|
93226 HOLTER MONITOR UP TO 48 HOURS
|
Facility
IP
|
$380.00
|
|
|
Service Code
|
CPT 93226 TC
|
| Hospital Charge Code |
8398130
|
|
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
|
|
|
93226 HOLTER MONITOR UP TO 48 HOURS
|
Facility
OP
|
$380.00
|
|
|
Service Code
|
CPT 93226 TC
|
| Hospital Charge Code |
8398130
|
|
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: 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
|
|
|
93798 CARD REHAB PHASEII W/TELE CHARGE
|
Facility
OP
|
$220.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
5596782
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$109.96 |
| Max. Negotiated Rate |
$255.07 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$111.03
|
| Rate for Payer: Amerigroup Medicare |
$111.10
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$110.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$109.96
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$110.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$111.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
| Rate for Payer: Wellmark IA HMO |
$231.88
|
| Rate for Payer: Wellmark IA PPO |
$255.07
|
|
|
93798 CARD REHAB PHASEII W/TELE CHARGE
|
Facility
IP
|
$220.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
5596782
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
|
|
94010 INCENTIVE SPIROMETRY CHARGE
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
8051728
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
|
|
94010 INCENTIVE SPIROMETRY CHARGE
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
8051728
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$282.35 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Aetna of IA Medicare |
$148.20
|
| Rate for Payer: Amerigroup Medicaid |
$131.22
|
| Rate for Payer: Amerigroup Medicare |
$131.30
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$130.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$129.95
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$130.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$131.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$195.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.40
|
| Rate for Payer: Wellmark IA HMO |
$256.68
|
| Rate for Payer: Wellmark IA PPO |
$282.35
|
|
|
94060 PULMONARY FUNCTION CHARGE
|
Facility
IP
|
$333.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
8037154
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
|
|
94060 PULMONARY FUNCTION CHARGE
|
Facility
OP
|
$333.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
8037154
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$166.43 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Aetna of IA Medicare |
$189.81
|
| Rate for Payer: Amerigroup Medicaid |
$168.07
|
| Rate for Payer: Amerigroup Medicare |
$168.16
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$166.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$166.43
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$166.50
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$169.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$249.75
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
| Rate for Payer: Wellmark IA HMO |
$256.68
|
| Rate for Payer: Wellmark IA PPO |
$282.35
|
|
|
94727 LUNG VOLUMES CHARGE
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
8036951
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
|
|
94727 LUNG VOLUMES CHARGE
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
8036951
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$282.35 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Aetna of IA Medicare |
$148.20
|
| Rate for Payer: Amerigroup Medicaid |
$131.22
|
| Rate for Payer: Amerigroup Medicare |
$131.30
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$130.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$129.95
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$130.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$131.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$195.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.40
|
| Rate for Payer: Wellmark IA HMO |
$256.68
|
| Rate for Payer: Wellmark IA PPO |
$282.35
|
|
|
94729 DLCO CHARGE
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
8051727
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
|
|
94729 DLCO CHARGE
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
8051727
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$282.35 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Aetna of IA Medicare |
$148.20
|
| Rate for Payer: Amerigroup Medicaid |
$131.22
|
| Rate for Payer: Amerigroup Medicare |
$131.30
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$130.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$129.95
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$130.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$131.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$195.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.40
|
| Rate for Payer: Wellmark IA HMO |
$256.68
|
| Rate for Payer: Wellmark IA PPO |
$282.35
|
|
|
95800 SLEEP STUDY UNATTENDED
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
CPT 95800
|
| Hospital Charge Code |
6608790
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of IA Commercial |
$315.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$262.50
|
| Rate for Payer: Medical Associates Commercial |
$262.50
|
| Rate for Payer: Midlands Choice Commercial |
$245.00
|
| Rate for Payer: United Healthcare Commercial |
$315.00
|
|
|
95800 SLEEP STUDY UNATTENDED
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
CPT 95800
|
| Hospital Charge Code |
6608790
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$174.93 |
| Max. Negotiated Rate |
$1,226.92 |
| Rate for Payer: Aetna of IA Commercial |
$315.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.00
|
| Rate for Payer: Aetna of IA Medicare |
$199.50
|
| Rate for Payer: Amerigroup Medicaid |
$176.64
|
| Rate for Payer: Amerigroup Medicare |
$176.75
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$262.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$175.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$174.93
|
| Rate for Payer: Medical Associates Commercial |
$262.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$175.00
|
| Rate for Payer: Midlands Choice Commercial |
$245.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$177.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$262.50
|
| Rate for Payer: United Healthcare Commercial |
$315.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$206.50
|
| Rate for Payer: Wellmark IA HMO |
$1,115.38
|
| Rate for Payer: Wellmark IA PPO |
$1,226.92
|
|
|
95806 SLEEP STUDY UNATT AND RESP EFFT
|
Facility
OP
|
$657.00
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
7832544
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$328.37 |
| Max. Negotiated Rate |
$1,226.92 |
