|
XR Hysterosalpingography
|
Facility
OP
|
$830.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
1170249
|
|
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 Hysterosalpingography
|
Facility
IP
|
$830.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
1170249
|
|
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 Inj Arthrogram Shoulder LT
|
Facility
OP
|
$218.00
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
7820769
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.96 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Aetna of IA Commercial |
$196.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$196.20
|
| Rate for Payer: Aetna of IA Medicare |
$124.26
|
| Rate for Payer: Amerigroup Medicaid |
$110.02
|
| Rate for Payer: Amerigroup Medicare |
$110.09
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$163.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$109.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$108.96
|
| Rate for Payer: Medical Associates Commercial |
$163.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$109.00
|
| Rate for Payer: Midlands Choice Commercial |
$152.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$110.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$163.50
|
| Rate for Payer: United Healthcare Commercial |
$196.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$128.62
|
|
|
XR Inj Arthrogram Shoulder LT
|
Facility
IP
|
$218.00
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
7820769
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Aetna of IA Commercial |
$196.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$196.20
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$163.50
|
| Rate for Payer: Medical Associates Commercial |
$163.50
|
| Rate for Payer: Midlands Choice Commercial |
$152.60
|
| Rate for Payer: United Healthcare Commercial |
$196.20
|
|
|
XR Inj Arthrogram Shoulder RT
|
Facility
IP
|
$218.00
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
7820772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Aetna of IA Commercial |
$196.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$196.20
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$163.50
|
| Rate for Payer: Medical Associates Commercial |
$163.50
|
| Rate for Payer: Midlands Choice Commercial |
$152.60
|
| Rate for Payer: United Healthcare Commercial |
$196.20
|
|
|
XR Inj Arthrogram Shoulder RT
|
Facility
OP
|
$218.00
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
7820772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.96 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Aetna of IA Commercial |
$196.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$196.20
|
| Rate for Payer: Aetna of IA Medicare |
$124.26
|
| Rate for Payer: Amerigroup Medicaid |
$110.02
|
| Rate for Payer: Amerigroup Medicare |
$110.09
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$163.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$109.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$108.96
|
| Rate for Payer: Medical Associates Commercial |
$163.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$109.00
|
| Rate for Payer: Midlands Choice Commercial |
$152.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$110.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$163.50
|
| Rate for Payer: United Healthcare Commercial |
$196.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$128.62
|
|
|
XR IVP
|
Facility
IP
|
$459.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
1170251
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$321.30 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna of IA Commercial |
$413.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$413.10
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$344.25
|
| Rate for Payer: Medical Associates Commercial |
$344.25
|
| Rate for Payer: Midlands Choice Commercial |
$321.30
|
| Rate for Payer: United Healthcare Commercial |
$413.10
|
|
|
XR IVP
|
Facility
OP
|
$459.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
1170251
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.56 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna of IA Commercial |
$413.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$413.10
|
| Rate for Payer: Aetna of IA Medicare |
$261.63
|
| Rate for Payer: Amerigroup Medicaid |
$231.66
|
| Rate for Payer: Amerigroup Medicare |
$231.80
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$344.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$229.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$229.41
|
| Rate for Payer: Medical Associates Commercial |
$344.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$229.50
|
| Rate for Payer: Midlands Choice Commercial |
$321.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$232.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$344.25
|
| Rate for Payer: United Healthcare Commercial |
$413.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$270.81
|
| Rate for Payer: Wellmark IA HMO |
$178.56
|
| Rate for Payer: Wellmark IA PPO |
$196.42
|
|
|
XR Knee 1 or 2 Views Left
|
Facility
OP
|
$138.00
|
|
|
Service Code
|
CPT 73560 LT
|
| Hospital Charge Code |
1170263
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of IA Commercial |
$124.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$124.20
|
| Rate for Payer: Aetna of IA Medicare |
$78.66
|
| Rate for Payer: Amerigroup Medicaid |
$69.65
|
| Rate for Payer: Amerigroup Medicare |
$69.69
