|
URINE PROTEIN
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
8419063
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.45 |
| 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 |
$35.18
|
| Rate for Payer: Amerigroup Medicare |
$27.72
|
| 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 |
$27.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.84
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.45
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.57
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
Urine Volume Measurement
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
7942975
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$28.12 |
| 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 |
$15.57
|
| Rate for Payer: Amerigroup Medicare |
$12.27
|
| 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 |
$12.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.42
|
| Rate for Payer: Medical Associates Commercial |
$20.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.15
|
| Rate for Payer: Midlands Choice Commercial |
$18.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$13.97
|
| Rate for Payer: United Healthcare Commercial |
$24.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.93
|
| Rate for Payer: Wellmark IA HMO WHPI |
$25.52
|
| Rate for Payer: Wellmark IA PPO |
$28.12
|
|
|
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
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
8093948
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$28.12 |
| 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 |
$15.57
|
| Rate for Payer: Amerigroup Medicare |
$12.27
|
| 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 |
$12.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.42
|
| Rate for Payer: Medical Associates Commercial |
$20.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.15
|
| Rate for Payer: Midlands Choice Commercial |
$18.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$13.97
|
| Rate for Payer: United Healthcare Commercial |
$24.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.93
|
| Rate for Payer: Wellmark IA HMO WHPI |
$25.52
|
| Rate for Payer: Wellmark IA PPO |
$28.12
|
|
|
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
|
|
|
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 ANTENNA
|
Facility
|
OP
|
$144.00
|
|
| Hospital Charge Code |
8026116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.80 |
| 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: Aetna of IA Medicare |
$82.08
|
| Rate for Payer: Amerigroup Medicaid |
$83.06
|
| Rate for Payer: Amerigroup Medicare |
$65.45
|
| 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 |
$64.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$82.25
|
| Rate for Payer: Medical Associates Commercial |
$108.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.80
|
| Rate for Payer: Midlands Choice Commercial |
$100.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$83.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.52
|
| Rate for Payer: United Healthcare Commercial |
$129.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.96
|
|
|
URO NEURO STIM LEAD
|
Facility
|
OP
|
$5,688.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
8026123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,559.60 |
| 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: Aetna of IA Medicare |
$3,242.16
|
| Rate for Payer: Amerigroup Medicaid |
$3,280.84
|
| Rate for Payer: Amerigroup Medicare |
$2,585.20
|
| Rate for Payer: Cash Price |
$4,550.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,266.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,559.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,248.99
|
| Rate for Payer: Medical Associates Commercial |
$4,266.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,559.60
|
| Rate for Payer: Midlands Choice Commercial |
$3,981.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,296.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,943.54
|
| Rate for Payer: United Healthcare Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,355.92
|
|
|
URO NEURO STIM LEAD
|
Facility
|
IP
|
$5,688.00
|
|
|
Service Code
|
HCPCS 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, PATIENT PROGRAM
|
Facility
|
IP
|
$2,142.00
|
|
|
Service Code
|
HCPCS 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
|
|
|
URO NEURO STIM, PATIENT PROGRAM
|
Facility
|
OP
|
$2,142.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
8026097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.90 |
| 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 |
$1,235.51
|
| Rate for Payer: Amerigroup Medicare |
$973.54
|
| 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 |
$963.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,223.51
|
| Rate for Payer: Medical Associates Commercial |
$1,606.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$963.90
|
| Rate for Payer: Midlands Choice Commercial |
$1,499.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,241.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,108.48
|
| Rate for Payer: United Healthcare Commercial |
$1,927.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,263.78
|
|
|
ursodiol 300 mg Cap [VDMC]
|
Facility
|
IP
|
$3.62
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426971
|
|
Hospital Revenue Code
|
259
|
| 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 |
$2.71
|
| Rate for Payer: Medical Associates Commercial |
$2.71
|
| Rate for Payer: Midlands Choice Commercial |
$2.53
|
| Rate for Payer: United Healthcare Commercial |
$3.26
|
|
|
ursodiol 300 mg Cap [VDMC]
|
Facility
|
OP
|
$3.62
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426971
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| 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 |
$2.09
|
| Rate for Payer: Amerigroup Medicare |
$1.64
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.71
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.63
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.07
|
| Rate for Payer: Medical Associates Commercial |
$2.71
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.63
|
| Rate for Payer: Midlands Choice Commercial |
$2.53
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.87
|
| Rate for Payer: United Healthcare Commercial |
$3.26
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.13
|
|
|
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
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
8300844
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$177.30 |
| 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 |
$227.26
|
| Rate for Payer: Amerigroup Medicare |
$179.07
|
| 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 |
$177.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$225.05
|
