|
US Pregnant < 14 Weeks Addl Gest
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 76802 TC
|
| Hospital Charge Code |
7960829
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$177.10 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Aetna of IA Commercial |
$227.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$227.70
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.75
|
| Rate for Payer: Medical Associates Commercial |
$189.75
|
| Rate for Payer: Midlands Choice Commercial |
$177.10
|
| Rate for Payer: United Healthcare Commercial |
$227.70
|
|
|
US Pregnant < 14 Weeks Addl Gest
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 76802 TC
|
| Hospital Charge Code |
7960829
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$113.85 |
| Max. Negotiated Rate |
$274.13 |
| Rate for Payer: Aetna of IA Commercial |
$227.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$227.70
|
| Rate for Payer: Aetna of IA Medicare |
$144.21
|
| Rate for Payer: Amerigroup Medicaid |
$145.93
|
| Rate for Payer: Amerigroup Medicare |
$114.99
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$113.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$144.51
|
| Rate for Payer: Medical Associates Commercial |
$189.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$113.85
|
| Rate for Payer: Midlands Choice Commercial |
$177.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$146.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$130.93
|
| Rate for Payer: United Healthcare Commercial |
$227.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$149.27
|
| Rate for Payer: Wellmark IA HMO WHPI |
$248.86
|
| Rate for Payer: Wellmark IA PPO |
$274.13
|
|
|
US Pregnant > 14 Weeks Addl Gest
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 76810 TC
|
| Hospital Charge Code |
7960835
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$177.10 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Aetna of IA Commercial |
$227.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$227.70
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.75
|
| Rate for Payer: Medical Associates Commercial |
$189.75
|
| Rate for Payer: Midlands Choice Commercial |
$177.10
|
| Rate for Payer: United Healthcare Commercial |
$227.70
|
|
|
US Pregnant > 14 Weeks Addl Gest
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 76810 TC
|
| Hospital Charge Code |
7960835
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$113.85 |
| Max. Negotiated Rate |
$274.13 |
| Rate for Payer: Aetna of IA Commercial |
$227.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$227.70
|
| Rate for Payer: Aetna of IA Medicare |
$144.21
|
| Rate for Payer: Amerigroup Medicaid |
$145.93
|
| Rate for Payer: Amerigroup Medicare |
$114.99
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$113.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$144.51
|
| Rate for Payer: Medical Associates Commercial |
$189.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$113.85
|
| Rate for Payer: Midlands Choice Commercial |
$177.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$146.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$130.93
|
| Rate for Payer: United Healthcare Commercial |
$227.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$149.27
|
| Rate for Payer: Wellmark IA HMO WHPI |
$248.86
|
| Rate for Payer: Wellmark IA PPO |
$274.13
|
|
|
US Retroperitoneal Complete
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
1169867
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$345.10 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Aetna of IA Commercial |
$443.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$443.70
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$369.75
|
| Rate for Payer: Medical Associates Commercial |
$369.75
|
| Rate for Payer: Midlands Choice Commercial |
$345.10
|
| Rate for Payer: United Healthcare Commercial |
$443.70
|
|
|
US Retroperitoneal Complete
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
1169867
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$221.85 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Aetna of IA Commercial |
$443.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$443.70
|
| Rate for Payer: Aetna of IA Medicare |
$281.01
|
| Rate for Payer: Amerigroup Medicaid |
$284.36
|
| Rate for Payer: Amerigroup Medicare |
$224.07
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$369.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$221.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$281.60
|
| Rate for Payer: Medical Associates Commercial |
$369.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$221.85
|
| Rate for Payer: Midlands Choice Commercial |
$345.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$285.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$255.13
|
| Rate for Payer: United Healthcare Commercial |
$443.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$290.87
|
| Rate for Payer: Wellmark IA HMO WHPI |
$375.06
|
| Rate for Payer: Wellmark IA PPO |
$413.15
|
|
|
US Retroperitoneal Limited
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
1169869
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$174.15 |
| Max. Negotiated Rate |
$348.30 |
