|
XR Fluoro Cath Placement
|
Facility
IP
|
$549.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
7960838
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$384.30 |
| Max. Negotiated Rate |
$494.10 |
| Rate for Payer: Aetna of IA Commercial |
$494.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$494.10
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$411.75
|
| Rate for Payer: Medical Associates Commercial |
$411.75
|
| Rate for Payer: Midlands Choice Commercial |
$384.30
|
| Rate for Payer: United Healthcare Commercial |
$494.10
|
|
|
XR Fluoro GI Tube Placement
|
Facility
IP
|
$830.00
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
7960841
|
|
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 GI Tube Placement
|
Facility
OP
|
$830.00
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
7960841
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$414.83 |
| 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 |
$655.34
|
| Rate for Payer: Wellmark IA PPO |
$720.87
|
|
|
XR Fluoro Guidance Needle Loc Spine
|
Facility
IP
|
$437.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
1170173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$305.90 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna of IA Commercial |
$393.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$393.30
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$327.75
|
| Rate for Payer: Medical Associates Commercial |
$327.75
|
| Rate for Payer: Midlands Choice Commercial |
$305.90
|
| Rate for Payer: United Healthcare Commercial |
$393.30
|
|
|
XR Fluoro Guidance Needle Loc Spine
|
Facility
OP
|
$437.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
1170173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.41 |
| Max. Negotiated Rate |
$720.87 |
| Rate for Payer: Aetna of IA Commercial |
$393.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$393.30
|
| Rate for Payer: Aetna of IA Medicare |
$249.09
|
| Rate for Payer: Amerigroup Medicaid |
$220.55
|
| Rate for Payer: Amerigroup Medicare |
$220.68
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$327.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$218.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$218.41
|
| Rate for Payer: Medical Associates Commercial |
$327.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$218.50
|
| Rate for Payer: Midlands Choice Commercial |
$305.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$221.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$327.75
|
| Rate for Payer: United Healthcare Commercial |
$393.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$257.83
|
| Rate for Payer: Wellmark IA HMO |
$655.34
|
| Rate for Payer: Wellmark IA PPO |
$720.87
|
|
|
XR Fluoro Guidance Needle Placement
|
Facility
IP
|
$735.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
1170175
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$514.50 |
| Max. Negotiated Rate |
$661.50 |
| Rate for Payer: Aetna of IA Commercial |
$661.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$661.50
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$551.25
|
| Rate for Payer: Medical Associates Commercial |
$551.25
|
| Rate for Payer: Midlands Choice Commercial |
$514.50
|
| Rate for Payer: United Healthcare Commercial |
$661.50
|
|
|
XR Fluoro Guidance Needle Placement
|
Facility
OP
|
$735.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
1170175
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$367.35 |
| Max. Negotiated Rate |
$720.87 |
| Rate for Payer: Aetna of IA Commercial |
$661.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$661.50
|
| Rate for Payer: Aetna of IA Medicare |
$418.95
|
| Rate for Payer: Amerigroup Medicaid |
$370.95
|
| Rate for Payer: Amerigroup Medicare |
$371.18
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$551.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$367.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$367.35
|
| Rate for Payer: Medical Associates Commercial |
$551.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$367.50
|
| Rate for Payer: Midlands Choice Commercial |
$514.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$373.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$551.25
|
| Rate for Payer: United Healthcare Commercial |
$661.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$433.65
|
| Rate for Payer: Wellmark IA HMO |
$655.34
|
| Rate for Payer: Wellmark IA PPO |
$720.87
|
|
|
XR Fluoroscopy Over 1 Hour Non Rad
|
Facility
OP
|
$354.00
|
|
|
Service Code
|
CPT 76001
|
| Hospital Charge Code |
1170177
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.93 |
| Max. Negotiated Rate |
$318.60 |
| Rate for Payer: Aetna of IA Commercial |
$318.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$318.60
|
| Rate for Payer: Aetna of IA Medicare |
$201.78
|
| Rate for Payer: Amerigroup Medicaid |
$178.66
|
| Rate for Payer: Amerigroup Medicare |
$178.77
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$265.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$177.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$176.93
|
| Rate for Payer: Medical Associates Commercial |
$265.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$177.00
|
| Rate for Payer: Midlands Choice Commercial |
$247.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$179.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$265.50
|
| Rate for Payer: United Healthcare Commercial |
