|
64632 Destruction by neurolytic agent; plantar common digital nerve
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
CPT 64632
|
| Hospital Charge Code |
8799215
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$72.30 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Amerigroup Medicaid |
$73.01
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$72.30
|
| Rate for Payer: Medical Associates Commercial |
$214.50
|
| Rate for Payer: Midlands Choice Commercial |
$200.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$72.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$214.50
|
| Rate for Payer: United Healthcare Commercial |
$135.02
|
| Rate for Payer: Wellmark IA HMO WHPI |
$171.00
|
| Rate for Payer: Wellmark IA PPO |
$201.20
|
|
|
64633 Destruction by neurolytic agent paravertebral facet joint nerve w/imaging
|
Professional
|
Both
|
$1,393.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
8799216
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$402.40 |
| Max. Negotiated Rate |
$1,044.75 |
| Rate for Payer: Amerigroup Medicaid |
$406.35
|
| Rate for Payer: Cash Price |
$1,114.40
|
| Rate for Payer: Cash Price |
$1,114.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$402.40
|
| Rate for Payer: Medical Associates Commercial |
$1,044.75
|
| Rate for Payer: Midlands Choice Commercial |
$975.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$404.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,044.75
|
| Rate for Payer: United Healthcare Commercial |
$635.63
|
| Rate for Payer: Wellmark IA HMO WHPI |
$823.80
|
| Rate for Payer: Wellmark IA PPO |
$969.20
|
|
|
64634 Destruction by neurolytic agent paravertebral facet (ea addl facet joint)
|
Professional
|
Both
|
$623.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
8799217
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$183.32 |
| Max. Negotiated Rate |
$565.30 |
| Rate for Payer: Amerigroup Medicaid |
$185.12
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$183.32
|
| Rate for Payer: Medical Associates Commercial |
$467.25
|
| Rate for Payer: Midlands Choice Commercial |
$436.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$184.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$467.25
|
| Rate for Payer: United Healthcare Commercial |
$283.41
|
| Rate for Payer: Wellmark IA HMO WHPI |
$480.50
|
| Rate for Payer: Wellmark IA PPO |
$565.30
|
|
|
64635 Destruction by neurolytic agent paravertebral facet joint nerve w/imaging
|
Professional
|
Both
|
$1,375.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
8799218
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$395.52 |
| Max. Negotiated Rate |
$1,031.25 |
| Rate for Payer: Amerigroup Medicaid |
$399.39
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$395.52
|
| Rate for Payer: Medical Associates Commercial |
$1,031.25
|
| Rate for Payer: Midlands Choice Commercial |
$962.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$397.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,031.25
|
| Rate for Payer: United Healthcare Commercial |
$629.07
|
| Rate for Payer: Wellmark IA HMO WHPI |
$830.70
|
| Rate for Payer: Wellmark IA PPO |
$977.30
|
|
|
64636 Destruction by neurolytic agent paravertebral facet (ea addl facet joint)
|
Professional
|
Both
|
$568.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
8799219
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$530.60 |
| Rate for Payer: Amerigroup Medicaid |
$166.61
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$426.00
|
| Rate for Payer: Midlands Choice Commercial |
$397.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$165.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$426.00
|
| Rate for Payer: United Healthcare Commercial |
$258.22
|
| Rate for Payer: Wellmark IA HMO WHPI |
$451.00
|
| Rate for Payer: Wellmark IA PPO |
$530.60
|
|
|
64640 Destruction by neurolytic agent; other perpheral nerve or branch
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
8799220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$191.33 |
| Max. Negotiated Rate |
$616.50 |
| Rate for Payer: Amerigroup Medicaid |
$193.21
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$191.33
|
| Rate for Payer: Medical Associates Commercial |
$616.50
|
| Rate for Payer: Midlands Choice Commercial |
$575.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$192.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$616.50
|
| Rate for Payer: United Healthcare Commercial |
$374.85
|
| Rate for Payer: Wellmark IA HMO WHPI |
$467.30
|
| Rate for Payer: Wellmark IA PPO |
$549.80
|
|
|
64718 Ulnar nerve at elbow - cubital tunnel
|
Professional
|
Both
|
$2,147.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
8981168
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$427.03 |
| Max. Negotiated Rate |
$1,610.25 |
| Rate for Payer: Amerigroup Medicaid |
$431.22
|
| Rate for Payer: Cash Price |
$1,717.60
|
| Rate for Payer: Cash Price |
$1,717.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$427.03
|
| Rate for Payer: Medical Associates Commercial |
$1,610.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,502.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$429.13
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,610.25
|
| Rate for Payer: United Healthcare Commercial |
$897.06
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,153.30
|
| Rate for Payer: Wellmark IA PPO |
$1,356.80
|
|
|
64721 Carpal tunnel
|
Professional
|
Both
|
$1,586.00
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
8981167
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$335.70 |
| Max. Negotiated Rate |
$1,189.50 |
| Rate for Payer: Amerigroup Medicaid |
$338.99
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$335.70
|
| Rate for Payer: Medical Associates Commercial |
$1,189.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,110.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$337.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,189.50
|
| Rate for Payer: United Healthcare Commercial |
$656.67
|
| Rate for Payer: Wellmark IA HMO WHPI |
$852.00
|
| Rate for Payer: Wellmark IA PPO |
$1,002.30
|
|
|
6 HOLE PLATE MINI
|
Facility
|
OP
|
