|
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 |
$76.50 |
| 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 |
$98.06
|
| Rate for Payer: Amerigroup Medicare |
$77.27
|
| 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 |
$76.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$97.10
|
| Rate for Payer: Medical Associates Commercial |
$127.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$76.50
|
| Rate for Payer: Midlands Choice Commercial |
$119.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$98.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$87.97
|
| Rate for Payer: United Healthcare Commercial |
$153.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$100.30
|
|
|
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 |
$27.90 |
| 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 |
$35.76
|
| Rate for Payer: Amerigroup Medicare |
$28.18
|
| 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 |
$27.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.41
|
| Rate for Payer: Medical Associates Commercial |
$46.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.90
|
| Rate for Payer: Midlands Choice Commercial |
$43.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$32.09
|
| Rate for Payer: United Healthcare Commercial |
$55.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$36.58
|
|
|
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 |
$2.94
|
| Rate for Payer: Medical Associates Commercial |
$2.94
|
| Rate for Payer: Midlands Choice Commercial |
$2.74
|
| Rate for Payer: United Healthcare Commercial |
$3.52
|
|
|
nebivolol 5 mg Tab [VDMC]
|
Facility
|
OP
|
$3.91
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11224858
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.76 |
| 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 |
$2.26
|
| Rate for Payer: Amerigroup Medicare |
$1.78
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.94
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.24
|
| Rate for Payer: Medical Associates Commercial |
$2.94
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.76
|
| Rate for Payer: Midlands Choice Commercial |
$2.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.03
|
| Rate for Payer: United Healthcare Commercial |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.31
|
|
|
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
|
|
|
NEB TRT/MDI - SPUTUM INDUCTION
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
5758782
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$100.80 |
| 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: Aetna of IA Medicare |
$127.68
|
| Rate for Payer: Amerigroup Medicaid |
$129.20
|
| Rate for Payer: Amerigroup Medicare |
$101.81
|
| 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 |
$100.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$127.95
|
| Rate for Payer: Medical Associates Commercial |
$168.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$100.80
|
| Rate for Payer: Midlands Choice Commercial |
$156.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$129.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$115.92
|
| Rate for Payer: United Healthcare Commercial |
$201.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$132.16
|
|
|
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
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4770831
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$100.80 |
| 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: Aetna of IA Medicare |
$127.68
|
| Rate for Payer: Amerigroup Medicaid |
$129.20
|
| Rate for Payer: Amerigroup Medicare |
$101.81
|
| 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 |
$100.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$127.95
|
| Rate for Payer: Medical Associates Commercial |
$168.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$100.80
|
| Rate for Payer: Midlands Choice Commercial |
$156.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$129.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$115.92
|
| Rate for Payer: United Healthcare Commercial |
$201.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$132.16
|
|
|
NECK ADJUSTMENT 4MM SLEEVE UNITRAX
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$878.40 |
| 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: Aetna of IA Medicare |
$1,112.64
|
| Rate for Payer: Amerigroup Medicaid |
$1,125.91
|
| Rate for Payer: Amerigroup Medicare |
$887.18
|
| 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 |
$878.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,114.98
|
| Rate for Payer: Medical Associates Commercial |
$1,464.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$878.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,366.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,131.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,010.16
|
| Rate for Payer: United Healthcare Commercial |
$1,756.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,151.68
|
|
|
NECK ADJUSTMENT 4MM SLEEVE UNITRAX
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
HCPCS 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-1
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
HCPCS 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 ADJUSTMENT 4MM SLEEVE UNITRAX-1
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.25 |
| 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 |
$233.60
|
| Rate for Payer: Amerigroup Medicare |
$184.07
|
| 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 |
$182.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$231.34
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$182.25
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$234.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$209.59
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
