|
XR Chest Decubitus Left
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 71035 LT
|
| Hospital Charge Code |
1170049
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$87.96 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna of IA Commercial |
$158.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$158.40
|
| Rate for Payer: Aetna of IA Medicare |
$100.32
|
| Rate for Payer: Amerigroup Medicaid |
$88.83
|
| Rate for Payer: Amerigroup Medicare |
$88.88
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$88.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$87.96
|
| Rate for Payer: Medical Associates Commercial |
$132.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.00
|
| Rate for Payer: Midlands Choice Commercial |
$123.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$89.32
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$89.27
|
| Rate for Payer: Oscar Health of IA Commercial |
$132.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$158.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.84
|
|
|
XR Chest Decubitus Right
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 71035 RT
|
| Hospital Charge Code |
1170051
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna of IA Commercial |
$158.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$158.40
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.00
|
| Rate for Payer: Medical Associates Commercial |
$132.00
|
| Rate for Payer: Midlands Choice Commercial |
$123.20
|
| Rate for Payer: United Healthcare Commercial |
$158.40
|
|
|
XR Chest Decubitus Right
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 71035 RT
|
| Hospital Charge Code |
1170051
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$87.96 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna of IA Commercial |
$158.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$158.40
|
| Rate for Payer: Aetna of IA Medicare |
$100.32
|
| Rate for Payer: Amerigroup Medicaid |
$88.83
|
| Rate for Payer: Amerigroup Medicare |
$88.88
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$88.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$87.96
|
| Rate for Payer: Medical Associates Commercial |
$132.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.00
|
| Rate for Payer: Midlands Choice Commercial |
$123.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$89.32
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$89.27
|
| Rate for Payer: Oscar Health of IA Commercial |
$132.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$158.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.84
|
|
|
XR CHEST MINIMUM 4 VIEWS
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
1170053
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$59.52 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna of IA Commercial |
$158.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$158.40
|
| Rate for Payer: Aetna of IA Medicare |
$100.32
|
| Rate for Payer: Amerigroup Medicaid |
$88.83
|
| Rate for Payer: Amerigroup Medicare |
$88.88
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$88.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$87.96
|
| Rate for Payer: Medical Associates Commercial |
$132.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.00
|
| Rate for Payer: Midlands Choice Commercial |
$123.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$89.32
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$89.27
|
| Rate for Payer: Oscar Health of IA Commercial |
$132.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$158.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.84
|
| Rate for Payer: Wellmark IA HMO |
$59.52
|
| Rate for Payer: Wellmark IA PPO |
$65.47
|
|
|
XR CHEST MINIMUM 4 VIEWS
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
1170053
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna of IA Commercial |
$158.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$158.40
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.00
|
| Rate for Payer: Medical Associates Commercial |
$132.00
|
| Rate for Payer: Midlands Choice Commercial |
$123.20
|
| Rate for Payer: United Healthcare Commercial |
$158.40
|
|
|
XR Cholangiogram in OR
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
1170065
|
|
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: Molina Healthcare Managed Medicare |
$420.98
|
| Rate for Payer: Oscar Health of IA Commercial |
$622.50
|
| 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 Cholangiogram in OR
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
1170065
|
|
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 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: Molina Healthcare Managed Medicare |
$76.59
|
| Rate for Payer: Oscar Health of IA Commercial |
$113.25
|
| 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 Left
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 73000 LT
|
| Hospital Charge Code |
1170075
|
|
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 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: Molina Healthcare Managed Medicare |
$76.59
|
| Rate for Payer: Oscar Health of IA Commercial |
$113.25
|
| 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
|
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 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: Molina Healthcare Managed Medicare |
$176.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$260.25
|
| 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 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: Molina Healthcare Managed Medicare |
$73.54
|
| Rate for Payer: Oscar Health of IA Commercial |
$108.75
|
| 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 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 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 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: Molina Healthcare Managed Medicare |
$73.54
|
| Rate for Payer: Oscar Health of IA Commercial |
$108.75
|
| 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 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: Molina Healthcare Managed Medicare |
$76.59
|
| Rate for Payer: Oscar Health of IA Commercial |
$113.25
|
| 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: Molina Healthcare Managed Medicare |
$76.59
|
| Rate for Payer: Oscar Health of IA Commercial |
$113.25
|
| 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
|
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: Molina Healthcare Managed Medicare |
$141.51
|
| Rate for Payer: Oscar Health of IA Commercial |
$209.25
|
| 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 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 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 < 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: Molina Healthcare Managed Medicare |
$76.59
|
| Rate for Payer: Oscar Health of IA Commercial |
$113.25
|
| 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
|
|