$1,476.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8956472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.20 |
| Max. Negotiated Rate |
$1,328.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,328.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,328.40
|
| Rate for Payer: Aetna of IA Medicare |
$841.32
|
| Rate for Payer: Amerigroup Medicaid |
$851.36
|
| Rate for Payer: Amerigroup Medicare |
$670.84
|
| Rate for Payer: Cash Price |
$1,180.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,107.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$664.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$843.09
|
| Rate for Payer: Medical Associates Commercial |
$1,107.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$664.20
|
| Rate for Payer: Midlands Choice Commercial |
$1,033.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$855.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$763.83
|
| Rate for Payer: United Healthcare Commercial |
$1,328.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$870.84
|
|
|
6 HOLE PLATE MINI
|
Facility
|
IP
|
$1,476.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8956472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,033.20 |
| Max. Negotiated Rate |
$1,328.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,328.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,328.40
|
| Rate for Payer: Cash Price |
$1,180.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,107.00
|
| Rate for Payer: Medical Associates Commercial |
$1,107.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,033.20
|
| Rate for Payer: United Healthcare Commercial |
$1,328.40
|
|
|
76942 Ultrasound needle guidance
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
8801480
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$357.70 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna of IA Commercial |
$459.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$459.90
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$383.25
|
| Rate for Payer: Medical Associates Commercial |
$383.25
|
| Rate for Payer: Midlands Choice Commercial |
$357.70
|
| Rate for Payer: United Healthcare Commercial |
$459.90
|
|
|
76942 Ultrasound needle guidance
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
8801480
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$229.95 |
| Max. Negotiated Rate |
$764.60 |
| Rate for Payer: Aetna of IA Commercial |
$459.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$459.90
|
| Rate for Payer: Aetna of IA Medicare |
$291.27
|
| Rate for Payer: Amerigroup Medicaid |
$294.74
|
| Rate for Payer: Amerigroup Medicare |
$232.25
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$383.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$229.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$291.88
|
| Rate for Payer: Medical Associates Commercial |
$383.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$229.95
|
| Rate for Payer: Midlands Choice Commercial |
$357.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$296.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$264.44
|
| Rate for Payer: United Healthcare Commercial |
$459.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$301.49
|
| Rate for Payer: Wellmark IA HMO WHPI |
$694.11
|
| Rate for Payer: Wellmark IA PPO |
$764.60
|
|
|
77002 Fluoroscopic guidance for needle placement
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
8801478
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.75 |
| Max. Negotiated Rate |
$661.50 |
| Rate for Payer: Aetna of IA Commercial |
$661.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$661.50
|
| Rate for Payer: Aetna of IA Medicare |
$418.95
|
| Rate for Payer: Amerigroup Medicaid |
$423.95
|
| Rate for Payer: Amerigroup Medicare |
$334.06
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$551.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$330.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$419.83
|
| Rate for Payer: Medical Associates Commercial |
$551.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$330.75
|
| Rate for Payer: Midlands Choice Commercial |
$514.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$426.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$380.36
|
| Rate for Payer: United Healthcare Commercial |
$661.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$433.65
|
| Rate for Payer: Wellmark IA HMO WHPI |
$463.69
|
| Rate for Payer: Wellmark IA PPO |
$510.77
|
|
|
77002 Fluoroscopic guidance for needle placement
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
8801478
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$514.50 |
| Max. Negotiated Rate |
$661.50 |
| Rate for Payer: Aetna of IA Commercial |
$661.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$661.50
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$551.25
|
| Rate for Payer: Medical Associates Commercial |
$551.25
|
| Rate for Payer: Midlands Choice Commercial |
$514.50
|
| Rate for Payer: United Healthcare Commercial |
$661.50
|
|
|
77003 Fluoroscopic guidance for needle placement with spinal or paraspinal injections
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
8801479
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$305.90 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna of IA Commercial |
$393.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$393.30
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$327.75
|
| Rate for Payer: Medical Associates Commercial |
$327.75
|
| Rate for Payer: Midlands Choice Commercial |
$305.90
|
| Rate for Payer: United Healthcare Commercial |
$393.30
|
|
|
77003 Fluoroscopic guidance for needle placement with spinal or paraspinal injections
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
8801479
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.65 |
| Max. Negotiated Rate |
$510.77 |
| Rate for Payer: Aetna of IA Commercial |
$393.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$393.30
|
| Rate for Payer: Aetna of IA Medicare |
$249.09
|
| Rate for Payer: Amerigroup Medicaid |
$252.06
|
| Rate for Payer: Amerigroup Medicare |
$198.62
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$327.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$196.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$249.61