| Rate for Payer: Medical Associates Commercial |
$295.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$177.30
|
| Rate for Payer: Midlands Choice Commercial |
$275.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$228.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$203.90
|
| Rate for Payer: United Healthcare Commercial |
$354.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$232.46
|
| Rate for Payer: Wellmark IA HMO WHPI |
$248.86
|
| Rate for Payer: Wellmark IA PPO |
$274.13
|
|
|
US ABDL AORTA SCREEN AAA
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT 76706 TC
|
| 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 ABDL AORTA SCREEN AAA
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 76706 TC
|
| Hospital Charge Code |
8606883
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$234.45 |
| 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 |
$300.51
|
| Rate for Payer: Amerigroup Medicare |
$236.79
|
| 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 |
$234.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$297.60
|
| Rate for Payer: Medical Associates Commercial |
$390.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$234.45
|
| Rate for Payer: Midlands Choice Commercial |
$364.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$301.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$269.62
|
| Rate for Payer: United Healthcare Commercial |
$468.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$307.39
|
| Rate for Payer: Wellmark IA HMO WHPI |
$241.06
|
| Rate for Payer: Wellmark IA PPO |
$265.54
|
|
|
US Abdomen Complete
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
1169567
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$238.05 |
| 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 |
$305.13
|
| Rate for Payer: Amerigroup Medicare |
$240.43
|
| 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 |
$238.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$302.16
|
| Rate for Payer: Medical Associates Commercial |
$396.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$238.05
|
| Rate for Payer: Midlands Choice Commercial |
$370.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$306.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$273.76
|
| Rate for Payer: United Healthcare Commercial |
$476.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$312.11
|
| Rate for Payer: Wellmark IA HMO WHPI |
$375.06
|
| Rate for Payer: Wellmark IA PPO |
$413.15
|
|
|
US Abdomen Complete
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 76700 TC
|
| 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 Limited
|
Facility
|
OP
|
$377.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
1169569
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.65 |
| 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 |
$217.45
|
| Rate for Payer: Amerigroup Medicare |
$171.35
|
| 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 |
$169.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$215.34
|
| Rate for Payer: Medical Associates Commercial |
$282.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$169.65
|
| Rate for Payer: Midlands Choice Commercial |
$263.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$218.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$195.10
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$222.43
|
| Rate for Payer: Wellmark IA HMO WHPI |
$241.06
|
| Rate for Payer: Wellmark IA PPO |
$265.54
|
|
|
US Abdomen Limited
|
Facility
|
IP
|
$377.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
1169569
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$263.90 |
| 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: Cash Price |
$301.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$282.75
|
| Rate for Payer: Medical Associates Commercial |
$282.75
|
| Rate for Payer: Midlands Choice Commercial |
$263.90
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
|
|
US Aorta IVC Iliac Duplex Complete
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 93978 TC
|
| Hospital Charge Code |
1169577
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$448.70 |
| Max. Negotiated Rate |
$576.90 |
| Rate for Payer: Aetna of IA Commercial |
$576.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$576.90
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$480.75
|
| Rate for Payer: Medical Associates Commercial |
$480.75
|
| Rate for Payer: Midlands Choice Commercial |
$448.70
|
| Rate for Payer: United Healthcare Commercial |
$576.90
|
|
|
US Aorta IVC Iliac Duplex Complete
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 93978 TC
|
| Hospital Charge Code |
1169577
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$288.45 |
| Max. Negotiated Rate |
$576.90 |
| Rate for Payer: Aetna of IA Commercial |
$576.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$576.90
|
| Rate for Payer: Aetna of IA Medicare |
$365.37
|
| Rate for Payer: Amerigroup Medicaid |
$369.73
|
| Rate for Payer: Amerigroup Medicare |
$291.33
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$480.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$288.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$366.14
|
| Rate for Payer: Medical Associates Commercial |
$480.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$288.45
|
| Rate for Payer: Midlands Choice Commercial |
$448.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$371.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$331.72
|
| Rate for Payer: United Healthcare Commercial |
$576.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$378.19
|
| Rate for Payer: Wellmark IA HMO WHPI |
$375.06
|
| Rate for Payer: Wellmark IA PPO |
$413.15
|
|
|
US Aorta IVC Iliac Duplex Limited
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT 93979 TC
|
| Hospital Charge Code |
1169579
|
|
Hospital Revenue Code
|
921
|
| 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 Aorta IVC Iliac Duplex Limited
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 93979 TC
|
| Hospital Charge Code |
1169579
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$234.45 |
| 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 |
$300.51
|
| Rate for Payer: Amerigroup Medicare |
$236.79
|
| 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 |
$234.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$297.60
|
| Rate for Payer: Medical Associates Commercial |
$390.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$234.45
|
| Rate for Payer: Midlands Choice Commercial |
$364.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$301.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$269.62
|
| Rate for Payer: United Healthcare Commercial |
$468.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$307.39
|
| Rate for Payer: Wellmark IA HMO WHPI |
$241.06
|
| Rate for Payer: Wellmark IA PPO |
$265.54
|
|