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$68.97
|
| Rate for Payer: Medical Associates Commercial |
$103.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.00
|
| Rate for Payer: Midlands Choice Commercial |
$96.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$103.50
|
| Rate for Payer: United Healthcare Commercial |
$124.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$81.42
|
|
|
XR Knee 1 or 2 Views Left
|
Facility
IP
|
$138.00
|
|
|
Service Code
|
CPT 73560 LT
|
| Hospital Charge Code |
1170263
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of IA Commercial |
$124.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$124.20
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.50
|
| Rate for Payer: Medical Associates Commercial |
$103.50
|
| Rate for Payer: Midlands Choice Commercial |
$96.60
|
| Rate for Payer: United Healthcare Commercial |
$124.20
|
|
|
XR Knee 1 or 2 Views Right
|
Facility
IP
|
$138.00
|
|
|
Service Code
|
CPT 73560 RT
|
| Hospital Charge Code |
1170265
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of IA Commercial |
$124.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$124.20
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.50
|
| Rate for Payer: Medical Associates Commercial |
$103.50
|
| Rate for Payer: Midlands Choice Commercial |
$96.60
|
| Rate for Payer: United Healthcare Commercial |
$124.20
|
|
|
XR Knee 1 or 2 Views Right
|
Facility
OP
|
$138.00
|
|
|
Service Code
|
CPT 73560 RT
|
| Hospital Charge Code |
1170265
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of IA Commercial |
$124.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$124.20
|
| Rate for Payer: Aetna of IA Medicare |
$78.66
|
| Rate for Payer: Amerigroup Medicaid |
$69.65
|
| Rate for Payer: Amerigroup Medicare |
$69.69
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$68.97
|
| Rate for Payer: Medical Associates Commercial |
$103.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.00
|
| Rate for Payer: Midlands Choice Commercial |
$96.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$103.50
|
| Rate for Payer: United Healthcare Commercial |
$124.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$81.42
|
|
|
XR Knee 3 Views Left
|
Facility
IP
|
$147.00
|
|
|
Service Code
|
CPT 73562 LT
|
| Hospital Charge Code |
1170269
|
|
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 Knee 3 Views Left
|
Facility
OP
|
$147.00
|
|
|
Service Code
|
CPT 73562 LT
|
| Hospital Charge Code |
1170269
|
|
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 Knee 3 Views Right
|
Facility
IP
|
$147.00
|
|
|
Service Code
|
CPT 73562 RT
|
| Hospital Charge Code |
1170271
|
|
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 Knee 3 Views Right
|
Facility
OP
|
$147.00
|
|
|
Service Code
|
CPT 73562 RT
|
| Hospital Charge Code |
1170271
|
|
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 Knee 4 Views w/ Patella Left
|
Facility
OP
|
$176.00
|
|
|
Service Code
|
CPT 73564 LT
|
| Hospital Charge Code |
1170273
|
|
Hospital Revenue Code
|
320
|
| 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: Partners Health Alliance Commercial |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$158.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.84
|
|
|
XR Knee 4 Views w/ Patella Left
|
Facility
IP
|
$176.00
|
|
|
Service Code
|
CPT 73564 LT
|
| Hospital Charge Code |
1170273
|
|
Hospital Revenue Code
|
320
|
| 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 Knee 4 Views w/ Patella Right
|
Facility
OP
|
$176.00
|
|
|
Service Code
|
CPT 73564 RT
|
| Hospital Charge Code |
1170276
|
|
Hospital Revenue Code
|
320
|
| 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: Partners Health Alliance Commercial |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$158.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.84
|
|
|
XR Knee 4 Views w/ Patella Right
|
Facility
IP
|
$176.00
|
|
|
Service Code
|
CPT 73564 RT
|
| Hospital Charge Code |
1170276
|
|
Hospital Revenue Code
|
320
|
| 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 Knee 4 Views w/ Tunnel + Sunrise Left
|
Facility
IP
|
$176.00
|
|
|
Service Code
|
CPT 73564 LT
|
| Hospital Charge Code |
1170279
|
|
Hospital Revenue Code
|
320
|
| 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 Knee 4 Views w/ Tunnel + Sunrise Left
|
Facility
OP
|
$176.00
|
|
|
Service Code
|
CPT 73564 LT
|
| Hospital Charge Code |
1170279
|
|
Hospital Revenue Code
|
320
|
| 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: Partners Health Alliance Commercial |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$158.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.84
|
|
|
XR Knee 4 Views w/ Tunnel + Sunrise Righ
|
Facility
IP
|
$176.00
|
|
|
Service Code
|
CPT 73564 RT
|
| Hospital Charge Code |
1170282
|
|
Hospital Revenue Code
|
320
|
| 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 Knee 4 Views w/ Tunnel + Sunrise Righ
|
Facility
OP
|
$176.00
|
|
|
Service Code
|
CPT 73564 RT
|
| Hospital Charge Code |
1170282
|
|
Hospital Revenue Code
|
320
|
| 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: Partners Health Alliance Commercial |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$158.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.84
|
|
|
XR Knee Standing AP Bilateral
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 73565 50
|
| Hospital Charge Code |
1170291
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.47 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
|
