|
Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)
|
Facility
OP
|
$705.87
|
|
|
Service Code
|
CPT 20552
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$641.70 |
| Max. Negotiated Rate |
$705.87 |
| Rate for Payer: Wellmark IA HMO |
$641.70
|
| Rate for Payer: Wellmark IA PPO |
$705.87
|
|
|
INJ FORAMEN EPIDURAL ADD ON
|
Professional
|
$289.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
8015854
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$47.10 |
| Max. Negotiated Rate |
$202.30 |
| Rate for Payer: Aetna of IA Medicare |
$47.10
|
| Rate for Payer: Amerigroup Medicaid |
$48.70
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$56.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$48.04
|
| Rate for Payer: Medical Associates Commercial |
$89.49
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.10
|
| Rate for Payer: Midlands Choice Commercial |
$202.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$70.65
|
| Rate for Payer: Wellmark IA HMO |
$91.00
|
| Rate for Payer: Wellmark IA PPO |
$107.00
|
|
|
INJ FORAMEN EPIDURAL L/S
|
Professional
|
$720.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
8015433
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna of IA Medicare |
$101.98
|
| Rate for Payer: Amerigroup Medicaid |
$105.45
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$122.38
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$104.02
|
| Rate for Payer: Medical Associates Commercial |
$193.76
|
| Rate for Payer: Medical Associates Managed Medicare |
$101.98
|
| Rate for Payer: Midlands Choice Commercial |
$504.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$152.97
|
| Rate for Payer: Wellmark IA HMO |
$196.00
|
| Rate for Payer: Wellmark IA PPO |
$230.00
|
|
|
INJ PARAVERTEBRAL FACET JOINT C/T
|
Professional
|
$624.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
8015855
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$96.37 |
| Max. Negotiated Rate |
$436.80 |
| Rate for Payer: Aetna of IA Medicare |
$96.37
|
| Rate for Payer: Amerigroup Medicaid |
$99.65
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$115.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.30
|
| Rate for Payer: Medical Associates Commercial |
$183.10
|
| Rate for Payer: Medical Associates Managed Medicare |
$96.37
|
| Rate for Payer: Midlands Choice Commercial |
$436.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$144.56
|
| Rate for Payer: Wellmark IA HMO |
$185.00
|
| Rate for Payer: Wellmark IA PPO |
$218.00
|
|
|
INJ PARAVERT F JNT L/S 1 LEV
|
Professional
|
$566.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
8015865
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$82.81 |
| Max. Negotiated Rate |
$396.20 |
| Rate for Payer: Aetna of IA Medicare |
$82.81
|
| Rate for Payer: Amerigroup Medicaid |
$85.63
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$99.37
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$84.47
|
| Rate for Payer: Medical Associates Commercial |
$157.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$82.81
|
| Rate for Payer: Midlands Choice Commercial |
$396.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$124.22
|
| Rate for Payer: Wellmark IA HMO |
$160.00
|
| Rate for Payer: Wellmark IA PPO |
$187.00
|
|
|
INJ PARAVERT F JNT L/S 2 LEV
|
Professional
|
$285.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
8015866
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Aetna of IA Medicare |
$46.50
|
| Rate for Payer: Amerigroup Medicaid |
$48.08
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.43
|
| Rate for Payer: Medical Associates Commercial |
$88.35
|
| Rate for Payer: Medical Associates Managed Medicare |
$46.50
|
| Rate for Payer: Midlands Choice Commercial |
$199.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$69.75
|
| Rate for Payer: Wellmark IA HMO |
$90.00
|
| Rate for Payer: Wellmark IA PPO |
$106.00
|
|
|
INJ PARAVERT F JNT L/S 2 LEV
|
Professional
|
$286.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
8015867
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna of IA Medicare |
$47.39
|
| Rate for Payer: Amerigroup Medicaid |
$49.00
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$56.87
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$48.34
|
| Rate for Payer: Medical Associates Commercial |
$90.04
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.39
|
| Rate for Payer: Midlands Choice Commercial |
$200.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.08
|
| Rate for Payer: Wellmark IA HMO |
$92.00
|
| Rate for Payer: Wellmark IA PPO |
$107.00
|
|
|
INJ PARAVERT F JOINT C/T 2 LEV
|
Professional
|
$309.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
8015859
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$54.13 |
| Max. Negotiated Rate |
$216.30 |
| Rate for Payer: Aetna of IA Medicare |
$54.13
|
| Rate for Payer: Amerigroup Medicaid |
$55.97
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$55.21
|
| Rate for Payer: Medical Associates Commercial |
$102.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$54.13
|
| Rate for Payer: Midlands Choice Commercial |
$216.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.20
|
| Rate for Payer: Wellmark IA HMO |
$105.00
|
| Rate for Payer: Wellmark IA PPO |
$123.00
|
|
|
INJ PARAVERT F JOINT C/T 3 LEV
|
Professional
|
$310.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
8015864
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$55.03 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna of IA Medicare |
$55.03
|
| Rate for Payer: Amerigroup Medicaid |
$56.90
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$66.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.13
|
| Rate for Payer: Medical Associates Commercial |
$104.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.03
|
| Rate for Payer: Midlands Choice Commercial |
$217.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.54
|
| Rate for Payer: Wellmark IA HMO |
$106.00
|
| Rate for Payer: Wellmark IA PPO |
