|
Connective Tissue Disorders With CC
|
Facility
IP
|
$11,948.69
|
|
|
Service Code
|
MS-DRG 546
|
| Hospital Charge Code |
353
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$11,948.69 |
| Rate for Payer: Amerigroup Medicaid |
$11,890.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11,775.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11,948.69
|
|
|
Connective Tissue Disorders With MCC
|
Facility
IP
|
$16,780.33
|
|
|
Service Code
|
MS-DRG 545
|
| Hospital Charge Code |
352
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$16,780.33 |
| Rate for Payer: Amerigroup Medicaid |
$16,699.27
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16,537.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16,780.33
|
|
|
Connective Tissue Disorders Without CC/MCC
|
Facility
IP
|
$7,882.79
|
|
|
Service Code
|
MS-DRG 547
|
| Hospital Charge Code |
354
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,882.79 |
| Rate for Payer: Amerigroup Medicaid |
$7,844.71
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,768.54
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,882.79
|
|
|
CONSCIOUS SED SCHD >5 1ST 30 M
|
Facility
IP
|
$235.00
|
|
| Hospital Charge Code |
8012943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna of IA Commercial |
$211.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$211.50
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$176.25
|
| Rate for Payer: Medical Associates Commercial |
$176.25
|
| Rate for Payer: Midlands Choice Commercial |
$164.50
|
| Rate for Payer: United Healthcare Commercial |
$211.50
|
|
|
CONSCIOUS SED SCHD >5 1ST 30 M
|
Facility
OP
|
$235.00
|
|
| Hospital Charge Code |
8012943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.45 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna of IA Commercial |
$211.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$211.50
|
| Rate for Payer: Aetna of IA Medicare |
$133.95
|
| Rate for Payer: Amerigroup Medicaid |
$118.60
|
| Rate for Payer: Amerigroup Medicare |
$118.68
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$176.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$117.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$117.45
|
| Rate for Payer: Medical Associates Commercial |
$176.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$117.50
|
| Rate for Payer: Midlands Choice Commercial |
$164.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$119.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$176.25
|
| Rate for Payer: United Healthcare Commercial |
$211.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$138.65
|
|
|
CONTINUOUS CARDIAC MONITORING 1-3 LEADS TRACING ONLY
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
7982922
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
|
|
CONTINUOUS CARDIAC MONITORING 1-3 LEADS TRACING ONLY
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
7982922
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Aetna of IA Medicare |
$59.28
|
| Rate for Payer: Amerigroup Medicaid |
$52.49
|
| Rate for Payer: Amerigroup Medicare |
$52.52
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.00
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.36
|
| Rate for Payer: Wellmark IA HMO |
$83.08
|
| Rate for Payer: Wellmark IA PPO |
$91.39
|
|
|
CONTRACEPTIVE CAPS INSERTION CHARGE
|
Professional
|
$345.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
8068935
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$56.02 |
| Max. Negotiated Rate |
$241.50 |
| Rate for Payer: Aetna of IA Medicare |
$56.02
|
| Rate for Payer: Amerigroup Medicaid |
$57.92
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$67.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.14
|
| Rate for Payer: Medical Associates Commercial |
$106.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.02
|
| Rate for Payer: Midlands Choice Commercial |
$241.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$84.03
|
| Rate for Payer: Wellmark IA HMO |
$119.00
|
| Rate for Payer: Wellmark IA PPO |
$139.00
|
|
|
CONTRACEPTIVE CAPS REMOVAL CHARGE
|
Professional
|
$484.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
8068933
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$338.80 |
| Rate for Payer: Aetna of IA Medicare |
$83.40
|
| Rate for Payer: Amerigroup Medicaid |
$86.24
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$85.07
|
| Rate for Payer: Medical Associates Commercial |
$158.46
|
| Rate for Payer: Medical Associates Managed Medicare |
$83.40
|
| Rate for Payer: Midlands Choice Commercial |
$338.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$125.10
|
| Rate for Payer: Wellmark IA HMO |
$165.00
|
| Rate for Payer: Wellmark IA PPO |
$194.00
|
|
|
CONTRAST BATH / 15 MIN APPLICATION
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT 97034 GP
|
| Hospital Charge Code |
1374011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of IA Commercial |
