|
XR Toes 5th Digit Right
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 73660 T9
|
| Hospital Charge Code |
1170534
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Aetna of IA Medicare |
$67.83
|
| Rate for Payer: Amerigroup Medicaid |
$60.06
|
| Rate for Payer: Amerigroup Medicare |
$60.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$59.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.48
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.50
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.39
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$60.36
|
| Rate for Payer: Oscar Health of IA Commercial |
$89.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$70.21
|
|
|
XR Toes 5th Digit Right
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 73660 T9
|
| Hospital Charge Code |
1170534
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
|
|
XR Toes Great Left
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 73660 TA
|
| Hospital Charge Code |
1170536
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
|
|
XR Toes Great Left
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 73660 TA
|
| Hospital Charge Code |
1170536
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Aetna of IA Medicare |
$67.83
|
| Rate for Payer: Amerigroup Medicaid |
$60.06
|
| Rate for Payer: Amerigroup Medicare |
$60.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$59.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.48
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.50
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.39
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$60.36
|
| Rate for Payer: Oscar Health of IA Commercial |
$89.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$70.21
|
|
|
XR Toes Great Right
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 73660 T5
|
| Hospital Charge Code |
1170538
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Aetna of IA Medicare |
$67.83
|
| Rate for Payer: Amerigroup Medicaid |
$60.06
|
| Rate for Payer: Amerigroup Medicare |
$60.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$59.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.48
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.50
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.39
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$60.36
|
| Rate for Payer: Oscar Health of IA Commercial |
$89.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$70.21
|
|
|
XR Toes Great Right
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 73660 T5
|
| Hospital Charge Code |
1170538
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of IA Commercial |
$107.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$107.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.25
|
| Rate for Payer: Medical Associates Commercial |
$89.25
|
| Rate for Payer: Midlands Choice Commercial |
$83.30
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
|
|
XR Upper Extremity Infant Left
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 73092 LT
|
| Hospital Charge Code |
1170558
|
|
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: 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 Upper Extremity Infant Left
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 73092 LT
|
| Hospital Charge Code |
1170558
|
|
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 Upper Extremity Infant Right
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 73092 RT
|
| Hospital Charge Code |
1170560
|
|
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 Upper Extremity Infant Right
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 73092 RT
|
| Hospital Charge Code |
1170560
|
|
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: 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 Upper GI
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
1170562
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$408.60 |
| Rate for Payer: Aetna of IA Commercial |
$408.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$408.60
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$340.50
|
| Rate for Payer: Medical Associates Commercial |
$340.50
|
| Rate for Payer: Midlands Choice Commercial |
$317.80
|
| Rate for Payer: United Healthcare Commercial |
$408.60
|
|
|
XR Upper GI
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
1170562
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.56 |
| Max. Negotiated Rate |
$408.60 |
| Rate for Payer: United Healthcare Commercial |
$408.60
|
| Rate for Payer: Aetna of IA Commercial |
$408.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$408.60
|
| Rate for Payer: Aetna of IA Medicare |
$258.78
|
| Rate for Payer: Amerigroup Medicaid |
$229.13
|
| Rate for Payer: Amerigroup Medicare |
$229.27
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$340.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$227.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$226.91
|
| Rate for Payer: Medical Associates Commercial |
$340.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$227.00
|
| Rate for Payer: Midlands Choice Commercial |
$317.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$230.40
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$230.27
|
| Rate for Payer: Oscar Health of IA Commercial |
$340.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$340.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$267.86
|
| Rate for Payer: Wellmark IA HMO |
$178.56
|
| Rate for Payer: Wellmark IA PPO |
$196.42
|
|
|
XR Upper GI + KUB
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 74241
|
| Hospital Charge Code |
1170564
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$340.20 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna of IA Commercial |
$437.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$437.40
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$364.50
|
| Rate for Payer: Medical Associates Commercial |
$364.50
|
| Rate for Payer: Midlands Choice Commercial |
$340.20
|
| Rate for Payer: United Healthcare Commercial |
$437.40
|
|
|
XR Upper GI + KUB
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 74241
|
| Hospital Charge Code |
1170564
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.90 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna of IA Commercial |
$437.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$437.40
|
| Rate for Payer: Aetna of IA Medicare |
$277.02
|
| Rate for Payer: Amerigroup Medicaid |
$245.28
|
| Rate for Payer: Amerigroup Medicare |
$245.43
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$364.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$243.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$242.90
|
| Rate for Payer: Medical Associates Commercial |
$364.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$243.00
|
| Rate for Payer: Midlands Choice Commercial |
$340.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$246.64
