|
Hip Replacement With Principal Diagnosis of Hip Fracture Without MCC
|
Facility
IP
|
$22,700.55
|
|
|
Service Code
|
MS-DRG 522
|
| Hospital Charge Code |
339
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$22,700.55 |
| Rate for Payer: Amerigroup Medicaid |
$22,590.89
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22,371.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22,700.55
|
|
|
HIP STEM #13
|
Facility
IP
|
$9,255.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,478.50 |
| Max. Negotiated Rate |
$8,329.50 |
| Rate for Payer: Aetna of IA Commercial |
$8,329.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8,329.50
|
| Rate for Payer: Cash Price |
$7,404.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,941.25
|
| Rate for Payer: Medical Associates Commercial |
$6,941.25
|
| Rate for Payer: Midlands Choice Commercial |
$6,478.50
|
| Rate for Payer: United Healthcare Commercial |
$8,329.50
|
|
|
HIP STEM #13
|
Facility
OP
|
$9,255.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,625.65 |
| Max. Negotiated Rate |
$8,329.50 |
| Rate for Payer: Aetna of IA Commercial |
$8,329.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8,329.50
|
| Rate for Payer: Aetna of IA Medicare |
$5,275.35
|
| Rate for Payer: Amerigroup Medicaid |
$4,671.00
|
| Rate for Payer: Amerigroup Medicare |
$4,673.78
|
| Rate for Payer: Cash Price |
$7,404.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,941.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4,627.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,625.65
|
| Rate for Payer: Medical Associates Commercial |
$6,941.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$4,627.50
|
| Rate for Payer: Midlands Choice Commercial |
$6,478.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,696.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,941.25
|
| Rate for Payer: United Healthcare Commercial |
$8,329.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$5,460.45
|
|
|
HIP STEM #6
|
Facility
OP
|
$9,255.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,625.65 |
| Max. Negotiated Rate |
$8,329.50 |
| Rate for Payer: Aetna of IA Commercial |
$8,329.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8,329.50
|
| Rate for Payer: Aetna of IA Medicare |
$5,275.35
|
| Rate for Payer: Amerigroup Medicaid |
$4,671.00
|
| Rate for Payer: Amerigroup Medicare |
$4,673.78
|
| Rate for Payer: Cash Price |
$7,404.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,941.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4,627.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,625.65
|
| Rate for Payer: Medical Associates Commercial |
$6,941.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$4,627.50
|
| Rate for Payer: Midlands Choice Commercial |
$6,478.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,696.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,941.25
|
| Rate for Payer: United Healthcare Commercial |
$8,329.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$5,460.45
|
|
|
HIP STEM #6
|
Facility
IP
|
$9,255.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,478.50 |
| Max. Negotiated Rate |
$8,329.50 |
| Rate for Payer: Aetna of IA Commercial |
$8,329.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8,329.50
|
| Rate for Payer: Cash Price |
$7,404.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,941.25
|
| Rate for Payer: Medical Associates Commercial |
$6,941.25
|
| Rate for Payer: Midlands Choice Commercial |
$6,478.50
|
| Rate for Payer: United Healthcare Commercial |
$8,329.50
|
|
|
Histoplasmosis Immunodiffusion DMCL
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
8037874
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
Histoplasmosis Immunodiffusion DMCL
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
8037874
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$57.54
|
| Rate for Payer: Amerigroup Medicare |
$57.57
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.98
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
HIV 1 2 DMCL
|
Facility
IP
|
$91.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
8037875
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of IA Commercial |
$81.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.90
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$68.25
|
| Rate for Payer: Medical Associates Commercial |
$68.25
|
| Rate for Payer: Midlands Choice Commercial |
$63.70
|
| Rate for Payer: United Healthcare Commercial |
$81.90
|
|
|
HIV 1 2 DMCL
|
Facility
OP
|
$91.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
8037875
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of IA Commercial |
$81.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.90
|
| Rate for Payer: Aetna of IA Medicare |
$51.87
|
| Rate for Payer: Amerigroup Medicaid |
$45.93
|
| Rate for Payer: Amerigroup Medicare |
$45.96
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$68.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$45.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$45.48
|
| Rate for Payer: Medical Associates Commercial |
$68.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$45.50
|
| Rate for Payer: Midlands Choice Commercial |
$63.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$46.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$68.25
|
| Rate for Payer: United Healthcare Commercial |
$81.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$53.69
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
HIV IN HOUSE
|
Facility
OP
|
$76.00
|
|
|
Service Code
|
CPT G0433
|
| Hospital Charge Code |
4017669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of IA Commercial |
$68.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.40
|
| Rate for Payer: Aetna of IA Medicare |
$43.32
|
| Rate for Payer: Amerigroup Medicaid |
$38.36
|
| Rate for Payer: Amerigroup Medicare |
$38.38
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.98
|
| Rate for Payer: Medical Associates Commercial |
$57.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.00
|
| Rate for Payer: Midlands Choice Commercial |
$53.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$57.00
|
| Rate for Payer: United Healthcare Commercial |
$68.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$44.84
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
HIV IN HOUSE
|
Facility
IP
|
$76.00
|
|
|
Service Code
|
CPT G0433
|
| Hospital Charge Code |
633757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of IA Commercial |
$68.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.40
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.00
|
| Rate for Payer: Medical Associates Commercial |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$53.20
|
| Rate for Payer: United Healthcare Commercial |
$68.40
|
|
|
HIV IN HOUSE
|
Facility
OP
|
$76.00
|
|
|
Service Code
|
CPT G0433
|
| Hospital Charge Code |
633757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of IA Commercial |
$68.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.40
|
| Rate for Payer: Aetna of IA Medicare |
$43.32
|
| Rate for Payer: Amerigroup Medicaid |
$38.36
|
| Rate for Payer: Amerigroup Medicare |
$38.38
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.98
|
| Rate for Payer: Medical Associates Commercial |
$57.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.00
|
| Rate for Payer: Midlands Choice Commercial |
