122.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$93.11
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.35
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$94.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$84.35
|
| Rate for Payer: United Healthcare Commercial |
$146.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$96.17
|
|
|
XR Hip Bilateral w/Pelvis
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 73520 50
|
| Hospital Charge Code |
1170229
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$142.65 |
| Max. Negotiated Rate |
$285.30 |
| Rate for Payer: Aetna of IA Commercial |
$285.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$285.30
|
| Rate for Payer: Aetna of IA Medicare |
$180.69
|
| Rate for Payer: Amerigroup Medicaid |
$182.85
|
| Rate for Payer: Amerigroup Medicare |
$144.08
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$237.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$142.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$181.07
|
| Rate for Payer: Medical Associates Commercial |
$237.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$142.65
|
| Rate for Payer: Midlands Choice Commercial |
$221.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$183.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$164.05
|
| Rate for Payer: United Healthcare Commercial |
$285.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$187.03
|
|
|
XR Hip Bilateral w/Pelvis
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 73520 50
|
| Hospital Charge Code |
1170229
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$221.90 |
| Max. Negotiated Rate |
$285.30 |
| Rate for Payer: Aetna of IA Commercial |
$285.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$285.30
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$237.75
|
| Rate for Payer: Medical Associates Commercial |
$237.75
|
| Rate for Payer: Midlands Choice Commercial |
$221.90
|
| Rate for Payer: United Healthcare Commercial |
$285.30
|
|
|
XR Hip Complete Left
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 73510 LT
|
| Hospital Charge Code |
1170233
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna of IA Commercial |
$151.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$151.20
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$126.00
|
| Rate for Payer: Medical Associates Commercial |
$126.00
|
| Rate for Payer: Midlands Choice Commercial |
$117.60
|
| Rate for Payer: United Healthcare Commercial |
$151.20
|
|
|
XR Hip Complete Left
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 73510 LT
|
| Hospital Charge Code |
1170233
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna of IA Commercial |
$151.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$151.20
|
| Rate for Payer: Aetna of IA Medicare |
$95.76
|
| Rate for Payer: Amerigroup Medicaid |
$96.90
|
| Rate for Payer: Amerigroup Medicare |
$76.36
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$126.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$75.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$95.96
|
| Rate for Payer: Medical Associates Commercial |
$126.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.60
|
| Rate for Payer: Midlands Choice Commercial |
$117.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$97.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$86.94
|
| Rate for Payer: United Healthcare Commercial |
$151.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$99.12
|
|
|
XR Hip Complete Right
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 73510 RT
|
| Hospital Charge Code |
1170235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna of IA Commercial |
$151.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$151.20
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$126.00
|
| Rate for Payer: Medical Associates Commercial |
$126.00
|
| Rate for Payer: Midlands Choice Commercial |
$117.60
|
| Rate for Payer: United Healthcare Commercial |
$151.20
|
|
|
XR Hip Complete Right
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 73510 RT
|
| Hospital Charge Code |
1170235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna of IA Commercial |
$151.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$151.20
|
| Rate for Payer: Aetna of IA Medicare |
$95.76
|
| Rate for Payer: Amerigroup Medicaid |
$96.90
|
| Rate for Payer: Amerigroup Medicare |
$76.36
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$126.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$75.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$95.96
|
| Rate for Payer: Medical Associates Commercial |
$126.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.60
|
| Rate for Payer: Midlands Choice Commercial |
$117.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$97.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$86.94
|
| Rate for Payer: United Healthcare Commercial |
$151.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$99.12
|
|
