|
COMPREHENSIVE METABOLIC PANEL
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
633709
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
COMPREHENSIVE METABOLIC PANEL
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
633709
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$114.21
|
| Rate for Payer: Amerigroup Medicare |
$89.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$89.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.10
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.10
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.47
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
COMPUTER XM OK
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
6306782
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Aetna of IA Medicare |
$41.61
|
| Rate for Payer: Amerigroup Medicaid |
$42.11
|
| Rate for Payer: Amerigroup Medicare |
$33.18
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.70
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.85
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$37.78
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.07
|
|
|
COMPUTER XM OK
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
6306782
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
|
|
CONCELLTRATE 100 2.5CC JAR
|
Facility
|
OP
|
$2,205.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8463706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$992.25 |
| Max. Negotiated Rate |
$1,984.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,984.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,984.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,256.85
|
| Rate for Payer: Amerigroup Medicaid |
$1,271.84
|
| Rate for Payer: Amerigroup Medicare |
$1,002.17
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,653.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$992.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,259.50
|
| Rate for Payer: Medical Associates Commercial |
$1,653.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$992.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,543.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,278.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,141.09
|
| Rate for Payer: United Healthcare Commercial |
$1,984.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,300.95
|
|
|
CONCELLTRATE 100 2.5CC JAR
|
Facility
|
IP
|
$2,205.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8463706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.50 |
| Max. Negotiated Rate |
$1,984.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,984.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,984.50
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,653.75
|
| Rate for Payer: Medical Associates Commercial |
$1,653.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,543.50
|
| Rate for Payer: United Healthcare Commercial |
$1,984.50
|
|
|
CONSCIOUS SED-ER >5 1ST 30 MIN
|
Facility
|
IP
|
$195.00
|
|
| Hospital Charge Code |
4866823
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna of IA Commercial |
$175.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$175.50
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$146.25
|
| Rate for Payer: Medical Associates Commercial |
$146.25
|
| Rate for Payer: Midlands Choice Commercial |
$136.50
|
| Rate for Payer: United Healthcare Commercial |
$175.50
|
|
|
CONSCIOUS SED-ER >5 1ST 30 MIN
|
Facility
|
OP
|
$195.00
|
|
| Hospital Charge Code |
4866823
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna of IA Commercial |
$175.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$175.50
|
| Rate for Payer: Aetna of IA Medicare |
$111.15
|
| Rate for Payer: Amerigroup Medicaid |
$112.48
|
| Rate for Payer: Amerigroup Medicare |
$88.63
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$146.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$87.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$111.38
|
| Rate for Payer: Medical Associates Commercial |
$146.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$87.75
|
| Rate for Payer: Midlands Choice Commercial |
$136.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$113.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$100.91
|
| Rate for Payer: United Healthcare Commercial |
$175.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$115.05
|
|
|
CONSCIOUS SED-ER EA ADDL 15MIN
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
4866821
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna of IA Commercial |
$22.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.50
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.75
|
| Rate for Payer: Medical Associates Commercial |
$18.75
|
| Rate for Payer: Midlands Choice Commercial |
$17.50
|
| Rate for Payer: United Healthcare Commercial |
$22.50
|
|
|
CONSCIOUS SED-ER EA ADDL 15MIN
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
4866821
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna of IA Commercial |
$22.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.50
|
| Rate for Payer: Aetna of IA Medicare |
$14.25
|
| Rate for Payer: Amerigroup Medicaid |
$14.42
|
| Rate for Payer: Amerigroup Medicare |
$11.36
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.28
|
| Rate for Payer: Medical Associates Commercial |
$18.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.25
|
| Rate for Payer: Midlands Choice Commercial |
$17.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.94
|
| Rate for Payer: United Healthcare Commercial |
$22.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.75
|
|
|
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 |
$105.75 |
| 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 |
$135.55
|
| Rate for Payer: Amerigroup Medicare |
$106.81
|
| 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 |
$105.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$134.23
|
| Rate for Payer: Medical Associates Commercial |
$176.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$105.75
|
| Rate for Payer: Midlands Choice Commercial |
$164.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$136.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$121.61
|
| 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
