|
THER ACTIVITY DIRECT 15 MIN
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97530 GN
|
| Hospital Charge Code |
752354
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.75
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
|
|
THER ACTIVITY DIRECT 15 MIN
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97530 GN
|
| Hospital Charge Code |
752354
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$165.57 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Aetna of IA Medicare |
$103.17
|
| Rate for Payer: Amerigroup Medicaid |
$104.40
|
| Rate for Payer: Amerigroup Medicare |
$82.26
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$103.39
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.45
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.67
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.79
|
| Rate for Payer: Wellmark IA HMO WHPI |
$150.31
|
| Rate for Payer: Wellmark IA PPO |
$165.57
|
|
|
THERA EXERCISES PER 15 MIN
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 97110 GO
|
| Hospital Charge Code |
1373449
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$165.57 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$150.31
|
| Rate for Payer: Wellmark IA PPO |
$165.57
|
|
|
THERA EXERCISES PER 15 MIN
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 97110 GO
|
| Hospital Charge Code |
1373449
|
|
Hospital Revenue Code
|
430
|
| 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
|
|
|
THERAPEUTIC EXERCISES 15 MINS
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97110 GN
|
| Hospital Charge Code |
753741
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.75
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
|
|
THERAPEUTIC EXERCISES 15 MINS
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97110 GN
|
| Hospital Charge Code |
753741
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$165.57 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Aetna of IA Medicare |
$103.17
|
| Rate for Payer: Amerigroup Medicaid |
$104.40
|
| Rate for Payer: Amerigroup Medicare |
$82.26
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$103.39
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.45
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.67
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.79
|
| Rate for Payer: Wellmark IA HMO WHPI |
$150.31
|
| Rate for Payer: Wellmark IA PPO |
$165.57
|
|
|
Therapeutic Multiple Vitamins Tab [VDMC]
|
Facility
|
IP
|
$1.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10424736
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Aetna of IA Commercial |
$1.01
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.01
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.84
|
| Rate for Payer: Medical Associates Commercial |
$0.84
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
|
|
Therapeutic Multiple Vitamins Tab [VDMC]
|
Facility
|
OP
|
$1.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10424736
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Aetna of IA Commercial |
$1.01
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.01
|
| Rate for Payer: Aetna of IA Medicare |
$0.64
|
| Rate for Payer: Amerigroup Medicaid |
$0.65
|
| Rate for Payer: Amerigroup Medicare |
$0.51
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.84
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.51
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.64
|
| Rate for Payer: Medical Associates Commercial |
$0.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.51
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.58
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.66
|
|
|
therapeutic multivitamin liqd [VDMC]
|
Facility
|
OP
|
$22.95
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10430580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$20.66 |
| Rate for Payer: Aetna of IA Commercial |
$20.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.66
|
| Rate for Payer: Aetna of IA Medicare |
$13.08
|
| Rate for Payer: Amerigroup Medicaid |
$13.24
|
| Rate for Payer: Amerigroup Medicare |
$10.43
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.33
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.11
|
| Rate for Payer: Medical Associates Commercial |
$17.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.33
|
| Rate for Payer: Midlands Choice Commercial |
$16.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.88
|
| Rate for Payer: United Healthcare Commercial |
$20.66
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.54
|
|
|
therapeutic multivitamin liqd [VDMC]
|
Facility
|
IP
|
$22.95
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10430580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$20.66 |
| Rate for Payer: Aetna of IA Commercial |
$20.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.66
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.22
|
| Rate for Payer: Medical Associates Commercial |
$17.22
|
| Rate for Payer: Midlands Choice Commercial |
$16.07
|
| Rate for Payer: United Healthcare Commercial |
$20.66
|
|
|
THERAPEUTIC SERVICES FOR USE OF SPEECH GENERATING DEVICE
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 92609 GN
|
| Hospital Charge Code |
5536782
|
|
Hospital Revenue Code
|
441
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Aetna of IA Medicare |
$131.10
|
| Rate for Payer: Amerigroup Medicaid |
$132.66
|
| Rate for Payer: Amerigroup Medicare |
$104.54
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$103.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$131.38
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$103.50
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$133.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$119.02
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$135.70
|
| Rate for Payer: Wellmark IA HMO WHPI |
$150.31
|
| Rate for Payer: Wellmark IA PPO |
$165.57
|
|
|
THERAPEUTIC SERVICES FOR USE OF SPEECH GENERATING DEVICE
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 92609 GN
|
| Hospital Charge Code |
5536782
|
|
Hospital Revenue Code
|
441
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
|
|
THERASKIN 1X1
|
Facility
|
OP
|
$1,791.00
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
8767259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$805.95 |
| Max. Negotiated Rate |
$1,611.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,611.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,611.90
|
| Rate for Payer: Aetna of IA Medicare |
$1,020.87
|
| Rate for Payer: Amerigroup Medicaid |
$1,033.05
|
| Rate for Payer: Amerigroup Medicare |
$814.01
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,343.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$805.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,023.02
|
| Rate for Payer: Medical Associates Commercial |
$1,343.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$805.95
|
| Rate for Payer: Midlands Choice Commercial |
$1,253.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,038.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$926.84
|
| Rate for Payer: United Healthcare Commercial |
$1,611.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,056.69
|
|
|
THERASKIN 1X1
|
Facility
|
IP
|
$1,791.00
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
8767259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,253.70 |
| Max. Negotiated Rate |
$1,611.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,611.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,611.90
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,343.25
|
| Rate for Payer: Medical Associates Commercial |
