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All Charges

Charge Type Setting Price  
Service Code HCPCS 90750
Hospital Charge Code 14503470
Hospital Revenue Code 259
Min. Negotiated Rate $164.63
Max. Negotiated Rate $329.26
Rate for Payer: Aetna of IA Commercial $329.26
Rate for Payer: Aetna of IA Medical Rental Products $329.26
Rate for Payer: Aetna of IA Medicare $208.53
Rate for Payer: Amerigroup Medicaid $211.02
Rate for Payer: Amerigroup Medicare $166.28
Rate for Payer: Cash Price $292.68
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial $274.39
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS $164.63
Rate for Payer: Iowa Total Care Managed Medicaid $208.97
Rate for Payer: Medical Associates Commercial $274.39
Rate for Payer: Medical Associates Managed Medicare $164.63
Rate for Payer: Midlands Choice Commercial $256.10
Rate for Payer: Molina Healthcare Managed Medicaid $212.05
Rate for Payer: Partners Health Alliance Commercial $189.33
Rate for Payer: United Healthcare Commercial $329.26
Rate for Payer: United Healthcare Managed Medicare $215.85