$73.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.80
|
| Rate for Payer: Aetna of IA Medicare |
$46.74
|
| Rate for Payer: Amerigroup Medicaid |
$41.39
|
| Rate for Payer: Amerigroup Medicare |
$41.41
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$41.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.98
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$41.00
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$61.50
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.38
|
|
|
CONTRAST BATH / 15 MIN APPLICATION
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT 97034 GP
|
| Hospital Charge Code |
1374011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of IA Commercial |
$73.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.50
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
|
|
CONTRAST BATH/PER 15 MIN
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT 97034 GO
|
| Hospital Charge Code |
1373567
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of IA Commercial |
$73.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.50
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
|
|
CONTRAST BATH/PER 15 MIN
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT 97034 GO
|
| Hospital Charge Code |
1373567
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of IA Commercial |
$73.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.80
|
| Rate for Payer: Aetna of IA Medicare |
$46.74
|
| Rate for Payer: Amerigroup Medicaid |
$41.39
|
| Rate for Payer: Amerigroup Medicare |
$41.41
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$41.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.98
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$41.00
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$61.50
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.38
|
|
|
CONTROLLER FOR INTELLIS ADAPTIVESTIM
|
Facility
OP
|
$1,971.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8557560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$985.11 |
| Max. Negotiated Rate |
$1,773.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,773.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,773.90
|
| Rate for Payer: Aetna of IA Medicare |
$1,123.47
|
| Rate for Payer: Amerigroup Medicaid |
$994.76
|
| Rate for Payer: Amerigroup Medicare |
$995.36
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,478.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$985.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$985.11
|
| Rate for Payer: Medical Associates Commercial |
$1,478.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$985.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,379.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,000.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,478.25
|
| Rate for Payer: United Healthcare Commercial |
$1,773.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,162.89
|
|
|
CONTROLLER FOR INTELLIS ADAPTIVESTIM
|
Facility
IP
|
$1,971.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8557560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,379.70 |
| Max. Negotiated Rate |
$1,773.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,773.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,773.90
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,478.25
|
| Rate for Payer: Medical Associates Commercial |
$1,478.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,379.70
|
| Rate for Payer: United Healthcare Commercial |
$1,773.90
|
|
|
Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method
|
Facility
OP
|
$362.82
|
|
|
Service Code
|
CPT 30901
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$329.84 |
| Max. Negotiated Rate |
$362.82 |
| Rate for Payer: Wellmark IA HMO |
$329.84
|
| Rate for Payer: Wellmark IA PPO |
$362.82
|
|
|
CONTROL OF NOSEBLEED
|
Professional
|
$730.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
7982781
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$69.26 |
| Max. Negotiated Rate |
$511.00 |
| Rate for Payer: Aetna of IA Medicare |
$69.26
|
| Rate for Payer: Amerigroup Medicaid |
$71.61
|
| Rate for Payer: Cash Price |
$584.00
|
| Rate for Payer: Cash Price |
$584.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$83.11
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$70.65
|
| Rate for Payer: Medical Associates Commercial |
$131.59
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.26
|
| Rate for Payer: Midlands Choice Commercial |
$511.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$103.89
|
| Rate for Payer: Wellmark IA HMO |
$147.00
|
| Rate for Payer: Wellmark IA PPO |
$173.00
|
|
|
CONTROL OF NOSEBLEED
|
Professional
|
$897.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
7982780
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$94.86 |
| Max. Negotiated Rate |
$627.90 |
| Rate for Payer: Aetna of IA Medicare |
$94.86
|
| Rate for Payer: Amerigroup Medicaid |
$98.09