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
7982922
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$46.80 |
| 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: Aetna of IA Medicare |
$59.28
|
| Rate for Payer: Amerigroup Medicaid |
$59.99
|
| Rate for Payer: Amerigroup Medicare |
$47.27
|
| 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 |
$46.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.40
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$46.80
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.82
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.36
|
|
|
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
|
|
|
CONTRACEPTIVE CAPS INSERTION CHARGE
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
8068935
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$155.01 |
| Max. Negotiated Rate |
$258.75 |
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Medical Associates Commercial |
$258.75
|
| Rate for Payer: Midlands Choice Commercial |
$241.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$258.75
|
| Rate for Payer: United Healthcare Commercial |
$155.01
|
|
|
CONTRACEPTIVE CAPS REMOVAL CHARGE
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
8068933
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$219.10 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Medical Associates Commercial |
$363.00
|
| Rate for Payer: Midlands Choice Commercial |
$338.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$363.00
|
| Rate for Payer: United Healthcare Commercial |
$219.10
|
|
|
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 / 15 MIN APPLICATION
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 97034 GP
|
| Hospital Charge Code |
1374011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.90 |
| 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 |
$47.30
|
| Rate for Payer: Amerigroup Medicare |
$37.27
|
| 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 |
$36.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$46.84
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.90
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$47.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.44
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.38
|
|
|
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 |
$36.90 |
| 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 |
$47.30
|
| Rate for Payer: Amerigroup Medicare |
$37.27
|
| 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 |
$36.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$46.84
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.90
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$47.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.44
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.38
|
|
|
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
|
|
|
CONTROLLER FOR INTELLIS ADAPTIVESTIM
|
Facility
|
OP
|
$1,971.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
8557560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$886.95 |
| 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 |
$1,136.87
|
| Rate for Payer: Amerigroup Medicare |
$895.82
|
| 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 |
$886.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,125.84
|
| Rate for Payer: Medical Associates Commercial |
$1,478.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$886.95
|
| Rate for Payer: Midlands Choice Commercial |
$1,379.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,142.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,019.99
|
| 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
|
HCPCS 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 OF NOSEBLEED
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
4864904
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$208.60 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Aetna of IA Commercial |
$268.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$268.20
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$223.50
|
| Rate for Payer: Medical Associates Commercial |
$223.50
|
| Rate for Payer: Midlands Choice Commercial |
$208.60
|
| Rate for Payer: United Healthcare Commercial |
$268.20
|
|
|
CONTROL OF NOSEBLEED
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
4864905
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna of IA Commercial |
$229.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$229.50
|
| Rate for Payer: Aetna of IA Medicare |
$145.35
|
| Rate for Payer: Amerigroup Medicaid |
$147.08
|
| Rate for Payer: Amerigroup Medicare |
$115.90
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$191.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$114.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$145.66
|
| Rate for Payer: Medical Associates Commercial |
$191.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$114.75
|
| Rate for Payer: Midlands Choice Commercial |
$178.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$147.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$131.96
|
| Rate for Payer: United Healthcare Commercial |
$229.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$150.45
|
|
|
CONTROL OF NOSEBLEED
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
4864906
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$153.45 |
| Max. Negotiated Rate |
$306.90 |
| Rate for Payer: Aetna of IA Commercial |
$306.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$306.90
|
| Rate for Payer: Aetna of IA Medicare |
$194.37
|
| Rate for Payer: Amerigroup Medicaid |
$196.69
|
| Rate for Payer: Amerigroup Medicare |
$154.98
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$255.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$153.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$194.78
|
| Rate for Payer: Medical Associates Commercial |
$255.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$153.45
|
| Rate for Payer: Midlands Choice Commercial |
$238.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$197.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$176.47
|
| Rate for Payer: United Healthcare Commercial |
$306.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$201.19
|
|