| Rate for Payer: Aetna of IA Commercial |
$591.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$591.30
|
| Rate for Payer: Aetna of IA Medicare |
$374.49
|
| Rate for Payer: Amerigroup Medicaid |
$331.59
|
| Rate for Payer: Amerigroup Medicare |
$331.78
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$492.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$328.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$328.37
|
| Rate for Payer: Medical Associates Commercial |
$492.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$328.50
|
| Rate for Payer: Midlands Choice Commercial |
$459.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$333.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$492.75
|
| Rate for Payer: United Healthcare Commercial |
$591.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$387.63
|
| Rate for Payer: Wellmark IA HMO |
$1,115.38
|
| Rate for Payer: Wellmark IA PPO |
$1,226.92
|
|
|
95806 SLEEP STUDY UNATT AND RESP EFFT
|
Facility
IP
|
$657.00
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
7832544
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$459.90 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Aetna of IA Commercial |
$591.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$591.30
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$492.75
|
| Rate for Payer: Medical Associates Commercial |
$492.75
|
| Rate for Payer: Midlands Choice Commercial |
$459.90
|
| Rate for Payer: United Healthcare Commercial |
$591.30
|
|
|
99217 HSPTLST OBS DISCHDAY MGMT CHARGE
|
Professional
|
$120.00
|
|
|
Service Code
|
CPT 99217
|
| Hospital Charge Code |
5136782
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$84.00
|
| Rate for Payer: Wellmark IA HMO |
$116.00
|
| Rate for Payer: Wellmark IA PPO |
$116.00
|
|
|
9 HOLE VL GRIDLOCK FIBULA PLATE
|
Facility
OP
|
$1,800.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8773163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$899.64 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,620.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,620.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,026.00
|
| Rate for Payer: Amerigroup Medicaid |
$908.46
|
| Rate for Payer: Amerigroup Medicare |
$909.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,350.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$900.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$899.64
|
| Rate for Payer: Medical Associates Commercial |
$1,350.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$900.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,260.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$913.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,350.00
|
| Rate for Payer: United Healthcare Commercial |
$1,620.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,062.00
|
|
|
9 HOLE VL GRIDLOCK FIBULA PLATE
|
Facility
IP
|
$1,800.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8773163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,260.00 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,620.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,350.00
|
| Rate for Payer: Medical Associates Commercial |
$1,350.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,260.00
|
| Rate for Payer: United Healthcare Commercial |
$1,620.00
|
|
|
abatacept 250 mg IV Inj SDV
|
Facility
IP
|
$2,856.44
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
43700369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,999.51 |
| Max. Negotiated Rate |
$2,570.80 |
| Rate for Payer: Aetna of IA Commercial |
$2,570.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,570.80
|
| Rate for Payer: Cash Price |
$2,285.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,142.33
|
| Rate for Payer: Medical Associates Commercial |
$2,142.33
|
| Rate for Payer: Midlands Choice Commercial |
$1,999.51
|
| Rate for Payer: United Healthcare Commercial |
$2,570.80
|
|
|
abatacept 250 mg IV Inj SDV
|
Facility
OP
|
$2,856.44
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
43700369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,427.65 |
| Max. Negotiated Rate |
$2,570.80 |
| Rate for Payer: Aetna of IA Commercial |
$2,570.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,570.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,628.17
|
| Rate for Payer: Amerigroup Medicaid |
$1,441.65
|
| Rate for Payer: Amerigroup Medicare |
$1,442.50
|
| Rate for Payer: Cash Price |
$2,285.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,142.33
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,428.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,427.65
|
| Rate for Payer: Medical Associates Commercial |
$2,142.33
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,428.22
|
| Rate for Payer: Midlands Choice Commercial |
$1,999.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,449.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,142.33
|
| Rate for Payer: United Healthcare Commercial |
$2,570.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,685.30
|
|
|
ABDOMINAL/FEMORAL BLOCK CHARGE
|
Facility
IP
|
$315.00
|
|
| Hospital Charge Code |
8059069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
|
|
ABDOMINAL/FEMORAL BLOCK CHARGE
|
Facility
OP
|
$315.00
|
|
| Hospital Charge Code |
8059069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Aetna of IA Medicare |
$179.55
|
| Rate for Payer: Amerigroup Medicaid |
$158.98
|
| Rate for Payer: Amerigroup Medicare |
$159.08
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$157.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$157.44
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$159.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$236.25
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
|
Abdominal paracentesis w/ abdominal imaging
|
Professional
|
$975.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
8068992
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$95.99 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna of IA Medicare |
$95.99
|
| Rate for Payer: Amerigroup Medicaid |
$99.25
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$115.19
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$97.91
|
| Rate for Payer: Medical Associates Commercial |
$182.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$95.99
|
| Rate for Payer: Midlands Choice Commercial |
$682.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$143.98
|
| Rate for Payer: Wellmark IA HMO |
$199.00
|
| Rate for Payer: Wellmark IA PPO |
$233.00
|
|
|
Abortion With D&C, Aspiration Curettage or Hysterotomy
|
Facility
IP
|
$6,091.47
|
|
|
Service Code
|
MS-DRG 770
|
| Hospital Charge Code |
522
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,091.47 |
| Rate for Payer: Amerigroup Medicaid |
$6,062.04
|
| 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 |
$6,003.19
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,091.47
|
|