$318.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$208.86
|
|
|
XR Fluoroscopy Over 1 Hour Non Rad
|
Facility
IP
|
$354.00
|
|
|
Service Code
|
CPT 76001
|
| Hospital Charge Code |
1170177
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$247.80 |
| Max. Negotiated Rate |
$318.60 |
| Rate for Payer: Aetna of IA Commercial |
$318.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$318.60
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$265.50
|
| Rate for Payer: Medical Associates Commercial |
$265.50
|
| Rate for Payer: Midlands Choice Commercial |
$247.80
|
| Rate for Payer: United Healthcare Commercial |
$318.60
|
|
|
XR Fluoroscopy Up to 1 Hour
|
Facility
OP
|
$221.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
1170181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.46 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of IA Commercial |
$198.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.90
|
| Rate for Payer: Aetna of IA Medicare |
$125.97
|
| Rate for Payer: Amerigroup Medicaid |
$111.54
|
| Rate for Payer: Amerigroup Medicare |
$111.60
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$110.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$110.46
|
| Rate for Payer: Medical Associates Commercial |
$165.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$110.50
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$112.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$165.75
|
| Rate for Payer: United Healthcare Commercial |
$198.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$130.39
|
| Rate for Payer: Wellmark IA HMO |
$178.56
|
| Rate for Payer: Wellmark IA PPO |
$196.42
|
|
|
XR Fluoroscopy Up to 1 Hour
|
Facility
IP
|
$221.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
1170181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of IA Commercial |
$198.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.90
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.75
|
| Rate for Payer: Medical Associates Commercial |
$165.75
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: United Healthcare Commercial |
$198.90
|
|
|
XR Fluoroscopy Up to 1 Hour NR
|
Facility
IP
|
$221.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5702788
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of IA Commercial |
$198.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.90
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.75
|
| Rate for Payer: Medical Associates Commercial |
$165.75
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: United Healthcare Commercial |
$198.90
|
|
|
XR Fluoroscopy Up to 1 Hour NR
|
Facility
OP
|
$221.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5702788
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.46 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of IA Commercial |
$198.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.90
|
| Rate for Payer: Aetna of IA Medicare |
$125.97
|
| Rate for Payer: Amerigroup Medicaid |
$111.54
|
| Rate for Payer: Amerigroup Medicare |
$111.60
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$110.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$110.46
|
| Rate for Payer: Medical Associates Commercial |
$165.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$110.50
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$112.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$165.75
|
| Rate for Payer: United Healthcare Commercial |
$198.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$130.39
|
| Rate for Payer: Wellmark IA HMO |
$178.56
|
| Rate for Payer: Wellmark IA PPO |
$196.42
|
|
|
XR Foot 2 Views Left
|
Facility
OP
|
$127.00
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
1170185
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.47 |
| 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 |
$64.10
|
| Rate for Payer: Amerigroup Medicare |
$64.14
|
| 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 |
$63.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$63.47
|
| Rate for Payer: Medical Associates Commercial |
$95.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$63.50
|
| Rate for Payer: Midlands Choice Commercial |
$88.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$64.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$95.25
|
| Rate for Payer: United Healthcare Commercial |
$114.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$74.93
|
|
|
XR Foot 2 Views Left
|
Facility
IP
|
$127.00
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
1170185
|
|
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 Foot 2 Views Right
|
Facility
OP
|
$127.00
|
|
|
Service Code
|
CPT 73620 RT
|
| Hospital Charge Code |
1170187
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.47 |
| 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 |
$64.10
|
| Rate for Payer: Amerigroup Medicare |
$64.14
|
| 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 |
$63.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$63.47
|
| Rate for Payer: Medical Associates Commercial |
$95.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$63.50
|
| Rate for Payer: Midlands Choice Commercial |
$88.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$64.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$95.25
|
| Rate for Payer: United Healthcare Commercial |
$114.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$74.93
|
|
|
XR Foot 2 Views Right
|
Facility
IP
|
$127.00
|
|
|
Service Code
|
CPT 73620 RT
