|
Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report)
|
Facility
|
OP
|
$1,368.09
|
|
|
Service Code
|
CPT 43752
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,243.72 |
| Max. Negotiated Rate |
$1,368.09 |
| Rate for Payer: Wellmark IA HMO |
$1,243.72
|
| Rate for Payer: Wellmark IA PPO |
$1,368.09
|
|
|
N BLOCK INJ FACIAL
|
Professional
|
Both
|
$444.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
7982765
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$310.80 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Medical Associates Commercial |
$333.00
|
| Rate for Payer: Midlands Choice Commercial |
$310.80
|
|
|
N BLOCK OTHER PERIPHERAL
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
7982764
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$141.40 |
| Rate for Payer: Aetna of IA Medicare |
$38.16
|
| Rate for Payer: Amerigroup Medicaid |
$39.46
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$161.60
|
| 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 |
$68.69
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.16
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Oscar Health of IA Commercial |
$66.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$57.24
|
|
|
NBS BIOTINIDASE
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 82261
|
| Hospital Charge Code |
8098975
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of IA Commercial |
$124.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$124.20
|
| Rate for Payer: Aetna of IA Medicare |
$78.66
|
| Rate for Payer: Amerigroup Medicaid |
$69.65
|
| Rate for Payer: Amerigroup Medicare |
$69.69
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$68.97
|
| Rate for Payer: Medical Associates Commercial |
$103.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.00
|
| Rate for Payer: Midlands Choice Commercial |
$96.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.04
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$69.99
|
| Rate for Payer: Oscar Health of IA Commercial |
$103.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$103.50
|
| Rate for Payer: United Healthcare Commercial |
$124.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$81.42
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
NBS BIOTINIDASE
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 82261
|
| Hospital Charge Code |
8098975
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of IA Commercial |
$124.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$124.20
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.50
|
| Rate for Payer: Medical Associates Commercial |
$103.50
|
| Rate for Payer: Midlands Choice Commercial |
$96.60
|
| Rate for Payer: United Healthcare Commercial |
$124.20
|
|
|
NBS FETAL ADN-HGB
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
8098976
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
NBS FETAL ADN-HGB
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
8098976
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$70.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$104.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
NBS PKU
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 84030
|
| Hospital Charge Code |
8099019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$30.79
|
| Rate for Payer: Amerigroup Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.49
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.50
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.96
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$30.94
|
| Rate for Payer: Oscar Health of IA Commercial |
$45.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
NBS PKU
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 84030
|
| Hospital Charge Code |
8099019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
NBS PROGESTERONE
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
8098974
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of IA Commercial |
$153.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$153.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$127.50
|
| Rate for Payer: Medical Associates Commercial |
$127.50
|
| Rate for Payer: Midlands Choice Commercial |
$119.00
|
| Rate for Payer: United Healthcare Commercial |
$153.00
|
|
|
NBS PROGESTERONE
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
8098974
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of IA Commercial |
$153.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$153.00
|
| Rate for Payer: Aetna of IA Medicare |
$96.90
|
| Rate for Payer: Amerigroup Medicaid |
$85.80
|
| Rate for Payer: Amerigroup Medicare |
$85.85
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$127.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$85.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$84.97
|
| Rate for Payer: Medical Associates Commercial |
$127.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$85.00
|
| Rate for Payer: Midlands Choice Commercial |
$119.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$86.28
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$86.22
|
| Rate for Payer: Oscar Health of IA Commercial |
$127.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$127.50
|
| Rate for Payer: United Healthcare Commercial |
$153.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$100.30
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
NBS T4 ELUTION
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 84437
|
| Hospital Charge Code |
8098977
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna of IA Commercial |
$55.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$55.80
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.50
|
| Rate for Payer: Medical Associates Commercial |
$46.50
|
| Rate for Payer: Midlands Choice Commercial |
$43.40
|
| Rate for Payer: United Healthcare Commercial |
$55.80
|
|
|
NBS T4 ELUTION
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 84437
|
| Hospital Charge Code |
8098977
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.99 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna of IA Commercial |
$55.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$55.80
|
| Rate for Payer: Aetna of IA Medicare |
$35.34
|
| Rate for Payer: Amerigroup Medicaid |
$31.29
|
| Rate for Payer: Amerigroup Medicare |
$31.31
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.99
|
| Rate for Payer: Medical Associates Commercial |
$46.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.00
|
| Rate for Payer: Midlands Choice Commercial |
$43.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$31.46
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$31.45
|
| Rate for Payer: Oscar Health of IA Commercial |
$46.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$46.50
|
| Rate for Payer: United Healthcare Commercial |
$55.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$36.58
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
nebivolol 5 mg Tab [VDMC]
|
Facility
|
OP
|
$3.91
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11224858
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna of IA Commercial |
$3.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.52
|
| Rate for Payer: Aetna of IA Medicare |
$2.23
|
| Rate for Payer: Amerigroup Medicaid |
$1.97
|
| Rate for Payer: Amerigroup Medicare |
$1.97
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.93
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.95
|
| Rate for Payer: Medical Associates Commercial |
$2.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.96
|
| Rate for Payer: Midlands Choice Commercial |
$2.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.98
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.98
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.93
|
| Rate for Payer: United Healthcare Commercial |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.31
|
|
|
nebivolol 5 mg Tab [VDMC]
