|
Pulmonary Rehab Non COPD Charge
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS G0239 KX
|
| Hospital Charge Code |
8059083
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna of IA Commercial |
$140.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.40
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.00
|
| Rate for Payer: Medical Associates Commercial |
$117.00
|
| Rate for Payer: Midlands Choice Commercial |
$109.20
|
| Rate for Payer: United Healthcare Commercial |
$140.40
|
|
|
Pulmonary Rehab Non COPD Charge
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
8059082
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$185.88 |
| Rate for Payer: Aetna of IA Commercial |
$140.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.40
|
| Rate for Payer: Aetna of IA Medicare |
$88.92
|
| Rate for Payer: Amerigroup Medicaid |
$89.98
|
| Rate for Payer: Amerigroup Medicare |
$70.90
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.11
|
| Rate for Payer: Medical Associates Commercial |
$117.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.20
|
| Rate for Payer: Midlands Choice Commercial |
$109.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$90.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$80.73
|
| Rate for Payer: United Healthcare Commercial |
$140.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.04
|
| Rate for Payer: Wellmark IA HMO WHPI |
$168.74
|
| Rate for Payer: Wellmark IA PPO |
$185.88
|
|
|
Pulmonary Rehab Non COPD Charge
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
8059082
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna of IA Commercial |
$140.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.40
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.00
|
| Rate for Payer: Medical Associates Commercial |
$117.00
|
| Rate for Payer: Midlands Choice Commercial |
$109.20
|
| Rate for Payer: United Healthcare Commercial |
$140.40
|
|
|
Pulmonary Rehab Non COPD Charge
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
8059081
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna of IA Commercial |
$140.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.40
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.00
|
| Rate for Payer: Medical Associates Commercial |
$117.00
|
| Rate for Payer: Midlands Choice Commercial |
$109.20
|
| Rate for Payer: United Healthcare Commercial |
$140.40
|
|
|
PULMONARY REHAB PHASE II
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 94625 KX
|
| Hospital Charge Code |
7827005
|
|
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
|
|
|
PULMONARY REHAB PHASE II
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 94625 KX
|
| Hospital Charge Code |
7827005
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$107.55 |
| 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: Aetna of IA Medicare |
$136.23
|
| Rate for Payer: Amerigroup Medicaid |
$137.86
|
| Rate for Payer: Amerigroup Medicare |
$108.63
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$107.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$136.52
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$107.55
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$138.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$123.68
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$141.01
|
| Rate for Payer: Wellmark IA HMO WHPI |
$168.74
|
| Rate for Payer: Wellmark IA PPO |
$185.88
|
|
|
PULMONARY REHAB PHASE II
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
7702165
|
|
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
|
|
|
PULMONARY REHAB PHASE II
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
7702165
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$107.55 |
| 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: Aetna of IA Medicare |
$136.23
|
| Rate for Payer: Amerigroup Medicaid |
$137.86
|
| Rate for Payer: Amerigroup Medicare |
$108.63
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$107.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$136.52
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$107.55
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$138.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$123.68
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$141.01
|
| Rate for Payer: Wellmark IA HMO WHPI |
$168.74
|
| Rate for Payer: Wellmark IA PPO |
$185.88
|
|
|
PULMONARY REHAB PHASE II
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
7827004
|
|
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
|
|
|
PULMONARY REHAB PHASE II
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
7827004
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$107.55 |
| 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: Aetna of IA Medicare |
$136.23
|
| Rate for Payer: Amerigroup Medicaid |
$137.86
|
| Rate for Payer: Amerigroup Medicare |
$108.63
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$107.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$136.52
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$107.55
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$138.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$123.68
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$141.01
|
| Rate for Payer: Wellmark IA HMO WHPI |
$168.74
|
| Rate for Payer: Wellmark IA PPO |
$185.88
|
|
|
PULMONARY REHAB PHASE II
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 94625 KX
|
| Hospital Charge Code |
7702164
|
|
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
|
|
|
PULMONARY REHAB PHASE II
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 94625 KX
|
| Hospital Charge Code |
7702164
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$107.55 |
| 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: Aetna of IA Medicare |
$136.23
|
| Rate for Payer: Amerigroup Medicaid |
$137.86
|
| Rate for Payer: Amerigroup Medicare |
$108.63
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$107.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$136.52
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$107.55
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$138.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$123.68
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$141.01
|
| Rate for Payer: Wellmark IA HMO WHPI |
$168.74
|
| Rate for Payer: Wellmark IA PPO |
$185.88
|
|
|
Pulmonary Rehab TherEx Charge
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
8058999
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
|
|
Pulmonary Rehab TherEx Charge
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
8058999
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$185.88 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Aetna of IA Medicare |
$56.43
|
| Rate for Payer: Amerigroup Medicaid |
$57.10
|
| Rate for Payer: Amerigroup Medicare |
$45.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$44.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.55
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.55
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.23