|
NECK UNITRAK 5MM
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.15 |
| 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 |
$211.69
|
| Rate for Payer: Amerigroup Medicare |
$166.80
|
| 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 |
$165.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$209.63
|
| Rate for Payer: Medical Associates Commercial |
$275.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$165.15
|
| Rate for Payer: Midlands Choice Commercial |
$256.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$212.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$189.92
|
| 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
|
HCPCS 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
|
|
|
NEEDLE BIOPSY OF LIVER
|
Facility
|
OP
|
$626.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
7983042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$281.70 |
| Max. Negotiated Rate |
$563.40 |
| Rate for Payer: Aetna of IA Commercial |
$563.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$563.40
|
| Rate for Payer: Aetna of IA Medicare |
$356.82
|
| Rate for Payer: Amerigroup Medicaid |
$361.08
|
| Rate for Payer: Amerigroup Medicare |
$284.52
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$469.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$281.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$357.57
|
| Rate for Payer: Medical Associates Commercial |
$469.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$281.70
|
| Rate for Payer: Midlands Choice Commercial |
$438.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$362.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$323.95
|
| Rate for Payer: United Healthcare Commercial |
$563.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$369.34
|
|
|
NEEDLE BIOPSY OF LIVER
|
Facility
|
IP
|
$626.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
7983042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$438.20 |
| Max. Negotiated Rate |
$563.40 |
| Rate for Payer: Aetna of IA Commercial |
$563.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$563.40
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$469.50
|
| Rate for Payer: Medical Associates Commercial |
$469.50
|
| Rate for Payer: Midlands Choice Commercial |
$438.20
|
| Rate for Payer: United Healthcare Commercial |
$563.40
|
|
|
NEEDLE LOCALIZATION BY XRAY
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
8015868
|
|
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: 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
|
|
|
NEEDLE LOCALIZATION BY XRAY
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
8015868
|
|
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
|
|
|
NEG PRESSURE WOUND THERAPY > 50 CM
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
7450784
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$186.20 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Aetna of IA Commercial |
$239.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$239.40
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$199.50
|
| Rate for Payer: Medical Associates Commercial |
$199.50
|
| Rate for Payer: Midlands Choice Commercial |
$186.20
|
| Rate for Payer: United Healthcare Commercial |
$239.40
|
|
|
NEG PRESSURE WOUND THERAPY > 50 CM
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
7450784
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.70 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Aetna of IA Commercial |
$239.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$239.40
|
| Rate for Payer: Aetna of IA Medicare |
$151.62
|
| Rate for Payer: Amerigroup Medicaid |
$153.43
|
| Rate for Payer: Amerigroup Medicare |
$120.90
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$199.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$119.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$151.94
|
| Rate for Payer: Medical Associates Commercial |
$199.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$119.70
|
| Rate for Payer: Midlands Choice Commercial |
$186.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$154.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$137.66
|
| Rate for Payer: United Healthcare Commercial |
$239.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$156.94
|
|
|
NEG PRESSURE WOUND THERAPY 50 CM OR LESS
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
7450783
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$42.09 |
| Max. Negotiated Rate |
$154.50 |
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Medical Associates Commercial |
$154.50
|
| Rate for Payer: Midlands Choice Commercial |
$144.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$154.50
|
| Rate for Payer: United Healthcare Commercial |
$42.09
|
|
|
NEG PRESSURE WOUND THERAPY 50 CM OR LESS
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
7450783
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.70 |
| Max. Negotiated Rate |
$185.40 |
| Rate for Payer: Aetna of IA Commercial |
$185.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$185.40
|
| Rate for Payer: Aetna of IA Medicare |
$117.42
|
| Rate for Payer: Amerigroup Medicaid |
$118.82
|
| Rate for Payer: Amerigroup Medicare |
$93.63
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$154.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$92.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$117.67
|
| Rate for Payer: Medical Associates Commercial |
$154.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$92.70
|
| Rate for Payer: Midlands Choice Commercial |
$144.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$119.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$106.61
|
| Rate for Payer: United Healthcare Commercial |
$185.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$121.54
|
|