$125.00
|
|
|
INJ PERFLUTREN LIP MICROS,ML
|
Facility
IP
|
$121.00
|
|
|
Service Code
|
CPT Q9957
|
| Hospital Charge Code |
8910875
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna of IA Commercial |
$108.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$108.90
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$90.75
|
| Rate for Payer: Medical Associates Commercial |
$90.75
|
| Rate for Payer: Midlands Choice Commercial |
$84.70
|
| Rate for Payer: United Healthcare Commercial |
$108.90
|
|
|
INJ PERFLUTREN LIP MICROS,ML
|
Facility
OP
|
$121.00
|
|
|
Service Code
|
CPT Q9957
|
| Hospital Charge Code |
8910875
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna of IA Commercial |
$108.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$108.90
|
| Rate for Payer: Aetna of IA Medicare |
$68.97
|
| Rate for Payer: Amerigroup Medicaid |
$61.07
|
| Rate for Payer: Amerigroup Medicare |
$61.10
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$90.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$60.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$60.48
|
| Rate for Payer: Medical Associates Commercial |
$90.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$60.50
|
| Rate for Payer: Midlands Choice Commercial |
$84.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$61.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$90.75
|
| Rate for Payer: United Healthcare Commercial |
$108.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$71.39
|
|
|
INJ SGL TENDON SHTH OR LIGAMENT
|
Professional
|
$175.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
8101266
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$35.32 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna of IA Medicare |
$35.32
|
| Rate for Payer: Amerigroup Medicaid |
$36.52
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.38
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.03
|
| Rate for Payer: Medical Associates Commercial |
$67.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.32
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$52.98
|
| Rate for Payer: Wellmark IA HMO |
$69.00
|
| Rate for Payer: Wellmark IA PPO |
$81.00
|
|
|
INJ SINGLE/MULT TRIGGER PTS 1/2 MUSCLES
|
Professional
|
$183.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
8037760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$128.10 |
| Rate for Payer: Aetna of IA Medicare |
$33.57
|
| Rate for Payer: Amerigroup Medicaid |
$34.71
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$40.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.24
|
| Rate for Payer: Medical Associates Commercial |
$63.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.57
|
| Rate for Payer: Midlands Choice Commercial |
$128.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.36
|
| Rate for Payer: Wellmark IA HMO |
$66.00
|
| Rate for Payer: Wellmark IA PPO |
$77.00
|
|
|
INJ SINGLE/MULT TRIGGER PTS 3 OR MORE MU
|
Professional
|
$211.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
8015253
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$147.70 |
| Rate for Payer: Aetna of IA Medicare |
$38.16
|
| Rate for Payer: Amerigroup Medicaid |
$39.46
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.79
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.92
|
| Rate for Payer: Medical Associates Commercial |
$72.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.16
|
| Rate for Payer: Midlands Choice Commercial |
$147.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$57.24
|
| Rate for Payer: Wellmark IA HMO |
$75.00
|
| Rate for Payer: Wellmark IA PPO |
$88.00
|
|
|
INJ SINGLE TENDON
|
Professional
|
$201.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
8015895
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$35.17 |
| Max. Negotiated Rate |
$140.70 |
| Rate for Payer: Aetna of IA Medicare |
$35.17
|
| Rate for Payer: Amerigroup Medicaid |
$36.37
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.87
|
| Rate for Payer: Medical Associates Commercial |
$66.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.17
|
| Rate for Payer: Midlands Choice Commercial |
$140.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$52.76
|
| Rate for Payer: Wellmark IA HMO |
$69.00
|
| Rate for Payer: Wellmark IA PPO |
$81.00
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Professional
|
$151.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
7982816
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$105.70 |
| Rate for Payer: Aetna of IA Medicare |
$33.57
|
| Rate for Payer: Amerigroup Medicaid |
$34.71
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$40.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.24
|
| Rate for Payer: Medical Associates Commercial |
$63.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.57
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.36
|
| Rate for Payer: Wellmark IA HMO |
$66.00
|
| Rate for Payer: Wellmark IA PPO |
$77.00
|
|
|
INR PROTIME PROTHROMBIN TIME
|
Facility
OP
|
$43.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
633793
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.49 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna of IA Commercial |
$38.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.70
|
| Rate for Payer: Aetna of IA Medicare |
$24.51
|
| Rate for Payer: Amerigroup Medicaid |
$21.70
|
| Rate for Payer: Amerigroup Medicare |
$21.72
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$21.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.49
|
| Rate for Payer: Medical Associates Commercial |
$32.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$21.50
|
| Rate for Payer: Midlands Choice Commercial |
$30.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$32.25
|
| Rate for Payer: United Healthcare Commercial |
$38.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.37
|
| Rate for Payer: Wellmark IA HMO |
$24.18
|
| Rate for Payer: Wellmark IA PPO |
$26.60
|
|
|
INR PROTIME PROTHROMBIN TIME
|
Facility
IP
|