|
| Rate for Payer: Medical Associates Commercial |
$327.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$196.65
|
| Rate for Payer: Midlands Choice Commercial |
$305.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$253.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$226.15
|
| Rate for Payer: United Healthcare Commercial |
$393.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$257.83
|
| Rate for Payer: Wellmark IA HMO WHPI |
$463.69
|
| Rate for Payer: Wellmark IA PPO |
$510.77
|
|
|
7 HOLE VL TIBIA PLATE
|
Facility
|
IP
|
$2,052.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8831365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.40 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
|
|
7 HOLE VL TIBIA PLATE
|
Facility
|
OP
|
$2,052.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8831365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.40 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,169.64
|
| Rate for Payer: Amerigroup Medicaid |
$1,183.59
|
| Rate for Payer: Amerigroup Medicare |
$932.63
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$923.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,172.10
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$923.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,189.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,061.91
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,210.68
|
|
|
92960 Cardioversion electric external
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
8799221
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$149.55 |
| Max. Negotiated Rate |
$394.50 |
| Rate for Payer: Amerigroup Medicaid |
$151.02
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$149.55
|
| Rate for Payer: Medical Associates Commercial |
$394.50
|
| Rate for Payer: Midlands Choice Commercial |
$368.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$150.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$394.50
|
| Rate for Payer: United Healthcare Commercial |
$190.09
|
| Rate for Payer: Wellmark IA HMO WHPI |
$294.20
|
| Rate for Payer: Wellmark IA PPO |
$346.10
|
|
|
93010 EKG- Interpretation and Report
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
CPT 93010
|
| Hospital Charge Code |
8998408
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$18.10 |
| Rate for Payer: Amerigroup Medicaid |
$7.82
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.74
|
| Rate for Payer: Medical Associates Commercial |
$14.25
|
| Rate for Payer: Midlands Choice Commercial |
$13.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.25
|
| Rate for Payer: United Healthcare Commercial |
$13.20
|
| Rate for Payer: Wellmark IA HMO WHPI |
$15.40
|
| Rate for Payer: Wellmark IA PPO |
$18.10
|
|
|
93016 Cardiovascular Stress Test- Supervision
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
CPT 93016
|
| Hospital Charge Code |
8998707
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$26.14 |
| Max. Negotiated Rate |
$46.70 |
| Rate for Payer: Amerigroup Medicaid |
$26.40
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$26.14
|
| Rate for Payer: Medical Associates Commercial |
$41.25
|
| Rate for Payer: Midlands Choice Commercial |
$38.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$41.25
|
| Rate for Payer: United Healthcare Commercial |
$27.23
|
| Rate for Payer: Wellmark IA HMO WHPI |
$39.70
|
| Rate for Payer: Wellmark IA PPO |
$46.70
|
|
|
93017 Cardiovascular Stress Test - Tracing
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
8998407
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Aetna of IA Commercial |
$382.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$382.50
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$318.75
|
| Rate for Payer: Medical Associates Commercial |
$318.75
|
| Rate for Payer: Midlands Choice Commercial |
$297.50
|
| Rate for Payer: United Healthcare Commercial |
$382.50
|
|
|
93017 Cardiovascular Stress Test - Tracing
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
8998407
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$191.25 |
| Max. Negotiated Rate |
$406.12 |
| Rate for Payer: Aetna of IA Commercial |
$382.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$382.50
|
| Rate for Payer: Aetna of IA Medicare |
$242.25
|
| Rate for Payer: Amerigroup Medicaid |
$245.14
|
| Rate for Payer: Amerigroup Medicare |
$193.16
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$318.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$191.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$242.76
|
| Rate for Payer: Medical Associates Commercial |
$318.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$191.25
|
| Rate for Payer: Midlands Choice Commercial |
$297.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$246.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$219.94
|
| Rate for Payer: United Healthcare Commercial |
$382.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$250.75
|
| Rate for Payer: Wellmark IA HMO WHPI |
$368.68
|
| Rate for Payer: Wellmark IA PPO |
$406.12
|
|
|
93224 HOLTER MONITOR UP TO 48 HOURS
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
8398129
|
|
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
|
|
|
93224 HOLTER MONITOR UP TO 48 HOURS
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
8398129
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$171.00 |
| 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: Aetna of IA Medicare |
$216.60
|
| Rate for Payer: Amerigroup Medicaid |
$219.18
|
| Rate for Payer: Amerigroup Medicare |
$172.71
|
| 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 |
$171.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$217.06
|
| Rate for Payer: Medical Associates Commercial |
$285.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$171.00
|
| Rate for Payer: Midlands Choice Commercial |
$266.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$220.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$196.65
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$224.20
|
| Rate for Payer: Wellmark IA HMO WHPI |
$183.63
|
| Rate for Payer: Wellmark IA PPO |
$202.28
|
|
