|
93284 Multi ICD - Programming
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 93284
|
| Hospital Charge Code |
8998698
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna of IA Commercial |
$247.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$247.50
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$206.25
|
| Rate for Payer: Medical Associates Commercial |
$206.25
|
| Rate for Payer: Midlands Choice Commercial |
$192.50
|
| Rate for Payer: United Healthcare Commercial |
$247.50
|
|
|
93285 ILR Programming
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
8998699
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of IA Commercial |
$112.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$112.50
|
| Rate for Payer: Aetna of IA Medicare |
$71.25
|
| Rate for Payer: Amerigroup Medicaid |
$72.10
|
| Rate for Payer: Amerigroup Medicare |
$56.81
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$56.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.40
|
| Rate for Payer: Medical Associates Commercial |
$93.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.25
|
| Rate for Payer: Midlands Choice Commercial |
$87.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$72.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.69
|
| Rate for Payer: United Healthcare Commercial |
$112.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$73.75
|
| Rate for Payer: Wellmark IA HMO WHPI |
$97.13
|
| Rate for Payer: Wellmark IA PPO |
$107.00
|
|
|
93285 ILR Programming
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
8998699
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of IA Commercial |
$112.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$112.50
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.75
|
| Rate for Payer: Medical Associates Commercial |
$93.75
|
| Rate for Payer: Midlands Choice Commercial |
$87.50
|
| Rate for Payer: United Healthcare Commercial |
$112.50
|
|
|
93288 PM Interrogation
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
8998700
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
|
|
93288 PM Interrogation
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
8998700
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Aetna of IA Medicare |
$99.75
|
| Rate for Payer: Amerigroup Medicaid |
$100.94
|
| Rate for Payer: Amerigroup Medicare |
$79.54
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$78.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$99.96
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$78.75
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$101.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$90.56
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.25
|
| Rate for Payer: Wellmark IA HMO WHPI |
$97.13
|
| Rate for Payer: Wellmark IA PPO |
$107.00
|
|
|
93289 ICD Interrogation
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
8998701
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Aetna of IA Medicare |
$99.75
|
| Rate for Payer: Amerigroup Medicaid |
$100.94
|
| Rate for Payer: Amerigroup Medicare |
$79.54
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$78.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$99.96
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$78.75
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$101.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$90.56
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.25
|
| Rate for Payer: Wellmark IA HMO WHPI |
$97.13
|
| Rate for Payer: Wellmark IA PPO |
$107.00
|
|
|
93289 ICD Interrogation
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
8998701
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
|
|
93291 ILR Interrogation
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
8998702
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of IA Commercial |
$112.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$112.50
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.75
|
| Rate for Payer: Medical Associates Commercial |
$93.75
|
| Rate for Payer: Midlands Choice Commercial |
$87.50
|
| Rate for Payer: United Healthcare Commercial |
$112.50
|
|
|
93291 ILR Interrogation
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
8998702
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of IA Commercial |
$112.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$112.50
|
| Rate for Payer: Aetna of IA Medicare |
$71.25
|
| Rate for Payer: Amerigroup Medicaid |
$72.10
|
| Rate for Payer: Amerigroup Medicare |
$56.81
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$56.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.40
|
| Rate for Payer: Medical Associates Commercial |
$93.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.25
|
| Rate for Payer: Midlands Choice Commercial |
$87.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$72.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.69
|
| Rate for Payer: United Healthcare Commercial |
$112.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$73.75
|
| Rate for Payer: Wellmark IA HMO WHPI |
$97.13
|
| Rate for Payer: Wellmark IA PPO |
$107.00
|
|
|
93294 Remote - PM
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 93294
|
| Hospital Charge Code |
8998703
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of IA Commercial |
$112.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$112.50
|
| Rate for Payer: Aetna of IA Medicare |
$71.25
|
| Rate for Payer: Amerigroup Medicaid |
$72.10
|
| Rate for Payer: Amerigroup Medicare |
$56.81
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$56.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.40
|
| Rate for Payer: Medical Associates Commercial |
$93.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.25
|
| Rate for Payer: Midlands Choice Commercial |
$87.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$72.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.69
|
| Rate for Payer: United Healthcare Commercial |
$112.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$73.75
|
| Rate for Payer: Wellmark IA HMO WHPI |
$97.13
|
| Rate for Payer: Wellmark IA PPO |
$107.00
|
|
|
93294 Remote - PM
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 93294
|
| Hospital Charge Code |
8998703
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of IA Commercial |
$112.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$112.50
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.75
|
| Rate for Payer: Medical Associates Commercial |
$93.75
|
| Rate for Payer: Midlands Choice Commercial |
$87.50
|
| Rate for Payer: United Healthcare Commercial |
$112.50
|
|
|
93295 Remote - ICD
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 93295
|
| Hospital Charge Code |
8998404
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Aetna of IA Medicare |
$99.75
|
| Rate for Payer: Amerigroup Medicaid |
$100.94
|