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.83
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$96.76
|
| Rate for Payer: Medical Associates Commercial |
$180.23
|
| Rate for Payer: Medical Associates Managed Medicare |
$94.86
|
| Rate for Payer: Midlands Choice Commercial |
$627.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$142.29
|
| Rate for Payer: Wellmark IA HMO |
$201.00
|
| Rate for Payer: Wellmark IA PPO |
$236.00
|
|
|
CORD ABO/RH
|
Facility
IP
|
$52.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
4022838
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
|
|
CORD ABO/RH
|
Facility
OP
|
$52.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
4022838
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Aetna of IA Medicare |
$29.64
|
| Rate for Payer: Amerigroup Medicaid |
$26.24
|
| Rate for Payer: Amerigroup Medicare |
$26.26
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.99
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.00
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.68
|
| Rate for Payer: Wellmark IA HMO |
$97.34
|
| Rate for Payer: Wellmark IA PPO |
$107.07
|
|
|
Cord Drug Screen Ref
|
Facility
IP
|
$287.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
8558202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$200.90 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Aetna of IA Commercial |
$258.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$258.30
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$215.25
|
| Rate for Payer: Medical Associates Commercial |
$215.25
|
| Rate for Payer: Midlands Choice Commercial |
$200.90
|
| Rate for Payer: United Healthcare Commercial |
$258.30
|
|
|
Cord Drug Screen Ref
|
Facility
IP
|
$287.00
|
|
|
Service Code
|
CPT 80301
|
| Hospital Charge Code |
7811988
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$200.90 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Aetna of IA Commercial |
$258.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$258.30
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$215.25
|
| Rate for Payer: Medical Associates Commercial |
$215.25
|
| Rate for Payer: Midlands Choice Commercial |
$200.90
|
| Rate for Payer: United Healthcare Commercial |
$258.30
|
|
|
Cord Drug Screen Ref
|
Facility
OP
|
$287.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
8558202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.92 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Aetna of IA Commercial |
$258.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$258.30
|
| Rate for Payer: Aetna of IA Medicare |
$163.59
|
| Rate for Payer: Amerigroup Medicaid |
$144.85
|
| Rate for Payer: Amerigroup Medicare |
$144.94
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$215.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$143.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$143.44
|
| Rate for Payer: Medical Associates Commercial |
$215.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$143.50
|
| Rate for Payer: Midlands Choice Commercial |
$200.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$145.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$215.25
|
| Rate for Payer: United Healthcare Commercial |
$258.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$169.33
|
| Rate for Payer: Wellmark IA HMO |
$102.92
|
| Rate for Payer: Wellmark IA PPO |
$113.21
|
|
|
Cord Drug Screen Ref
|
Facility
OP
|
$287.00
|
|
|
Service Code
|
CPT 80301
|
| Hospital Charge Code |
7811988
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$143.44 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Aetna of IA Commercial |
$258.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$258.30
|
| Rate for Payer: Aetna of IA Medicare |
$163.59
|
| Rate for Payer: Amerigroup Medicaid |
$144.85
|
| Rate for Payer: Amerigroup Medicare |
$144.94
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$215.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$143.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$143.44
|
| Rate for Payer: Medical Associates Commercial |
$215.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$143.50
|
| Rate for Payer: Midlands Choice Commercial |
$200.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$145.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$215.25
|
| Rate for Payer: United Healthcare Commercial |
$258.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$169.33
|
|
|
CORKSCREW BIO 3.7MM X 17.9
|
Facility
IP
|
$621.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.70 |
| Max. Negotiated Rate |
$558.90 |
| Rate for Payer: Aetna of IA Commercial |
$558.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$558.90
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$465.75
|
| Rate for Payer: Medical Associates Commercial |
$465.75
|
| Rate for Payer: Midlands Choice Commercial |
$434.70
|
| Rate for Payer: United Healthcare Commercial |
$558.90
|
|