$43.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
8093940
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna of IA Commercial |
$38.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.70
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.25
|
| Rate for Payer: Medical Associates Commercial |
$32.25
|
| Rate for Payer: Midlands Choice Commercial |
$30.10
|
| Rate for Payer: United Healthcare Commercial |
$38.70
|
|
|
INR PROTIME PROTHROMBIN TIME
|
Facility
OP
|
$43.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
8093940
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.49 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna of IA Commercial |
$38.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.70
|
| Rate for Payer: Aetna of IA Medicare |
$24.51
|
| Rate for Payer: Amerigroup Medicaid |
$21.70
|
| Rate for Payer: Amerigroup Medicare |
$21.72
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$21.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.49
|
| Rate for Payer: Medical Associates Commercial |
$32.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$21.50
|
| Rate for Payer: Midlands Choice Commercial |
$30.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$32.25
|
| Rate for Payer: United Healthcare Commercial |
$38.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.37
|
| Rate for Payer: Wellmark IA HMO |
$24.18
|
| Rate for Payer: Wellmark IA PPO |
$26.60
|
|
|
INR PROTIME PROTHROMBIN TIME
|
Facility
IP
|
$43.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
633793
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna of IA Commercial |
$38.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.70
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.25
|
| Rate for Payer: Medical Associates Commercial |
$32.25
|
| Rate for Payer: Midlands Choice Commercial |
$30.10
|
| Rate for Payer: United Healthcare Commercial |
$38.70
|
|
|
INSERT BLADDER CATHETER
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
4863314
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.45 |
| Max. Negotiated Rate |
$403.74 |
| Rate for Payer: Aetna of IA Commercial |
$211.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$211.50
|
| Rate for Payer: Aetna of IA Medicare |
$133.95
|
| Rate for Payer: Amerigroup Medicaid |
$118.60
|
| Rate for Payer: Amerigroup Medicare |
$118.68
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$176.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$117.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$117.45
|
| Rate for Payer: Medical Associates Commercial |
$176.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$117.50
|
| Rate for Payer: Midlands Choice Commercial |
$164.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$119.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$176.25
|
| Rate for Payer: United Healthcare Commercial |
$211.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$138.65
|
| Rate for Payer: Wellmark IA HMO |
$367.04
|
| Rate for Payer: Wellmark IA PPO |
$403.74
|
|
|
INSERT BLADDER CATHETER
|
Facility
IP
|
$235.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
4863314
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna of IA Commercial |
$211.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$211.50
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$176.25
|
| Rate for Payer: Medical Associates Commercial |
$176.25
|
| Rate for Payer: Midlands Choice Commercial |
$164.50
|
| Rate for Payer: United Healthcare Commercial |
$211.50
|
|
|
Insert Chest Tube Procedure
|
Facility
OP
|
$1,299.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
8069122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$649.24 |
| Max. Negotiated Rate |
$1,703.64 |
| Rate for Payer: Aetna of IA Commercial |
$1,169.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,169.10
|
| Rate for Payer: Aetna of IA Medicare |
$740.43
|
| Rate for Payer: Amerigroup Medicaid |
$655.61
|
| Rate for Payer: Amerigroup Medicare |
$656.00
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$974.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$649.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$649.24
|
| Rate for Payer: Medical Associates Commercial |
$974.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$649.50
|
| Rate for Payer: Midlands Choice Commercial |
$909.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$659.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$974.25
|
| Rate for Payer: United Healthcare Commercial |
$1,169.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$766.41
|
| Rate for Payer: Wellmark IA HMO |
$1,548.76
|
| Rate for Payer: Wellmark IA PPO |
$1,703.64
|
|
|
Insert Chest Tube Procedure
|
Facility
IP
|
$1,299.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
8069122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$909.30 |
| Max. Negotiated Rate |
$1,169.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,169.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,169.10
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$974.25
|
| Rate for Payer: Medical Associates Commercial |
$974.25
|
| Rate for Payer: Midlands Choice Commercial |
$909.30
|
| Rate for Payer: United Healthcare Commercial |
$1,169.10
|
|
|
INSERT EMERGENCY AIRWAY
|
Professional
|
$440.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
7822790
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$126.79 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna of IA Medicare |
$126.79
|
| Rate for Payer: Amerigroup Medicaid |
$131.10
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$152.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$129.33
|
| Rate for Payer: Medical Associates Commercial |
$240.90
|
| Rate for Payer: Medical Associates Managed Medicare |
$126.79
|
| Rate for Payer: Midlands Choice Commercial |
$308.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$190.18
|
| Rate for Payer: Wellmark IA HMO |
$249.00
|
| Rate for Payer: Wellmark IA PPO |
$293.00
|
|
