|
SLEEP STUDY/CPAP TRIAL
|
Facility
|
IP
|
$3,376.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
5338943
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$2,363.20 |
| Max. Negotiated Rate |
$3,038.40 |
| Rate for Payer: Aetna of IA Commercial |
$3,038.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,038.40
|
| Rate for Payer: Cash Price |
$2,700.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,532.00
|
| Rate for Payer: Medical Associates Commercial |
$2,532.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,363.20
|
| Rate for Payer: United Healthcare Commercial |
$3,038.40
|
|
|
SLEEP STUDY/CPAP TRIAL
|
Facility
|
OP
|
$3,376.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
5338943
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,115.38 |
| Max. Negotiated Rate |
$3,038.40 |
| Rate for Payer: Aetna of IA Commercial |
$3,038.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,038.40
|
| Rate for Payer: Aetna of IA Medicare |
$1,924.32
|
| Rate for Payer: Amerigroup Medicaid |
$1,703.87
|
| Rate for Payer: Amerigroup Medicare |
$1,704.88
|
| Rate for Payer: Cash Price |
$2,700.80
|
| Rate for Payer: Cash Price |
$2,700.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,532.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,688.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,687.32
|
| Rate for Payer: Medical Associates Commercial |
$2,532.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,688.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,363.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,713.32
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,712.31
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,532.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,532.00
|
| Rate for Payer: United Healthcare Commercial |
$3,038.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,991.84
|
| Rate for Payer: Wellmark IA HMO |
$1,115.38
|
| Rate for Payer: Wellmark IA PPO |
$1,226.92
|
|
|
SLEEP STUDY MSLT
|
Facility
|
OP
|
$3,126.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
6608799
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,115.38 |
| Max. Negotiated Rate |
$2,813.40 |
| Rate for Payer: Aetna of IA Commercial |
$2,813.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,813.40
|
| Rate for Payer: Aetna of IA Medicare |
$1,781.82
|
| Rate for Payer: Amerigroup Medicaid |
$1,577.69
|
| Rate for Payer: Amerigroup Medicare |
$1,578.63
|
| Rate for Payer: Cash Price |
$2,500.80
|
| Rate for Payer: Cash Price |
$2,500.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,344.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,563.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,562.37
|
| Rate for Payer: Medical Associates Commercial |
$2,344.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,563.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,188.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,586.44
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,585.51
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,344.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,344.50
|
| Rate for Payer: United Healthcare Commercial |
$2,813.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,844.34
|
| Rate for Payer: Wellmark IA HMO |
$1,115.38
|
| Rate for Payer: Wellmark IA PPO |
$1,226.92
|
|
|
SLEEP STUDY MSLT
|
Facility
|
IP
|
$3,126.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
6608799
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$2,188.20 |
| Max. Negotiated Rate |
$2,813.40 |
| Rate for Payer: Aetna of IA Commercial |
$2,813.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,813.40
|
| Rate for Payer: Cash Price |
$2,500.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,344.50
|
| Rate for Payer: Medical Associates Commercial |
$2,344.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,188.20
|
| Rate for Payer: United Healthcare Commercial |
$2,813.40
|
|
|
SLP Eval of Speech Sound Prod Units
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
5528784
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$144.20 |
| 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: Cash Price |
$164.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$154.50
|
| Rate for Payer: Medical Associates Commercial |
$154.50
|
| Rate for Payer: Midlands Choice Commercial |
$144.20
|
| Rate for Payer: United Healthcare Commercial |
$185.40
|
|
|
SLP Eval of Speech Sound Prod Units
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
5528784
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$102.96 |
| 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 |
$103.97
|
| Rate for Payer: Amerigroup Medicare |
$104.03
|
| Rate for Payer: Cash Price |
$164.80
|
| 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 |
$103.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$102.96
|
| Rate for Payer: Medical Associates Commercial |
$154.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$103.00
|
| Rate for Payer: Midlands Choice Commercial |
$144.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$104.48
|
| Rate for Payer: Oscar Health of IA Commercial |
$154.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$154.50
|
| Rate for Payer: United Healthcare Commercial |
$185.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$121.54
|
| Rate for Payer: Wellmark IA HMO |
$128.96
|
| Rate for Payer: Wellmark IA PPO |
$141.86
|
|
|
SMALL MPX GRIDLOCK PLATE
|
Facility
|
IP
|
$1,323.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8909889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.10 |
| Max. Negotiated Rate |
$1,190.70 |
| Rate for Payer: Aetna of IA Commercial |
$1,190.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,190.70
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$992.25
|
| Rate for Payer: Medical Associates Commercial |
$992.25
|
| Rate for Payer: Midlands Choice Commercial |
$926.10
|
| Rate for Payer: United Healthcare Commercial |
$1,190.70
|
|
|
SMALL MPX GRIDLOCK PLATE
|
Facility
|
OP
|
$1,323.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8909889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.24 |
| Max. Negotiated Rate |
$1,190.70 |
| Rate for Payer: Aetna of IA Commercial |
$1,190.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,190.70
|
| Rate for Payer: Aetna of IA Medicare |
$754.11
|
| Rate for Payer: Amerigroup Medicaid |
$667.72
|
| Rate for Payer: Amerigroup Medicare |
$668.12
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$992.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$661.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$661.24
|
| Rate for Payer: Medical Associates Commercial |
$992.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$661.50
|
| Rate for Payer: Midlands Choice Commercial |
$926.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$671.42
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$671.03
|
| Rate for Payer: Oscar Health of IA Commercial |
$992.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$992.25
|