| Rate for Payer: Aetna of IA Commercial |
$348.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$348.30
|
| Rate for Payer: Aetna of IA Medicare |
$220.59
|
| Rate for Payer: Amerigroup Medicaid |
$223.22
|
| Rate for Payer: Amerigroup Medicare |
$175.89
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$290.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$174.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$221.05
|
| Rate for Payer: Medical Associates Commercial |
$290.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$174.15
|
| Rate for Payer: Midlands Choice Commercial |
$270.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$224.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$200.27
|
| Rate for Payer: United Healthcare Commercial |
$348.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$228.33
|
| Rate for Payer: Wellmark IA HMO WHPI |
$241.06
|
| Rate for Payer: Wellmark IA PPO |
$265.54
|
|
|
US Retroperitoneal Limited
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
1169869
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$270.90 |
| Max. Negotiated Rate |
$348.30 |
| Rate for Payer: Aetna of IA Commercial |
$348.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$348.30
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$290.25
|
| Rate for Payer: Medical Associates Commercial |
$290.25
|
| Rate for Payer: Midlands Choice Commercial |
$270.90
|
| Rate for Payer: United Healthcare Commercial |
$348.30
|
|
|
US Scrotum (Contents)
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 76870 TC
|
| Hospital Charge Code |
1169877
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$321.30 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna of IA Commercial |
$413.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$413.10
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$344.25
|
| Rate for Payer: Medical Associates Commercial |
$344.25
|
| Rate for Payer: Midlands Choice Commercial |
$321.30
|
| Rate for Payer: United Healthcare Commercial |
$413.10
|
|
|
US Scrotum (Contents)
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 76870 TC
|
| Hospital Charge Code |
1169877
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$206.55 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna of IA Commercial |
$413.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$413.10
|
| Rate for Payer: Aetna of IA Medicare |
$261.63
|
| Rate for Payer: Amerigroup Medicaid |
$264.75
|
| Rate for Payer: Amerigroup Medicare |
$208.62
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$344.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$206.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$262.18
|
| Rate for Payer: Medical Associates Commercial |
$344.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$206.55
|
| Rate for Payer: Midlands Choice Commercial |
$321.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$266.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$237.53
|
| Rate for Payer: United Healthcare Commercial |
$413.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$270.81
|
| Rate for Payer: Wellmark IA HMO WHPI |
$241.06
|
| Rate for Payer: Wellmark IA PPO |
$265.54
|
|
|
US Thyroid
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
1169883
|
|
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 |
$241.06
|
| Rate for Payer: Wellmark IA PPO |
$265.54
|
|
|
US Thyroid
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
1169883
|
|
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 UE Arterial Duplex Bilateral
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
CPT 93930 TC
|
| Hospital Charge Code |
1169895
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$241.06 |
| Max. Negotiated Rate |
$575.10 |
| Rate for Payer: Aetna of IA Commercial |
$575.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$575.10
|
| Rate for Payer: Aetna of IA Medicare |
$364.23
|
| Rate for Payer: Amerigroup Medicaid |
$368.58
|
| Rate for Payer: Amerigroup Medicare |
$290.43
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$479.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$287.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$365.00
|
| Rate for Payer: Medical Associates Commercial |
$479.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$287.55
|
| Rate for Payer: Midlands Choice Commercial |
$447.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$370.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$330.68
|
| Rate for Payer: United Healthcare Commercial |
$575.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$377.01
|
| Rate for Payer: Wellmark IA HMO WHPI |
$241.06
|
| Rate for Payer: Wellmark IA PPO |
$265.54
|
|
|
US UE Arterial Duplex Bilateral
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
CPT 93930 TC
|
| Hospital Charge Code |
1169895
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$447.30 |
| Max. Negotiated Rate |
$575.10 |
| Rate for Payer: Aetna of IA Commercial |
$575.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$575.10
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$479.25
|
| Rate for Payer: Medical Associates Commercial |
$479.25
|
| Rate for Payer: Midlands Choice Commercial |
$447.30
|
| Rate for Payer: United Healthcare Commercial |
