|
URINE PROTEIN
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
8419063
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
URINE PROTEIN
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
4006798
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$30.79
|
| Rate for Payer: Amerigroup Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.49
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.50
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
URINE PROTEIN
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
8419063
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$30.79
|
| Rate for Payer: Amerigroup Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.49
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.50
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
URINE PROTEIN
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
8094266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
URINE PROTEIN
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
4006798
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
URINE PROTEIN
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
8094266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$30.79
|
| Rate for Payer: Amerigroup Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.49
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.50
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
Urine Volume Measurement
|
Facility
OP
|
$27.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
7942975
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.49 |
| Max. Negotiated Rate |
$24.55 |
| Rate for Payer: Aetna of IA Commercial |
$24.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.30
|
| Rate for Payer: Aetna of IA Medicare |
$15.39
|
| Rate for Payer: Amerigroup Medicaid |
$13.63
|
| Rate for Payer: Amerigroup Medicare |
$13.64
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.49
|
| Rate for Payer: Medical Associates Commercial |
$20.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.50
|
| Rate for Payer: Midlands Choice Commercial |
$18.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.25
|
| Rate for Payer: United Healthcare Commercial |
$24.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.93
|
| Rate for Payer: Wellmark IA HMO |
$22.32
|
| Rate for Payer: Wellmark IA PPO |
$24.55
|
|
|
Urine Volume Measurement
|
Facility
IP
|
$27.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
7942975
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$24.30 |
| Rate for Payer: Aetna of IA Commercial |
$24.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.30
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.25
|
| Rate for Payer: Medical Associates Commercial |
$20.25
|
| Rate for Payer: Midlands Choice Commercial |
$18.90
|
| Rate for Payer: United Healthcare Commercial |
$24.30
|
|
|
URINE VOLUME MEASUREMENT
|
Facility
IP
|
$27.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
8093948
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$24.30 |
| Rate for Payer: Aetna of IA Commercial |
$24.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.30
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.25
|
| Rate for Payer: Medical Associates Commercial |
$20.25
|
| Rate for Payer: Midlands Choice Commercial |
$18.90
|
| Rate for Payer: United Healthcare Commercial |
$24.30
|
|
|
URINE VOLUME MEASUREMENT
|
Facility
OP
|
$27.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
8093948
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.49 |
| Max. Negotiated Rate |
$24.55 |
| Rate for Payer: Aetna of IA Commercial |
$24.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.30
|
| Rate for Payer: Aetna of IA Medicare |
$15.39
|
| Rate for Payer: Amerigroup Medicaid |
$13.63
|
| Rate for Payer: Amerigroup Medicare |
$13.64
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.49
|
| Rate for Payer: Medical Associates Commercial |
$20.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.50
|
| Rate for Payer: Midlands Choice Commercial |
$18.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.25
|
| Rate for Payer: United Healthcare Commercial |
$24.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.93
|
| Rate for Payer: Wellmark IA HMO |
$22.32
|
| Rate for Payer: Wellmark IA PPO |
$24.55
|
|
|
URO NEURO STIM ANTENNA
|
Facility
OP
|
$144.00
|
|
| Hospital Charge Code |
8026116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.97 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna of IA Commercial |
$129.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$129.60
|
| Rate for Payer: Aetna of IA Medicare |
$82.08
|
| Rate for Payer: Amerigroup Medicaid |
$72.68
|
| Rate for Payer: Amerigroup Medicare |
$72.72
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$72.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.97
|
| Rate for Payer: Medical Associates Commercial |
$108.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.00
|
| Rate for Payer: Midlands Choice Commercial |
$100.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$73.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$108.00
|
| Rate for Payer: United Healthcare Commercial |
$129.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.96
|
|
|
URO NEURO STIM ANTENNA
|
Facility
IP
|
$144.00
|
|
| Hospital Charge Code |
8026116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna of IA Commercial |
$129.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$129.60
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.00