| Rate for Payer: United Healthcare Commercial |
$1,190.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$780.57
|
|
|
SMALL VLC PLATE RIGHT
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8700302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$899.64 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,620.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,620.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,026.00
|
| Rate for Payer: Amerigroup Medicaid |
$908.46
|
| Rate for Payer: Amerigroup Medicare |
$909.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,350.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$900.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$899.64
|
| Rate for Payer: Medical Associates Commercial |
$1,350.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$900.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,260.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$913.50
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$912.96
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,350.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,350.00
|
| Rate for Payer: United Healthcare Commercial |
$1,620.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,062.00
|
|
|
SMALL VLC PLATE RIGHT
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8700302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,260.00 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,620.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,350.00
|
| Rate for Payer: Medical Associates Commercial |
$1,350.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,260.00
|
| Rate for Payer: United Healthcare Commercial |
$1,620.00
|
|
|
Smooth Muscle Antibody DMCL
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
8037802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna of IA Commercial |
$103.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$103.50
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$86.25
|
| Rate for Payer: Medical Associates Commercial |
$86.25
|
| Rate for Payer: Midlands Choice Commercial |
$80.50
|
| Rate for Payer: United Healthcare Commercial |
$103.50
|
|
|
Smooth Muscle Antibody DMCL
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
8037802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna of IA Commercial |
$103.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$103.50
|
| Rate for Payer: Aetna of IA Medicare |
$65.55
|
| Rate for Payer: Amerigroup Medicaid |
$58.04
|
| Rate for Payer: Amerigroup Medicare |
$58.08
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$86.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.48
|
| Rate for Payer: Medical Associates Commercial |
$86.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.50
|
| Rate for Payer: Midlands Choice Commercial |
$80.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$58.36
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$58.33
|
| Rate for Payer: Oscar Health of IA Commercial |
$86.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$86.25
|
| Rate for Payer: United Healthcare Commercial |
$103.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.85
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
SNIPER STAPLE 18MMX18MMX18MM
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8713571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,197.00 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,539.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,539.00
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,282.50
|
| Rate for Payer: Medical Associates Commercial |
$1,282.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,197.00
|
| Rate for Payer: United Healthcare Commercial |
$1,539.00
|
|
|
SNIPER STAPLE 18MMX18MMX18MM
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8713571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$854.66 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,539.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,539.00
|
| Rate for Payer: Aetna of IA Medicare |
$974.70
|
| Rate for Payer: Amerigroup Medicaid |
$863.04
|
| Rate for Payer: Amerigroup Medicare |
$863.55
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,282.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$855.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$854.66
|
| Rate for Payer: Medical Associates Commercial |
$1,282.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$855.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,197.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$867.82
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$867.31
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,282.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,282.50
|
| Rate for Payer: United Healthcare Commercial |
$1,539.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,008.90
|
|
|
SNIPER STAPLE IMPLANT 10X10X10
|
Facility
|
IP
|
$2,520.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8734824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,764.00 |
| Max. Negotiated Rate |
$2,268.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,268.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,268.00
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,890.00
|
| Rate for Payer: Medical Associates Commercial |
$1,890.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,764.00
|
| Rate for Payer: United Healthcare Commercial |
$2,268.00
|
|
|
SNIPER STAPLE IMPLANT 10X10X10
|
Facility
|
OP
|
$2,520.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8734824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.50 |
| Max. Negotiated Rate |
$2,268.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,268.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,268.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,436.40
|
| Rate for Payer: Amerigroup Medicaid |
$1,271.84
|
| Rate for Payer: Amerigroup Medicare |
$1,272.60
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,890.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,260.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,259.50
|
| Rate for Payer: Medical Associates Commercial |
$1,890.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,260.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,764.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,278.90
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,278.14
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,890.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,890.00
|
| Rate for Payer: United Healthcare Commercial |
$2,268.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,486.80
|
|
|
SNIPER STAPLE IMPLANT 15X15X15
|
Facility
|
OP
|
$1,629.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8852333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$814.17 |
| Max. Negotiated Rate |
$1,466.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,466.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,466.10
|
| Rate for Payer: Aetna of IA Medicare |
$928.53
|
| Rate for Payer: Amerigroup Medicaid |
$822.16
|