$575.10
|
|
|
US UE Arterial Duplex Left
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT 93931 LT|TC
|
| Hospital Charge Code |
1169897
|
|
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 UE Arterial Duplex Left
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 93931 LT|TC
|
| Hospital Charge Code |
1169897
|
|
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
|
|
|
US UE Arterial Duplex Right
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT 93931 RT|TC
|
| Hospital Charge Code |
1169899
|
|
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 UE Arterial Duplex Right
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 93931 RT|TC
|
| Hospital Charge Code |
1169899
|
|
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
|
|
|
US UE Venous Duplex Left
|
Facility
|
OP
|
$582.00
|
|
|
Service Code
|
CPT 93971 LT|TC
|
| Hospital Charge Code |
1169903
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$241.06 |
| Max. Negotiated Rate |
$523.80 |
| Rate for Payer: Aetna of IA Commercial |
$523.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$523.80
|
| Rate for Payer: Aetna of IA Medicare |
$331.74
|
| Rate for Payer: Amerigroup Medicaid |
$335.70
|
| Rate for Payer: Amerigroup Medicare |
$264.52
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$436.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$261.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$332.44
|
| Rate for Payer: Medical Associates Commercial |
$436.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$261.90
|
| Rate for Payer: Midlands Choice Commercial |
$407.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$337.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$301.18
|
| Rate for Payer: United Healthcare Commercial |
$523.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$343.38
|
| Rate for Payer: Wellmark IA HMO WHPI |
$241.06
|
| Rate for Payer: Wellmark IA PPO |
$265.54
|
|
|
US UE Venous Duplex Left
|
Facility
|
IP
|
$582.00
|
|
|
Service Code
|
CPT 93971 LT|TC
|
| Hospital Charge Code |
1169903
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$407.40 |
| Max. Negotiated Rate |
$523.80 |
| Rate for Payer: Aetna of IA Commercial |
$523.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$523.80
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$436.50
|
| Rate for Payer: Medical Associates Commercial |
$436.50
|
| Rate for Payer: Midlands Choice Commercial |
$407.40
|
| Rate for Payer: United Healthcare Commercial |
$523.80
|
|
|
US UE Venous Duplex Right
|
Facility
|
IP
|
$582.00
|
|
|
Service Code
|
CPT 93971 RT|TC
|
| Hospital Charge Code |
1169905
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$407.40 |
| Max. Negotiated Rate |
$523.80 |
| Rate for Payer: Aetna of IA Commercial |
$523.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$523.80
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$436.50
|
| Rate for Payer: Medical Associates Commercial |
$436.50
|
| Rate for Payer: Midlands Choice Commercial |
$407.40
|
| Rate for Payer: United Healthcare Commercial |
$523.80
|
|
|
US UE Venous Duplex Right
|
Facility
|
OP
|
$582.00
|
|
|
Service Code
|
CPT 93971 RT|TC
|
| Hospital Charge Code |
1169905
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$241.06 |
| Max. Negotiated Rate |
$523.80 |
| Rate for Payer: Aetna of IA Commercial |
$523.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$523.80
|
| Rate for Payer: Aetna of IA Medicare |
$331.74
|
| Rate for Payer: Amerigroup Medicaid |
$335.70
|
| Rate for Payer: Amerigroup Medicare |
$264.52
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$436.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$261.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$332.44
|
| Rate for Payer: Medical Associates Commercial |
$436.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$261.90
|
| Rate for Payer: Midlands Choice Commercial |
$407.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$337.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$301.18
|
| Rate for Payer: United Healthcare Commercial |
$523.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$343.38
|
| Rate for Payer: Wellmark IA HMO WHPI |
$241.06
|
| Rate for Payer: Wellmark IA PPO |
$265.54
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
6456817
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
6456817
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$267.88 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Aetna of IA Medicare |
$31.92
|
| Rate for Payer: Amerigroup Medicaid |
$32.30
|
| Rate for Payer: Amerigroup Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.99
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.20
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.98
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.04
|
| Rate for Payer: Wellmark IA HMO WHPI |
$243.19
|
| Rate for Payer: Wellmark IA PPO |
$267.88
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$12,884.55
|
|
|
Service Code
|
MSDRG 742
|
| Min. Negotiated Rate |
$12,697.82 |
| Max. Negotiated Rate |
$12,884.55 |
| Rate for Payer: Amerigroup Medicaid |
$12,822.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12,697.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,884.55
|
|