| Rate for Payer: Amerigroup Medicare |
$79.54
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$78.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$99.96
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$78.75
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$101.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$90.56
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.25
|
| Rate for Payer: Wellmark IA HMO WHPI |
$97.13
|
| Rate for Payer: Wellmark IA PPO |
$107.00
|
|
|
93295 Remote - ICD
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 93295
|
| Hospital Charge Code |
8998404
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
|
|
93296 Remote - Technical
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 93296
|
| Hospital Charge Code |
8998405
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of IA Commercial |
$112.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$112.50
|
| Rate for Payer: Aetna of IA Medicare |
$71.25
|
| Rate for Payer: Amerigroup Medicaid |
$72.10
|
| Rate for Payer: Amerigroup Medicare |
$56.81
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$56.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.40
|
| Rate for Payer: Medical Associates Commercial |
$93.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.25
|
| Rate for Payer: Midlands Choice Commercial |
$87.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$72.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.69
|
| Rate for Payer: United Healthcare Commercial |
$112.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$73.75
|
| Rate for Payer: Wellmark IA HMO WHPI |
$97.13
|
| Rate for Payer: Wellmark IA PPO |
$107.00
|
|
|
93296 Remote - Technical
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 93296
|
| Hospital Charge Code |
8998405
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of IA Commercial |
$112.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$112.50
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.75
|
| Rate for Payer: Medical Associates Commercial |
$93.75
|
| Rate for Payer: Midlands Choice Commercial |
$87.50
|
| Rate for Payer: United Healthcare Commercial |
$112.50
|
|
|
93298 Remote - ILR
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 93298
|
| Hospital Charge Code |
8998704
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna of IA Commercial |
$202.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$202.50
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$168.75
|
| Rate for Payer: Medical Associates Commercial |
$168.75
|
| Rate for Payer: Midlands Choice Commercial |
$157.50
|
| Rate for Payer: United Healthcare Commercial |
$202.50
|
|
|
93298 Remote - ILR
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 93298
|
| Hospital Charge Code |
8998704
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$101.25 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna of IA Commercial |
$202.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$202.50
|
| Rate for Payer: Aetna of IA Medicare |
$128.25
|
| Rate for Payer: Amerigroup Medicaid |
$129.78
|
| Rate for Payer: Amerigroup Medicare |
$102.26
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$168.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$101.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$128.52
|
| Rate for Payer: Medical Associates Commercial |
$168.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$101.25
|
| Rate for Payer: Midlands Choice Commercial |
$157.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$130.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$116.44
|
| Rate for Payer: United Healthcare Commercial |
$202.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$132.75
|
| Rate for Payer: Wellmark IA HMO WHPI |
$136.13
|
| Rate for Payer: Wellmark IA PPO |
$149.95
|
|
|
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
|
|
|
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 |
$99.00 |
| Max. Negotiated Rate |
$361.60 |
| 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 |
$126.90
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| 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 |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.66
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.85
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
| Rate for Payer: Wellmark IA HMO WHPI |
$328.27
|
| Rate for Payer: Wellmark IA PPO |
$361.60
|
|
|
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 |
$117.00 |
| 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: Aetna of IA Medicare |
$148.20
|
| Rate for Payer: Amerigroup Medicaid |
$149.97
|
| Rate for Payer: Amerigroup Medicare |
$118.17
|
| 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 |
$117.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$148.51
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$117.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$150.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$134.55
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.40
|
| Rate for Payer: Wellmark IA HMO WHPI |
$185.05
|
| Rate for Payer: Wellmark IA PPO |
$203.84
|
|
|
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 |
$149.85 |
| Max. Negotiated Rate |
$430.33 |
| 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 |
$192.07
|
| Rate for Payer: Amerigroup Medicare |
$151.35
|
| 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 |
$149.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$190.21
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$149.85
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$193.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$172.33
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
| Rate for Payer: Wellmark IA HMO WHPI |
$390.66
|
| Rate for Payer: Wellmark IA PPO |
$430.33
|
|
|
94425 Inject Ilioinguinal Iliohypogastric Nerve
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
8814672
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$111.32 |
| Max. Negotiated Rate |
$290.25 |
| Rate for Payer: Amerigroup Medicaid |
$112.41
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$111.32
|
| Rate for Payer: Medical Associates Commercial |
$290.25
|
| Rate for Payer: Midlands Choice Commercial |
$270.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$111.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$290.25
|
| Rate for Payer: United Healthcare Commercial |
$169.38
|
| Rate for Payer: Wellmark IA HMO WHPI |
$208.00
|
| Rate for Payer: Wellmark IA PPO |
$244.70
|
|
|
94625 : Pulmonary rehabilitation without continuous oximetry
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
8873990
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$215.10 |
| Rate for Payer: Aetna of IA Commercial |
$215.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$215.10
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
|