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$246.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$364.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$364.50
|
| Rate for Payer: United Healthcare Commercial |
$437.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$286.74
|
|
|
XR Upper GI w/ Air Contrast
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
1170566
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.56 |
| Max. Negotiated Rate |
$408.60 |
| Rate for Payer: Aetna of IA Commercial |
$408.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$408.60
|
| Rate for Payer: Aetna of IA Medicare |
$258.78
|
| Rate for Payer: Amerigroup Medicaid |
$229.13
|
| Rate for Payer: Amerigroup Medicare |
$229.27
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$340.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$227.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$226.91
|
| Rate for Payer: Medical Associates Commercial |
$340.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$227.00
|
| Rate for Payer: Midlands Choice Commercial |
$317.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$230.40
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$230.27
|
| Rate for Payer: Oscar Health of IA Commercial |
$340.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$340.50
|
| Rate for Payer: United Healthcare Commercial |
$408.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$267.86
|
| Rate for Payer: Wellmark IA HMO |
$178.56
|
| Rate for Payer: Wellmark IA PPO |
$196.42
|
|
|
XR Upper GI w/ Air Contrast
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
1170566
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$408.60 |
| Rate for Payer: Aetna of IA Commercial |
$408.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$408.60
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$340.50
|
| Rate for Payer: Medical Associates Commercial |
$340.50
|
| Rate for Payer: Midlands Choice Commercial |
$317.80
|
| Rate for Payer: United Healthcare Commercial |
$408.60
|
|
|
XR Upper GI w/ Air w/ Small Bowel
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 74249
|
| Hospital Charge Code |
1170570
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$333.87 |
| Max. Negotiated Rate |
$601.20 |
| Rate for Payer: Aetna of IA Commercial |
$601.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$601.20
|
| Rate for Payer: Aetna of IA Medicare |
$380.76
|
| Rate for Payer: Amerigroup Medicaid |
$337.14
|
| Rate for Payer: Amerigroup Medicare |
$337.34
|
| Rate for Payer: Cash Price |
$534.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$501.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$334.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$333.87
|
| Rate for Payer: Medical Associates Commercial |
$501.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$334.00
|
| Rate for Payer: Midlands Choice Commercial |
$467.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$339.01
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$338.81
|
| Rate for Payer: Oscar Health of IA Commercial |
$501.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$501.00
|
| Rate for Payer: United Healthcare Commercial |
$601.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$394.12
|
|
|
XR Upper GI w/ Air w/ Small Bowel
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 74249
|
| Hospital Charge Code |
1170570
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$467.60 |
| Max. Negotiated Rate |
$601.20 |
| Rate for Payer: Aetna of IA Commercial |
$601.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$601.20
|
| Rate for Payer: Cash Price |
$534.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$501.00
|
| Rate for Payer: Medical Associates Commercial |
$501.00
|
| Rate for Payer: Midlands Choice Commercial |
$467.60
|
| Rate for Payer: United Healthcare Commercial |
$601.20
|
|
|
XR Upper GI w/ Small Bowel
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 74245
|
| Hospital Charge Code |
1170574
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$333.87 |
| Max. Negotiated Rate |
$601.20 |
| Rate for Payer: Aetna of IA Commercial |
$601.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$601.20
|
| Rate for Payer: Aetna of IA Medicare |
$380.76
|
| Rate for Payer: Amerigroup Medicaid |
$337.14
|
| Rate for Payer: Amerigroup Medicare |
$337.34
|
| Rate for Payer: Cash Price |
$534.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$501.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$334.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$333.87
|
| Rate for Payer: Medical Associates Commercial |
$501.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$334.00
|
| Rate for Payer: Midlands Choice Commercial |
$467.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$339.01
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$338.81
|
| Rate for Payer: Oscar Health of IA Commercial |
$501.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$501.00
|
| Rate for Payer: United Healthcare Commercial |
$601.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$394.12
|
|
|
XR Upper GI w/ Small Bowel
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 74245
|
| Hospital Charge Code |
1170574
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$467.60 |
| Max. Negotiated Rate |
$601.20 |
| Rate for Payer: Aetna of IA Commercial |
$601.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$601.20
|
| Rate for Payer: Cash Price |
$534.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$501.00
|
| Rate for Payer: Medical Associates Commercial |
$501.00
|
| Rate for Payer: Midlands Choice Commercial |
$467.60
|
| Rate for Payer: United Healthcare Commercial |
$601.20
|
|
|
XR Urethrocystography Retrograde
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
1170578
|
|
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: 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 |
$178.56
|
| Rate for Payer: Wellmark IA PPO |
$196.42
|
|
|
XR Urethrocystography Retrograde
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
1170578
|
|
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 Urethrocystography Voiding
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
CPT 74455
|
| Hospital Charge Code |
1170580
|
|
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 Urethrocystography Voiding
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
CPT 74455
|
| Hospital Charge Code |
1170580
|
|
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: 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 |
$178.56
|
| Rate for Payer: Wellmark IA PPO |
$196.42
|
|
|
XR Venogram Lower Extremity Left
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
CPT 75820 LT
|
| Hospital Charge Code |
1170592
|
|
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: 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
|
|