|
| Rate for Payer: Medical Associates Commercial |
$108.00
|
| Rate for Payer: Midlands Choice Commercial |
$100.80
|
| Rate for Payer: United Healthcare Commercial |
$129.60
|
|
|
URO NEURO STIM LEAD
|
Facility
IP
|
$5,688.00
|
|
|
Service Code
|
CPT C1780
|
| Hospital Charge Code |
8026123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,981.60 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna of IA Commercial |
$5,119.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,119.20
|
| Rate for Payer: Cash Price |
$4,550.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,266.00
|
| Rate for Payer: Medical Associates Commercial |
$4,266.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,981.60
|
| Rate for Payer: United Healthcare Commercial |
$5,119.20
|
|
|
URO NEURO STIM LEAD
|
Facility
OP
|
$5,688.00
|
|
|
Service Code
|
CPT C1780
|
| Hospital Charge Code |
8026123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,842.86 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna of IA Commercial |
$5,119.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,119.20
|
| Rate for Payer: Aetna of IA Medicare |
$3,242.16
|
| Rate for Payer: Amerigroup Medicaid |
$2,870.73
|
| Rate for Payer: Amerigroup Medicare |
$2,872.44
|
| Rate for Payer: Cash Price |
$4,550.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,266.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,844.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,842.86
|
| Rate for Payer: Medical Associates Commercial |
$4,266.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,844.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,981.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,886.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,266.00
|
| Rate for Payer: United Healthcare Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,355.92
|
|
|
URO NEURO STIM, PATIENT PROGRAM
|
Facility
OP
|
$2,142.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8026097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,070.57 |
| Max. Negotiated Rate |
$1,927.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,927.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,927.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,220.94
|
| Rate for Payer: Amerigroup Medicaid |
$1,081.07
|
| Rate for Payer: Amerigroup Medicare |
$1,081.71
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,606.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,071.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,070.57
|
| Rate for Payer: Medical Associates Commercial |
$1,606.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,071.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,499.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,087.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,606.50
|
| Rate for Payer: United Healthcare Commercial |
$1,927.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,263.78
|
|
|
URO NEURO STIM, PATIENT PROGRAM
|
Facility
IP
|
$2,142.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8026097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| Max. Negotiated Rate |
$1,927.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,927.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,927.80
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,606.50
|
| Rate for Payer: Medical Associates Commercial |
$1,606.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,499.40
|
| Rate for Payer: United Healthcare Commercial |
$1,927.80
|
|
|
ursodiol 300 mg Cap
|
Facility
IP
|
$3.62
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Aetna of IA Commercial |
$3.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.26
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.72
|
| Rate for Payer: Medical Associates Commercial |
$2.72
|
| Rate for Payer: Midlands Choice Commercial |
$2.53
|
| Rate for Payer: United Healthcare Commercial |
$3.26
|
|
|
ursodiol 300 mg Cap
|
Facility
OP
|
$3.62
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Aetna of IA Commercial |
$3.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.26
|
| Rate for Payer: Aetna of IA Medicare |
$2.06
|
| Rate for Payer: Amerigroup Medicaid |
$1.83
|
| Rate for Payer: Amerigroup Medicare |
$1.83
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.72
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.81
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.81
|
| Rate for Payer: Medical Associates Commercial |
$2.72
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.81
|
| Rate for Payer: Midlands Choice Commercial |
$2.53
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.72
|
| Rate for Payer: United Healthcare Commercial |
$3.26
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.14
|
|
|
US
|
Facility
OP
|
$394.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
8300844
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.88 |
| Max. Negotiated Rate |
$354.60 |
| Rate for Payer: Aetna of IA Commercial |
$354.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$354.60
|
| Rate for Payer: Aetna of IA Medicare |
$224.58
|
| Rate for Payer: Amerigroup Medicaid |
$198.85
|
| Rate for Payer: Amerigroup Medicare |
$198.97
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$295.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$197.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$196.92
|
| Rate for Payer: Medical Associates Commercial |
$295.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$197.00
|