|
| Hospital Charge Code |
1170187
|
|
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 Foot Complete Left
|
Facility
OP
|
$146.00
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
1170191
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.97 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of IA Commercial |
$131.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
| Rate for Payer: Aetna of IA Medicare |
$83.22
|
| Rate for Payer: Amerigroup Medicaid |
$73.69
|
| Rate for Payer: Amerigroup Medicare |
$73.73
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$72.97
|
| Rate for Payer: Medical Associates Commercial |
$109.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.00
|
| Rate for Payer: Midlands Choice Commercial |
$102.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$109.50
|
| Rate for Payer: United Healthcare Commercial |
$131.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.14
|
|
|
XR Foot Complete Left
|
Facility
IP
|
$146.00
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
1170191
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.20 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of IA Commercial |
$131.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
| Rate for Payer: Medical Associates Commercial |
$109.50
|
| Rate for Payer: Midlands Choice Commercial |
$102.20
|
| Rate for Payer: United Healthcare Commercial |
$131.40
|
|
|
XR Foot Complete Right
|
Facility
OP
|
$146.00
|
|
|
Service Code
|
CPT 73630 RT
|
| Hospital Charge Code |
1170193
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.97 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of IA Commercial |
$131.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
| Rate for Payer: Aetna of IA Medicare |
$83.22
|
| Rate for Payer: Amerigroup Medicaid |
$73.69
|
| Rate for Payer: Amerigroup Medicare |
$73.73
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$72.97
|
| Rate for Payer: Medical Associates Commercial |
$109.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.00
|
| Rate for Payer: Midlands Choice Commercial |
$102.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$109.50
|
| Rate for Payer: United Healthcare Commercial |
$131.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.14
|
|
|
XR Foot Complete Right
|
Facility
IP
|
$146.00
|
|
|
Service Code
|
CPT 73630 RT
|
| Hospital Charge Code |
1170193
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.20 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of IA Commercial |
$131.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
| Rate for Payer: Medical Associates Commercial |
$109.50
|
| Rate for Payer: Midlands Choice Commercial |
$102.20
|
| Rate for Payer: United Healthcare Commercial |
$131.40
|
|
|
XR Forearm 2 Views Left
|
Facility
OP
|
$132.00
|
|
|
Service Code
|
CPT 73090 LT
|
| Hospital Charge Code |
1170197
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.97 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna of IA Commercial |
$118.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$118.80
|
| Rate for Payer: Aetna of IA Medicare |
$75.24
|
| Rate for Payer: Amerigroup Medicaid |
$66.62
|
| Rate for Payer: Amerigroup Medicare |
$66.66
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$99.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$66.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.97
|
| Rate for Payer: Medical Associates Commercial |
$99.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$66.00
|
| Rate for Payer: Midlands Choice Commercial |
$92.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$118.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$77.88
|
|
|
XR Forearm 2 Views Left
|
Facility
IP
|
$132.00
|
|
|
Service Code
|
CPT 73090 LT
|
| Hospital Charge Code |
1170197
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna of IA Commercial |
$118.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$118.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$99.00
|
| Rate for Payer: Medical Associates Commercial |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$118.80
|
|
|
XR Forearm 2 Views Right
|
Facility
IP
|
$132.00
|
|
|
Service Code
|
CPT 73090 RT
|
| Hospital Charge Code |
1170199
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna of IA Commercial |
$118.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$118.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$99.00
|
| Rate for Payer: Medical Associates Commercial |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$118.80
|
|
|
XR Forearm 2 Views Right
|
Facility
OP
|
$132.00
|
|
|
Service Code
|
CPT 73090 RT
|
| Hospital Charge Code |
1170199
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.97 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna of IA Commercial |
$118.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$118.80
|
| Rate for Payer: Aetna of IA Medicare |
$75.24
|
| Rate for Payer: Amerigroup Medicaid |
$66.62
|
| Rate for Payer: Amerigroup Medicare |
$66.66
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$99.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$66.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.97
|
| Rate for Payer: Medical Associates Commercial |
$99.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$66.00
|
| Rate for Payer: Midlands Choice Commercial |
$92.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$118.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$77.88
|
|