| Rate for Payer: Amerigroup Medicare |
$822.64
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,221.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$814.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$814.17
|
| Rate for Payer: Medical Associates Commercial |
$1,221.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$814.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,140.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$826.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$826.23
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,221.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,221.75
|
| Rate for Payer: United Healthcare Commercial |
$1,466.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$961.11
|
|
|
SNIPER STAPLE IMPLANT 15X15X15
|
Facility
|
IP
|
$1,629.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8852333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.30 |
| Max. Negotiated Rate |
$1,466.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,466.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,466.10
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,221.75
|
| Rate for Payer: Medical Associates Commercial |
$1,221.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,140.30
|
| Rate for Payer: United Healthcare Commercial |
$1,466.10
|
|
|
SNIPER STAPLE IMPLANT 20X20X20MM
|
Facility
|
OP
|
$1,710.00
|
|
| Hospital Charge Code |
8783240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$854.66 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,539.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,539.00
|
| Rate for Payer: Aetna of IA Medicare |
$974.70
|
| Rate for Payer: Amerigroup Medicaid |
$863.04
|
| Rate for Payer: Amerigroup Medicare |
$863.55
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,282.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$855.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$854.66
|
| Rate for Payer: Medical Associates Commercial |
$1,282.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$855.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,197.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$867.82
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$867.31
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,282.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,282.50
|
| Rate for Payer: United Healthcare Commercial |
$1,539.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,008.90
|
|
|
SNIPER STAPLE IMPLANT 20X20X20MM
|
Facility
|
IP
|
$1,710.00
|
|
| Hospital Charge Code |
8783240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,197.00 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,539.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,539.00
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,282.50
|
| Rate for Payer: Medical Associates Commercial |
$1,282.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,197.00
|
| Rate for Payer: United Healthcare Commercial |
$1,539.00
|
|
|
SNIPER STAPLE IMPLANT 25X20X20MM
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8783242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,197.00 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,539.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,539.00
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,282.50
|
| Rate for Payer: Medical Associates Commercial |
$1,282.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,197.00
|
| Rate for Payer: United Healthcare Commercial |
$1,539.00
|
|
|
SNIPER STAPLE IMPLANT 25X20X20MM
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8783242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$854.66 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,539.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,539.00
|
| Rate for Payer: Aetna of IA Medicare |
$974.70
|
| Rate for Payer: Amerigroup Medicaid |
$863.04
|
| Rate for Payer: Amerigroup Medicare |
$863.55
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,282.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$855.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$854.66
|
| Rate for Payer: Medical Associates Commercial |
$1,282.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$855.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,197.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$867.82
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$867.31
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,282.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,282.50
|
| Rate for Payer: United Healthcare Commercial |
$1,539.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,008.90
|
|
|
SODIUM
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
633611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna of IA Commercial |
$41.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.40
|
| Rate for Payer: Aetna of IA Medicare |
$26.22
|
| Rate for Payer: Amerigroup Medicaid |
$23.22
|
| Rate for Payer: Amerigroup Medicare |
$23.23
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.99
|
| Rate for Payer: Medical Associates Commercial |
$34.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.00
|
| Rate for Payer: Midlands Choice Commercial |
$32.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.34
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$23.33
|
| Rate for Payer: Oscar Health of IA Commercial |
$34.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.50
|
| Rate for Payer: United Healthcare Commercial |
$41.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$27.14
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
SODIUM
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
633611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna of IA Commercial |
$41.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.50
|
| Rate for Payer: Medical Associates Commercial |
$34.50
|
| Rate for Payer: Midlands Choice Commercial |
$32.20
|
| Rate for Payer: United Healthcare Commercial |
$41.40
|
|
|
sodium acetate 2meq/ml 20ml [VDMC]
|
Facility
|
OP
|
$30.98
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10430446
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.48 |
| Max. Negotiated Rate |
$27.88 |
| Rate for Payer: Aetna of IA Commercial |
$27.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.88
|
| Rate for Payer: Aetna of IA Medicare |
$17.66
|
| Rate for Payer: Amerigroup Medicaid |
$15.64
|
| Rate for Payer: Amerigroup Medicare |
$15.64
|
| Rate for Payer: Cash Price |
$24.78
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.49
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.48
|
| Rate for Payer: Medical Associates Commercial |
$23.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.49
|
| Rate for Payer: Midlands Choice Commercial |
$21.69
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$15.71
|
| Rate for Payer: Oscar Health of IA Commercial |
$23.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.24
|
| Rate for Payer: United Healthcare Commercial |
$27.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.28
|
|