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.41
|
| Rate for Payer: Wellmark IA HMO WHPI |
$168.74
|
| Rate for Payer: Wellmark IA PPO |
$185.88
|
|
|
Pulm Rehab w Continuos Oximetry
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
8873992
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$148.05 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna of IA Commercial |
$296.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$296.10
|
| Rate for Payer: Aetna of IA Medicare |
$187.53
|
| Rate for Payer: Amerigroup Medicaid |
$189.77
|
| Rate for Payer: Amerigroup Medicare |
$149.53
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$246.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$148.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$187.92
|
| Rate for Payer: Medical Associates Commercial |
$246.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$148.05
|
| Rate for Payer: Midlands Choice Commercial |
$230.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$190.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$170.26
|
| Rate for Payer: United Healthcare Commercial |
$296.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$194.11
|
| Rate for Payer: Wellmark IA HMO WHPI |
$168.74
|
| Rate for Payer: Wellmark IA PPO |
$185.88
|
|
|
Pulm Rehab w Continuos Oximetry
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
8873992
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$230.30 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna of IA Commercial |
$296.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$296.10
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$246.75
|
| Rate for Payer: Medical Associates Commercial |
$246.75
|
| Rate for Payer: Midlands Choice Commercial |
$230.30
|
| Rate for Payer: United Healthcare Commercial |
$296.10
|
|
|
PUNCH FOR 3.5MM PUNCHLOCK
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.10 |
| Max. Negotiated Rate |
$322.20 |
| Rate for Payer: Aetna of IA Commercial |
$322.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$322.20
|
| Rate for Payer: Aetna of IA Medicare |
$204.06
|
| Rate for Payer: Amerigroup Medicaid |
$206.49
|
| Rate for Payer: Amerigroup Medicare |
$162.71
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$268.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$161.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$204.49
|
| Rate for Payer: Medical Associates Commercial |
$268.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$161.10
|
| Rate for Payer: Midlands Choice Commercial |
$250.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$207.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$185.26
|
| Rate for Payer: United Healthcare Commercial |
$322.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$211.22
|
|
|
PUNCH FOR 3.5MM PUNCHLOCK
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.60 |
| Max. Negotiated Rate |
$322.20 |
| Rate for Payer: Aetna of IA Commercial |
$322.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$322.20
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$268.50
|
| Rate for Payer: Medical Associates Commercial |
$268.50
|
| Rate for Payer: Midlands Choice Commercial |
$250.60
|
| Rate for Payer: United Healthcare Commercial |
$322.20
|
|
|
PUNCTURE DRAINAGE OF LESION
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
4862801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$267.30 |
| Max. Negotiated Rate |
$534.60 |
| Rate for Payer: Aetna of IA Commercial |
$534.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$534.60
|
| Rate for Payer: Aetna of IA Medicare |
$338.58
|
| Rate for Payer: Amerigroup Medicaid |
$342.62
|
| Rate for Payer: Amerigroup Medicare |
$269.97
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$445.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$267.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$339.29
|
| Rate for Payer: Medical Associates Commercial |
$445.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$267.30
|
| Rate for Payer: Midlands Choice Commercial |
$415.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$344.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$307.40
|
| Rate for Payer: United Healthcare Commercial |
$534.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$350.46
|
| Rate for Payer: Wellmark IA HMO WHPI |
$302.74
|
| Rate for Payer: Wellmark IA PPO |
$333.49
|
|
|
PUNCTURE DRAINAGE OF LESION
|
Professional
|
Both
|
$294.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
7982854
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$75.86 |
| Max. Negotiated Rate |
$279.60 |
| Rate for Payer: Amerigroup Medicaid |
$76.60
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$75.86
|
| Rate for Payer: Medical Associates Commercial |
$220.50
|
| Rate for Payer: Midlands Choice Commercial |
$205.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$76.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$220.50
|
| Rate for Payer: United Healthcare Commercial |
$196.83
|
| Rate for Payer: Wellmark IA HMO WHPI |
$237.60
|
| Rate for Payer: Wellmark IA PPO |
$279.60
|
|
|
PUNCTURE DRAINAGE OF LESION
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
4862801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$415.80 |
| Max. Negotiated Rate |
$534.60 |
| Rate for Payer: Aetna of IA Commercial |
$534.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$534.60
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$445.50
|
| Rate for Payer: Medical Associates Commercial |
$445.50
|
| Rate for Payer: Midlands Choice Commercial |
$415.80
|
| Rate for Payer: United Healthcare Commercial |
$534.60
|
|
|
PUSHLOCK DISPOSABLE KIT FOR HIP
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
|
|
PUSHLOCK DISPOSABLE KIT FOR HIP
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.75 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Aetna of IA Medicare |
$179.55
|
| Rate for Payer: Amerigroup Medicaid |
$181.69
|
| Rate for Payer: Amerigroup Medicare |
$143.17
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$141.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$179.93
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$141.75
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$182.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$163.01
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
|
PUSHLOCK KIT
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
|
|
PUSHLOCK KIT
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.75 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Aetna of IA Medicare |
$179.55
|
| Rate for Payer: Amerigroup Medicaid |
$181.69
|
| Rate for Payer: Amerigroup Medicare |
$143.17
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$141.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$179.93
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$141.75
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$182.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$163.01
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
