|
STERISHIELD II DUAL LAYER AMNION PATCH 4X4
|
Facility
|
OP
|
$4,131.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8578902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,858.95 |
| Max. Negotiated Rate |
$3,717.90 |
| Rate for Payer: Aetna of IA Commercial |
$3,717.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,717.90
|
| Rate for Payer: Aetna of IA Medicare |
$2,354.67
|
| Rate for Payer: Amerigroup Medicaid |
$2,382.76
|
| Rate for Payer: Amerigroup Medicare |
$1,877.54
|
| Rate for Payer: Cash Price |
$3,304.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,098.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,858.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,359.63
|
| Rate for Payer: Medical Associates Commercial |
$3,098.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,858.95
|
| Rate for Payer: Midlands Choice Commercial |
$2,891.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,394.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,137.79
|
| Rate for Payer: United Healthcare Commercial |
$3,717.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,437.29
|
|
|
STIM SUP
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS G0283 GO
|
| Hospital Charge Code |
1373552
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of IA Commercial |
$76.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.50
|
| Rate for Payer: Aetna of IA Medicare |
$48.45
|
| Rate for Payer: Amerigroup Medicaid |
$49.03
|
| Rate for Payer: Amerigroup Medicare |
$38.63
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$48.55
|
| Rate for Payer: Medical Associates Commercial |
$63.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.25
|
| Rate for Payer: Midlands Choice Commercial |
$59.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.99
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.15
|
|
|
STIM SUP
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS G0283 GO
|
| Hospital Charge Code |
1373552
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of IA Commercial |
$76.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.50
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.75
|
| Rate for Payer: Medical Associates Commercial |
$63.75
|
| Rate for Payer: Midlands Choice Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
|
|
Stone (Calculus) Analysis DMCL
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
8505620
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.55 |
| 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 |
$80.18
|
| Rate for Payer: Amerigroup Medicare |
$63.18
|
| 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 |
$62.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.40
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.55
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.93
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
|
|
Stone (Calculus) Analysis DMCL
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
8505620
|
|
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
|
|
|
STOOL CULTURE
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 87045
|
| Hospital Charge Code |
633904
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of IA Commercial |
$69.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.30
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.75
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
|
|
STOOL CULTURE
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 87045
|
| Hospital Charge Code |
633904
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of IA Commercial |
$69.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.30
|
| Rate for Payer: Aetna of IA Medicare |
$43.89
|
| Rate for Payer: Amerigroup Medicaid |
$44.41
|
| Rate for Payer: Amerigroup Medicare |
$35.00
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.98
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.65
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.85
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.43
|
|
|
Stool Pathogen PCR Panel
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
7812190
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna of IA Commercial |
$675.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$675.00
|
| Rate for Payer: Aetna of IA Medicare |
$427.50
|
| Rate for Payer: Amerigroup Medicaid |
$432.60
|
| Rate for Payer: Amerigroup Medicare |
$340.88
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$562.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$337.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$428.40
|
| Rate for Payer: Medical Associates Commercial |
$562.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$337.50
|
| Rate for Payer: Midlands Choice Commercial |
$525.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$434.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$388.12
|
| Rate for Payer: United Healthcare Commercial |
$675.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$442.50
|
|
|
Stool Pathogen PCR Panel
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
7812190
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna of IA Commercial |
$675.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$675.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$562.50
|
| Rate for Payer: Medical Associates Commercial |
$562.50
|
| Rate for Payer: Midlands Choice Commercial |
$525.00
|
| Rate for Payer: United Healthcare Commercial |
$675.00
|
|
|
STRAPPING ANKLE FOOT
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 29540 GP
|
| Hospital Charge Code |
6344976
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of IA Commercial |
$105.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.30
|
| Rate for Payer: Aetna of IA Medicare |
$66.69
|
| Rate for Payer: Amerigroup Medicaid |
$67.49
|
| Rate for Payer: Amerigroup Medicare |
$53.18
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$66.83
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.65
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$67.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$60.55
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.03
|
|
|
STRAPPING ANKLE FOOT
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 29540 GP
|
| Hospital Charge Code |
6344976
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of IA Commercial |
$105.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.30
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.75
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
|
|
STRAPPING HAND/FINGER
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 29280 GO
|
| Hospital Charge Code |
1374354
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna of IA Commercial |
$91.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$91.80
|
| Rate for Payer: Aetna of IA Medicare |
$58.14
|
| Rate for Payer: Amerigroup Medicaid |
$58.83
|
| Rate for Payer: Amerigroup Medicare |
$46.36
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$76.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$45.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$58.26
|
| Rate for Payer: Medical Associates Commercial |
$76.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$45.90
|