| Rate for Payer: Midlands Choice Commercial |
$275.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$199.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$295.50
|
| Rate for Payer: United Healthcare Commercial |
$354.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$232.46
|
| Rate for Payer: Wellmark IA HMO |
$169.88
|
| Rate for Payer: Wellmark IA PPO |
$186.87
|
|
|
US
|
Facility
IP
|
$394.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
8300844
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$275.80 |
| Max. Negotiated Rate |
$354.60 |
| Rate for Payer: Aetna of IA Commercial |
$354.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$354.60
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$295.50
|
| Rate for Payer: Medical Associates Commercial |
$295.50
|
| Rate for Payer: Midlands Choice Commercial |
$275.80
|
| Rate for Payer: United Healthcare Commercial |
$354.60
|
|
|
US ABDL AORTA SCREEN AAA
|
Facility
OP
|
$521.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
8606883
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$191.58 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Aetna of IA Commercial |
$468.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$468.90
|
| Rate for Payer: Aetna of IA Medicare |
$296.97
|
| Rate for Payer: Amerigroup Medicaid |
$262.95
|
| Rate for Payer: Amerigroup Medicare |
$263.10
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$390.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$260.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$260.40
|
| Rate for Payer: Medical Associates Commercial |
$390.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$260.50
|
| Rate for Payer: Midlands Choice Commercial |
$364.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$264.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$390.75
|
| Rate for Payer: United Healthcare Commercial |
$468.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$307.39
|
| Rate for Payer: Wellmark IA HMO |
$191.58
|
| Rate for Payer: Wellmark IA PPO |
$210.74
|
|
|
US ABDL AORTA SCREEN AAA
|
Facility
IP
|
$521.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
8606883
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$364.70 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Aetna of IA Commercial |
$468.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$468.90
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$390.75
|
| Rate for Payer: Medical Associates Commercial |
$390.75
|
| Rate for Payer: Midlands Choice Commercial |
$364.70
|
| Rate for Payer: United Healthcare Commercial |
$468.90
|
|
|
US Abdomen Complete
|
Facility
IP
|
$529.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
1169567
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$370.30 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Aetna of IA Commercial |
$476.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$476.10
|
| Rate for Payer: Cash Price |
$423.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$396.75
|
| Rate for Payer: Medical Associates Commercial |
$396.75
|
| Rate for Payer: Midlands Choice Commercial |
$370.30
|
| Rate for Payer: United Healthcare Commercial |
$476.10
|
|
|
US Abdomen Complete
|
Facility
OP
|
$529.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
1169567
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$264.39 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Aetna of IA Commercial |
$476.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$476.10
|
| Rate for Payer: Aetna of IA Medicare |
$301.53
|
| Rate for Payer: Amerigroup Medicaid |
$266.99
|
| Rate for Payer: Amerigroup Medicare |
$267.14
|
| Rate for Payer: Cash Price |
$423.20
|
| Rate for Payer: Cash Price |
$423.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$396.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$264.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$264.39
|
| Rate for Payer: Medical Associates Commercial |
$396.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$264.50
|
| Rate for Payer: Midlands Choice Commercial |
$370.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$268.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$396.75
|
| Rate for Payer: United Healthcare Commercial |
$476.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$312.11
|
| Rate for Payer: Wellmark IA HMO |
$302.56
|
| Rate for Payer: Wellmark IA PPO |
$332.82
|
|
|
US Abdomen Limited
|
Facility
OP
|
$377.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
1169569
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$188.42 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Aetna of IA Commercial |
$339.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$339.30
|
| Rate for Payer: Aetna of IA Medicare |
$214.89
|
| Rate for Payer: Amerigroup Medicaid |
$190.27
|
| Rate for Payer: Amerigroup Medicare |
$190.38
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$282.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$188.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$188.42
|
| Rate for Payer: Medical Associates Commercial |
$282.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$188.50
|
| Rate for Payer: Midlands Choice Commercial |
$263.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$191.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$282.75
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$222.43
|
| Rate for Payer: Wellmark IA HMO |
$191.58
|
| Rate for Payer: Wellmark IA PPO |
$210.74
|
|
