|
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: Molina Healthcare Managed Medicare |
$74.05
|
| Rate for Payer: Oscar Health of IA Commercial |
$109.50
|
| 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
|
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 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: Molina Healthcare Managed Medicare |
$74.05
|
| Rate for Payer: Oscar Health of IA Commercial |
$109.50
|
| 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 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 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: Molina Healthcare Managed Medicare |
$66.95
|
| Rate for Payer: Oscar Health of IA Commercial |
$99.00
|
| 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 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: Molina Healthcare Managed Medicare |
$66.95
|
| Rate for Payer: Oscar Health of IA Commercial |
$99.00
|
| 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 Foreign Body Loc Eye Bilateral
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 70030 50
|
| Hospital Charge Code |
1170201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.97 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Aetna of IA Commercial |
$138.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$138.60
|
| Rate for Payer: Aetna of IA Medicare |
$87.78
|
| Rate for Payer: Amerigroup Medicaid |
$77.72
|
| Rate for Payer: Amerigroup Medicare |
$77.77
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$115.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$77.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$76.97
|
| Rate for Payer: Medical Associates Commercial |
$115.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$77.00
|
| Rate for Payer: Midlands Choice Commercial |
$107.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$78.16
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$78.11
|
| Rate for Payer: Oscar Health of IA Commercial |
$115.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$138.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$90.86
|
|
|
XR Foreign Body Loc Eye Bilateral
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 70030 50
|
| Hospital Charge Code |
1170201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Aetna of IA Commercial |
$138.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$138.60
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$115.50
|
| Rate for Payer: Medical Associates Commercial |
$115.50
|
| Rate for Payer: Midlands Choice Commercial |
$107.80
|
| Rate for Payer: United Healthcare Commercial |
$138.60
|
|
|
XR Gastrografin Enema
|
Facility
|
OP
|
$718.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1170209
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.56 |
| Max. Negotiated Rate |
$646.20 |
| Rate for Payer: Aetna of IA Commercial |
$646.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$646.20
|
| Rate for Payer: Aetna of IA Medicare |
$409.26
|
| Rate for Payer: Amerigroup Medicaid |
$362.37
|
| Rate for Payer: Amerigroup Medicare |
$362.59
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$538.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$359.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$358.86
|
| Rate for Payer: Medical Associates Commercial |
$538.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$359.00
|
| Rate for Payer: Midlands Choice Commercial |
$502.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$364.38
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$364.17
|
| Rate for Payer: Oscar Health of IA Commercial |
$538.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$538.50
|
| Rate for Payer: United Healthcare Commercial |
$646.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$423.62
|
| Rate for Payer: Wellmark IA HMO |
$178.56
|
| Rate for Payer: Wellmark IA PPO |
$196.42
|
|
|
XR Gastrografin Enema
|
Facility
|
IP
|
$718.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1170209
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$502.60 |
| Max. Negotiated Rate |
$646.20 |
| Rate for Payer: Aetna of IA Commercial |
$646.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$646.20
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$538.50
|
| Rate for Payer: Medical Associates Commercial |
$538.50
|
| Rate for Payer: Midlands Choice Commercial |
$502.60
|
| Rate for Payer: United Healthcare Commercial |
$646.20
|
|
|
XR GI Tube Inj for Placement
|
Facility
|
IP
|
$432.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
7960844
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$302.40 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna of IA Commercial |
$388.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$388.80
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$324.00
|
| Rate for Payer: Medical Associates Commercial |
$324.00
|
| Rate for Payer: Midlands Choice Commercial |
$302.40
|
| Rate for Payer: United Healthcare Commercial |
$388.80
|
|
|
XR GI Tube Inj for Placement
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
7960844
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.56 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna of IA Commercial |
$388.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$388.80
|
| Rate for Payer: Aetna of IA Medicare |
$246.24
|
| Rate for Payer: Amerigroup Medicaid |
$218.03
|
| Rate for Payer: Amerigroup Medicare |
$218.16
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$324.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$216.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$215.91
|
| Rate for Payer: Medical Associates Commercial |
$324.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$216.00
|
| Rate for Payer: Midlands Choice Commercial |
$302.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$219.24
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$219.11
|
| Rate for Payer: Oscar Health of IA Commercial |
$324.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$324.00
|
| Rate for Payer: United Healthcare Commercial |
$388.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$254.88
|
| Rate for Payer: Wellmark IA HMO |
$178.56
|
| Rate for Payer: Wellmark IA PPO |
$196.42
|
|
|
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 |
$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: Molina Healthcare Managed Medicare |
$64.41
|
| Rate for Payer: Oscar Health of IA Commercial |
$95.25
|
| 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 Hand 2 Views Left
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 73120 LT
|
| Hospital Charge Code |
1170215
|
|
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 2 Views Right
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 73120 RT
|
| Hospital Charge Code |
1170217
|
|
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: Molina Healthcare Managed Medicare |
$64.41
|
| Rate for Payer: Oscar Health of IA Commercial |
$95.25
|
| 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 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
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 73130 LT
|
| Hospital Charge Code |
1170221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.46 |
| 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 |
$101.44
|
| Rate for Payer: Amerigroup Medicare |
$101.50
|
| 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 |
$100.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.46
|
| Rate for Payer: Medical Associates Commercial |
$150.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$100.50
|
| Rate for Payer: Midlands Choice Commercial |
$140.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.01
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$101.95
|
| Rate for Payer: Oscar Health of IA Commercial |
$150.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$150.75
|
| Rate for Payer: United Healthcare Commercial |
$180.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$118.59
|
|
|
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 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 Hand Complete Right
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 73130 RT
|
| Hospital Charge Code |
1170223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.46 |
| 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 |
$101.44
|
| Rate for Payer: Amerigroup Medicare |
$101.50
|
| 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 |
$100.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.46
|
| Rate for Payer: Medical Associates Commercial |
$150.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$100.50
|
| Rate for Payer: Midlands Choice Commercial |
$140.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.01
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$101.95
|
| Rate for Payer: Oscar Health of IA Commercial |
$150.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$150.75
|
| Rate for Payer: United Healthcare Commercial |
$180.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$118.59
|
|
|
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 Left
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
1170225
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.47 |
| 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 |
$82.27
|
| Rate for Payer: Amerigroup Medicare |
$82.32
|
| 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 |
$81.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$81.47
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.50
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$82.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$82.67
|
| Rate for Payer: Oscar Health of IA Commercial |
$122.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$122.25
|
| 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
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
8025370
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.47 |
| 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 |
$82.27
|
| Rate for Payer: Amerigroup Medicare |
$82.32
|
| 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 |
$81.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$81.47
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.50
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$82.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$82.67
|
| Rate for Payer: Oscar Health of IA Commercial |
$122.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$122.25
|
| Rate for Payer: United Healthcare Commercial |
$146.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$96.17
|
|