$1,343.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,253.70
|
| Rate for Payer: United Healthcare Commercial |
$1,611.90
|
|
|
THERASKIN 1X2
|
Facility
|
IP
|
$1,944.00
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
8793727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,360.80 |
| Max. Negotiated Rate |
$1,749.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,749.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,749.60
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,458.00
|
| Rate for Payer: Medical Associates Commercial |
$1,458.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,360.80
|
| Rate for Payer: United Healthcare Commercial |
$1,749.60
|
|
|
THERASKIN 1X2
|
Facility
|
OP
|
$1,944.00
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
8793727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$874.80 |
| Max. Negotiated Rate |
$1,749.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,749.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,749.60
|
| Rate for Payer: Aetna of IA Medicare |
$1,108.08
|
| Rate for Payer: Amerigroup Medicaid |
$1,121.30
|
| Rate for Payer: Amerigroup Medicare |
$883.55
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,458.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$874.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,110.41
|
| Rate for Payer: Medical Associates Commercial |
$1,458.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$874.80
|
| Rate for Payer: Midlands Choice Commercial |
$1,360.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,126.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,006.02
|
| Rate for Payer: United Healthcare Commercial |
$1,749.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,146.96
|
|
|
THERA SKIN 2X3
|
Facility
|
OP
|
$2,180.00
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
8823254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.00 |
| Max. Negotiated Rate |
$1,962.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,962.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,962.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,242.60
|
| Rate for Payer: Amerigroup Medicaid |
$1,257.42
|
| Rate for Payer: Amerigroup Medicare |
$990.81
|
| Rate for Payer: Cash Price |
$1,744.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,635.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$981.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,245.22
|
| Rate for Payer: Medical Associates Commercial |
$1,635.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$981.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,526.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,263.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,128.15
|
| Rate for Payer: United Healthcare Commercial |
$1,962.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,286.20
|
|
|
THERA SKIN 2X3
|
Facility
|
IP
|
$2,180.00
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
8823254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,526.00 |
| Max. Negotiated Rate |
$1,962.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,962.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,962.00
|
| Rate for Payer: Cash Price |
$1,744.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,635.00
|
| Rate for Payer: Medical Associates Commercial |
$1,635.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,526.00
|
| Rate for Payer: United Healthcare Commercial |
$1,962.00
|
|
|
THER EXERCISES PER 15 MIN
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
1374020
|
|
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
|
|
|
THER EXERCISES PER 15 MIN
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
1374020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$165.57 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$150.31
|
| Rate for Payer: Wellmark IA PPO |
$165.57
|
|
|
THER INJECTION CARP TUNNEL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
7982933
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$782.56 |
| Rate for Payer: Aetna of IA Commercial |
$315.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.00
|
| Rate for Payer: Aetna of IA Medicare |
$199.50
|
| Rate for Payer: Amerigroup Medicaid |
$201.88
|
| Rate for Payer: Amerigroup Medicare |
$159.08
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$262.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$157.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$199.92
|
| Rate for Payer: Medical Associates Commercial |
$262.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$245.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$202.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$181.12
|
| Rate for Payer: United Healthcare Commercial |
$315.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$206.50
|
| Rate for Payer: Wellmark IA HMO WHPI |
$710.42
|
| Rate for Payer: Wellmark IA PPO |
$782.56
|
|
|
THER INJECTION CARP TUNNEL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
7982933
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of IA Commercial |
$315.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$262.50
|
| Rate for Payer: Medical Associates Commercial |
$262.50
|
| Rate for Payer: Midlands Choice Commercial |
$245.00
|
| Rate for Payer: United Healthcare Commercial |
$315.00
|
|
|
THER INJECTION CARP TUNNEL
|
Professional
|
Both
|
$257.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
7982746
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$192.75 |
| Rate for Payer: Amerigroup Medicaid |
$59.17
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$58.60
|
| Rate for Payer: Medical Associates Commercial |
$192.75
|
| Rate for Payer: Midlands Choice Commercial |
$179.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$58.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$192.75
|
| Rate for Payer: United Healthcare Commercial |
$118.43
|
| Rate for Payer: Wellmark IA HMO WHPI |
$156.00
|
| Rate for Payer: Wellmark IA PPO |
$183.50
|
|
|
THERMA CHOICE CATHETER
|
Facility
|
IP
|
$1,780.00
|
|
| Hospital Charge Code |
8025932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.00 |
| Max. Negotiated Rate |
$1,602.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,602.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,602.00
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,335.00
|
| Rate for Payer: Medical Associates Commercial |
$1,335.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,246.00
|
| Rate for Payer: United Healthcare Commercial |
$1,602.00
|
|
|
THERMA CHOICE CATHETER
|
Facility
|
OP
|
$1,780.00
|
|
| Hospital Charge Code |
8025932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$801.00 |
| Max. Negotiated Rate |
$1,602.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,602.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,602.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,014.60
|
| Rate for Payer: Amerigroup Medicaid |
$1,026.70
|
| Rate for Payer: Amerigroup Medicare |
$809.01
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,335.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$801.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,016.74
|
| Rate for Payer: Medical Associates Commercial |
$1,335.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$801.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,246.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,031.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$921.15
|
| Rate for Payer: United Healthcare Commercial |
$1,602.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,050.20
|
|