$53.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$57.00
|
| Rate for Payer: United Healthcare Commercial |
$68.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$44.84
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
HIV IN HOUSE
|
Facility
IP
|
$76.00
|
|
|
Service Code
|
CPT G0433
|
| Hospital Charge Code |
4017669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of IA Commercial |
$68.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.40
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.00
|
| Rate for Payer: Medical Associates Commercial |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$53.20
|
| Rate for Payer: United Healthcare Commercial |
$68.40
|
|
|
HIV With Extensive O.R. Procedures With MCC
|
Facility
IP
|
$56,976.76
|
|
|
Service Code
|
MS-DRG 969
|
| Hospital Charge Code |
666
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$56,976.76 |
| Rate for Payer: Amerigroup Medicaid |
$56,701.51
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56,151.01
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$56,976.76
|
|
|
HIV With Extensive O.R. Procedures Without MCC
|
Facility
IP
|
$28,986.89
|
|
|
Service Code
|
MS-DRG 970
|
| Hospital Charge Code |
667
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$28,986.89 |
| Rate for Payer: Amerigroup Medicaid |
$28,846.86
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28,566.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28,986.89
|
|
|
HIV With Major Related Condition With CC
|
Facility
IP
|
$8,633.76
|
|
|
Service Code
|
MS-DRG 975
|
| Hospital Charge Code |
669
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,633.76 |
| Rate for Payer: Amerigroup Medicaid |
$8,592.05
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,508.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,633.76
|
|
|
HIV With Major Related Condition With MCC
|
Facility
IP
|
$19,834.44
|
|
|
Service Code
|
MS-DRG 974
|
| Hospital Charge Code |
668
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$19,834.44 |
| Rate for Payer: Amerigroup Medicaid |
$19,738.62
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19,546.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19,834.44
|
|
|
HIV With Major Related Condition Without CC/MCC
|
Facility
IP
|
$8,633.76
|
|
|
Service Code
|
MS-DRG 976
|
| Hospital Charge Code |
670
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,633.76 |
| Rate for Payer: Amerigroup Medicaid |
$8,592.05
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,508.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,633.76
|
|
|
HIV With or Without Other Related Condition
|
Facility
IP
|
$9,940.84
|
|
|
Service Code
|
MS-DRG 977
|
| Hospital Charge Code |
671
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,940.84 |
| Rate for Payer: Amerigroup Medicaid |
$9,892.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9,796.77
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,940.84
|
|
|
HLA B27 Blood DMCL
|
Facility
IP
|
$152.00
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
8519282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of IA Commercial |
$136.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$136.80
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.00
|
| Rate for Payer: Medical Associates Commercial |
$114.00
|
| Rate for Payer: Midlands Choice Commercial |
$106.40
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
|
|
HLA B27 Blood DMCL
|
Facility
OP
|
$152.00
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
8519282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of IA Commercial |
$136.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$136.80
|
| Rate for Payer: Aetna of IA Medicare |
$86.64
|
| Rate for Payer: Amerigroup Medicaid |
$76.71
|
| Rate for Payer: Amerigroup Medicare |
$76.76
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$76.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$75.97
|
| Rate for Payer: Medical Associates Commercial |
$114.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$76.00
|
| Rate for Payer: Midlands Choice Commercial |
$106.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$77.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$114.00
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$89.68
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
Holter Monitor 24 Hour RT
|
Facility
OP
|
$380.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
7068790
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$189.92 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of IA Commercial |
$342.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$342.00
|
| Rate for Payer: Aetna of IA Medicare |
$216.60
|
| Rate for Payer: Amerigroup Medicaid |
$191.79
|
| Rate for Payer: Amerigroup Medicare |
$191.90
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$285.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$190.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$189.92
|
| Rate for Payer: Medical Associates Commercial |
$285.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$190.00
|
| Rate for Payer: Midlands Choice Commercial |
$266.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$192.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$285.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$224.20
|
| Rate for Payer: Wellmark IA HMO |
$281.48
|
| Rate for Payer: Wellmark IA PPO |
$309.63
|
|
|
Holter Monitor 24 Hour RT
|
Facility
IP
|
$380.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
7068790
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of IA Commercial |
$342.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$342.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$285.00
|
| Rate for Payer: Medical Associates Commercial |
$285.00
|
| Rate for Payer: Midlands Choice Commercial |
$266.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
|
|
Holter Monitor 48 Hour RT
|
Facility
OP
|
$380.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
7068791
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$189.92 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of IA Commercial |
$342.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$342.00
|
| Rate for Payer: Aetna of IA Medicare |
$216.60
|
| Rate for Payer: Amerigroup Medicaid |
$191.79
|
| Rate for Payer: Amerigroup Medicare |
$191.90
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$285.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$190.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$189.92
|
| Rate for Payer: Medical Associates Commercial |
$285.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$190.00
|
| Rate for Payer: Midlands Choice Commercial |
$266.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$192.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$285.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$224.20
|
| Rate for Payer: Wellmark IA HMO |
$281.48
|
| Rate for Payer: Wellmark IA PPO |
$309.63
|
|
|
Holter Monitor 48 Hour RT
|
Facility
IP
|
$380.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
7068791
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of IA Commercial |
$342.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$342.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$285.00
|
| Rate for Payer: Medical Associates Commercial |
$285.00
|
| Rate for Payer: Midlands Choice Commercial |
$266.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
|