| Rate for Payer: Midlands Choice Commercial |
$71.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$59.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$52.78
|
| Rate for Payer: United Healthcare Commercial |
$91.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$60.18
|
|
|
STRAPPING HAND/FINGER
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 29280 GO
|
| Hospital Charge Code |
1374354
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna of IA Commercial |
$91.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$91.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$76.50
|
| Rate for Payer: Medical Associates Commercial |
$76.50
|
| Rate for Payer: Midlands Choice Commercial |
$71.40
|
| Rate for Payer: United Healthcare Commercial |
$91.80
|
|
|
STRAPPING KNEE
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 29530 GP
|
| Hospital Charge Code |
1374356
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.70 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna of IA Commercial |
$95.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$95.40
|
| Rate for Payer: Aetna of IA Medicare |
$60.42
|
| Rate for Payer: Amerigroup Medicaid |
$61.14
|
| Rate for Payer: Amerigroup Medicare |
$48.18
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$79.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$47.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$60.55
|
| Rate for Payer: Medical Associates Commercial |
$79.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.70
|
| Rate for Payer: Midlands Choice Commercial |
$74.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$61.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.85
|
| Rate for Payer: United Healthcare Commercial |
$95.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$62.54
|
|
|
STRAPPING KNEE
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 29530 GP
|
| Hospital Charge Code |
1374356
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna of IA Commercial |
$95.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$95.40
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$79.50
|
| Rate for Payer: Medical Associates Commercial |
$79.50
|
| Rate for Payer: Midlands Choice Commercial |
$74.20
|
| Rate for Payer: United Healthcare Commercial |
$95.40
|
|
|
STRAPPING OF ANKLE AND/OR FT
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
4864895
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
|
|
STRAPPING OF ANKLE AND/OR FT
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
4864895
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Aetna of IA Medicare |
$102.60
|
| Rate for Payer: Amerigroup Medicaid |
$103.82
|
| Rate for Payer: Amerigroup Medicare |
$81.81
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$102.82
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.15
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.20
|
|
|
STRAPPING OF SHOULDER
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
7822785
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Medical Associates Commercial |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$53.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$57.00
|
| Rate for Payer: United Healthcare Commercial |
$47.63
|
|
|
STRAPPING SHOULDER
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 29240 GP
|
| Hospital Charge Code |
1374352
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.05 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Aetna of IA Medicare |
$73.53
|
| Rate for Payer: Amerigroup Medicaid |
$74.41
|
| Rate for Payer: Amerigroup Medicare |
$58.63
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$58.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.68
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.05
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$66.76
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.11
|
|
|
STRAPPING SHOULDER
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 29240 GP
|
| Hospital Charge Code |
1374352
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
|
|
STRAPPING TOES
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 29550 GP
|
| Hospital Charge Code |
1374358
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of IA Commercial |
$84.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$84.60
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$70.50
|
| Rate for Payer: Medical Associates Commercial |
$70.50
|
| Rate for Payer: Midlands Choice Commercial |
$65.80
|
| Rate for Payer: United Healthcare Commercial |
$84.60
|
|
|
STRAPPING TOES
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 29550 GP
|
| Hospital Charge Code |
1374358
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of IA Commercial |
$84.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$84.60
|
| Rate for Payer: Aetna of IA Medicare |
$53.58
|
| Rate for Payer: Amerigroup Medicaid |
$54.22
|
| Rate for Payer: Amerigroup Medicare |
$42.72
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$70.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$53.69
|
| Rate for Payer: Medical Associates Commercial |
$70.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.30
|
| Rate for Payer: Midlands Choice Commercial |
$65.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$54.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.65
|
| Rate for Payer: United Healthcare Commercial |
$84.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$55.46
|
|
|
STREP A TEST, THROAT
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
633913
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of IA Commercial |
$44.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$44.10
|
| Rate for Payer: Aetna of IA Medicare |
$27.93
|
| Rate for Payer: Amerigroup Medicaid |
$28.26
|
| Rate for Payer: Amerigroup Medicare |
$22.27
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.99
|
| Rate for Payer: Medical Associates Commercial |
$36.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.05
|
| Rate for Payer: Midlands Choice Commercial |
$34.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$25.36
|
| Rate for Payer: United Healthcare Commercial |
$44.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$28.91
|
|
|
STREP A TEST, THROAT
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
633913
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of IA Commercial |
$44.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$44.10
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.75
|
| Rate for Payer: Medical Associates Commercial |
$36.75
|
| Rate for Payer: Midlands Choice Commercial |
$34.30
|
| Rate for Payer: United Healthcare Commercial |
$44.10
|
|
|
STRESS TEST
|
Facility
|
IP
|
$738.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
8012934
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$516.60 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Aetna of IA Commercial |
$664.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$664.20
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$553.50
|
| Rate for Payer: Medical Associates Commercial |
$553.50
|
| Rate for Payer: Midlands Choice Commercial |
$516.60
|
| Rate for Payer: United Healthcare Commercial |
$664.20
|
|