|
Facility
|
IP
|
$3.91
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11224858
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna of IA Commercial |
$3.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.52
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.93
|
| Rate for Payer: Medical Associates Commercial |
$2.93
|
| Rate for Payer: Midlands Choice Commercial |
$2.74
|
| Rate for Payer: United Healthcare Commercial |
$3.52
|
|
|
NEB TRT/MDI - SPUTUM INDUCTION
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
5758782
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$111.96 |
| Max. Negotiated Rate |
$360.78 |
| Rate for Payer: Aetna of IA Commercial |
$201.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$201.60
|
| Rate for Payer: Aetna of IA Medicare |
$127.68
|
| Rate for Payer: Amerigroup Medicaid |
$113.05
|
| Rate for Payer: Amerigroup Medicare |
$113.12
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$168.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$112.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$111.96
|
| Rate for Payer: Medical Associates Commercial |
$168.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$112.00
|
| Rate for Payer: Midlands Choice Commercial |
$156.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$113.68
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$113.61
|
| Rate for Payer: Oscar Health of IA Commercial |
$168.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$168.00
|
| Rate for Payer: United Healthcare Commercial |
$201.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$132.16
|
| Rate for Payer: Wellmark IA HMO |
$327.98
|
| Rate for Payer: Wellmark IA PPO |
$360.78
|
|
|
NEB TRT/MDI - SPUTUM INDUCTION
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4770831
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$111.96 |
| Max. Negotiated Rate |
$360.78 |
| Rate for Payer: Aetna of IA Commercial |
$201.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$201.60
|
| Rate for Payer: Aetna of IA Medicare |
$127.68
|
| Rate for Payer: Amerigroup Medicaid |
$113.05
|
| Rate for Payer: Amerigroup Medicare |
$113.12
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$168.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$112.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$111.96
|
| Rate for Payer: Medical Associates Commercial |
$168.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$112.00
|
| Rate for Payer: Midlands Choice Commercial |
$156.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$113.68
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$113.61
|
| Rate for Payer: Oscar Health of IA Commercial |
$168.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$168.00
|
| Rate for Payer: United Healthcare Commercial |
$201.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$132.16
|
| Rate for Payer: Wellmark IA HMO |
$327.98
|
| Rate for Payer: Wellmark IA PPO |
$360.78
|
|
|
NEB TRT/MDI - SPUTUM INDUCTION
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
5758782
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna of IA Commercial |
$201.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$201.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$168.00
|
| Rate for Payer: Medical Associates Commercial |
$168.00
|
| Rate for Payer: Midlands Choice Commercial |
$156.80
|
| Rate for Payer: United Healthcare Commercial |
$201.60
|
|
|
NEB TRT/MDI - SPUTUM INDUCTION
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4770831
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna of IA Commercial |
$201.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$201.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$168.00
|
| Rate for Payer: Medical Associates Commercial |
$168.00
|
| Rate for Payer: Midlands Choice Commercial |
$156.80
|
| Rate for Payer: United Healthcare Commercial |
$201.60
|
|
|
NECK ADJUSTMENT 4MM SLEEVE UNITRAX
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,366.40 |
| Max. Negotiated Rate |
$1,756.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,756.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,756.80
|
| Rate for Payer: Cash Price |
$1,561.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,464.00
|
| Rate for Payer: Medical Associates Commercial |
$1,464.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,366.40
|
| Rate for Payer: United Healthcare Commercial |
$1,756.80
|
|
|
NECK ADJUSTMENT 4MM SLEEVE UNITRAX
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.61 |
| Max. Negotiated Rate |
$1,756.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,756.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,756.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,112.64
|
| Rate for Payer: Amerigroup Medicaid |
$985.17
|
| Rate for Payer: Amerigroup Medicare |
$985.76
|
| Rate for Payer: Cash Price |
$1,561.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,464.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$976.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$975.61
|
| Rate for Payer: Medical Associates Commercial |
$1,464.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$976.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,366.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$990.64
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$990.05
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,464.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,464.00
|
| Rate for Payer: United Healthcare Commercial |
$1,756.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,151.68
|
|
|
NECK ADJUSTMENT 4MM SLEEVE UNITRAX-1
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.42 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Aetna of IA Medicare |
$230.85
|
| Rate for Payer: Amerigroup Medicaid |
$204.40
|
| Rate for Payer: Amerigroup Medicare |
$204.52
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$202.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.42
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$205.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$205.42
|
| Rate for Payer: Oscar Health of IA Commercial |
$303.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$303.75
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
|
NECK ADJUSTMENT 4MM SLEEVE UNITRAX-1
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
|
|
NECK UNITRAK 5MM
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.43 |
| Max. Negotiated Rate |
$330.30 |
| Rate for Payer: Aetna of IA Commercial |
$330.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$330.30
|
| Rate for Payer: Aetna of IA Medicare |
$209.19
|
| Rate for Payer: Amerigroup Medicaid |
$185.22
|
| Rate for Payer: Amerigroup Medicare |
$185.34
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$275.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$183.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$183.43
|
| Rate for Payer: Medical Associates Commercial |
$275.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$183.50
|
| Rate for Payer: Midlands Choice Commercial |
$256.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$186.25
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$186.14
|
| Rate for Payer: Oscar Health of IA Commercial |
$275.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$275.25
|
| Rate for Payer: United Healthcare Commercial |
$330.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$216.53
|
|
|
NECK UNITRAK 5MM
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.90 |
| Max. Negotiated Rate |
$330.30 |
| Rate for Payer: Aetna of IA Commercial |
$330.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$330.30
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$275.25
|
| Rate for Payer: Medical Associates Commercial |
$275.25
|
| Rate for Payer: Midlands Choice Commercial |
$256.90
|
| Rate for Payer: United Healthcare Commercial |
$330.30
|
|
