|
cosyntropin 0.25 mg SDV Inj
|
Facility
IP
|
$93.20
|
|
|
Service Code
|
CPT J0834
|
| Hospital Charge Code |
43701424
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.24 |
| Max. Negotiated Rate |
$83.88 |
| Rate for Payer: Aetna of IA Commercial |
$83.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$83.88
|
| Rate for Payer: Cash Price |
$74.56
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$69.90
|
| Rate for Payer: Medical Associates Commercial |
$69.90
|
| Rate for Payer: Midlands Choice Commercial |
$65.24
|
| Rate for Payer: United Healthcare Commercial |
$83.88
|
|
|
C Peptide DMCL
|
Facility
OP
|
$170.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
8037503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of IA Commercial |
$153.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$153.00
|
| Rate for Payer: Aetna of IA Medicare |
$96.90
|
| Rate for Payer: Amerigroup Medicaid |
$85.80
|
| Rate for Payer: Amerigroup Medicare |
$85.85
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$127.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$85.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$84.97
|
| Rate for Payer: Medical Associates Commercial |
$127.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$85.00
|
| Rate for Payer: Midlands Choice Commercial |
$119.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$86.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$127.50
|
| Rate for Payer: United Healthcare Commercial |
$153.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$100.30
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
C Peptide DMCL
|
Facility
IP
|
$170.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
8037503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of IA Commercial |
$153.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$153.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$127.50
|
| Rate for Payer: Medical Associates Commercial |
$127.50
|
| Rate for Payer: Midlands Choice Commercial |
$119.00
|
| Rate for Payer: United Healthcare Commercial |
$153.00
|
|
|
CPR - PHYSICIAN ONLY
|
Professional
|
$1,004.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
7982758
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$167.16 |
| Max. Negotiated Rate |
$702.80 |
| Rate for Payer: Aetna of IA Medicare |
$167.16
|
| Rate for Payer: Amerigroup Medicaid |
$172.84
|
| Rate for Payer: Cash Price |
$803.20
|
| Rate for Payer: Cash Price |
$803.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$200.59
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$170.50
|
| Rate for Payer: Medical Associates Commercial |
$317.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$167.16
|
| Rate for Payer: Midlands Choice Commercial |
$702.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$250.74
|
| Rate for Payer: Wellmark IA HMO |
$322.00
|
| Rate for Payer: Wellmark IA PPO |
$378.00
|
|
|
Cranial and Peripheral Nerve Disorders With MCC
|
Facility
IP
|
$15,499.84
|
|
|
Service Code
|
MS-DRG 073
|
| Hospital Charge Code |
753
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$15,499.84 |
| Rate for Payer: Amerigroup Medicaid |
$15,424.96
|
| 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 |
$15,275.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15,499.84
|
|
|
Cranial and Peripheral Nerve Disorders Without MCC
|
Facility
IP
|
$9,775.48
|
|
|
Service Code
|
MS-DRG 074
|
| Hospital Charge Code |
754
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,775.48 |
| Rate for Payer: Amerigroup Medicaid |
$9,728.26
|
| 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 |
$9,633.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,775.48
|
|
|
CRANIOFACIAL MAXILLOFACIAL OP
|
Facility
IP
|
$831.00
|
|
|
Service Code
|
CPT 21299
|
| Hospital Charge Code |
8300880
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$581.70 |
| Max. Negotiated Rate |
$747.90 |
| Rate for Payer: Aetna of IA Commercial |
$747.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$747.90
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$623.25
|
| Rate for Payer: Medical Associates Commercial |
$623.25
|
| Rate for Payer: Midlands Choice Commercial |
$581.70
|
| Rate for Payer: United Healthcare Commercial |
$747.90
|
|
|
CRANIOFACIAL MAXILLOFACIAL OP
|
Facility
OP
|
$831.00
|
|
|
Service Code
|
CPT 21299
|
| Hospital Charge Code |
8300880
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$415.33 |
| Max. Negotiated Rate |
$3,851.25 |
| Rate for Payer: Aetna of IA Commercial |
$747.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$747.90
|
| Rate for Payer: Aetna of IA Medicare |
$473.67
|
| Rate for Payer: Amerigroup Medicaid |
$419.41
|
| Rate for Payer: Amerigroup Medicare |
$419.66
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$623.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$415.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$415.33
|
| Rate for Payer: Medical Associates Commercial |
$623.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$415.50
|
| Rate for Payer: Midlands Choice Commercial |
$581.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$421.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$623.25
|
| Rate for Payer: United Healthcare Commercial |
$747.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$490.29
|
| Rate for Payer: Wellmark IA HMO |
$3,501.14
|
| Rate for Payer: Wellmark IA PPO |
$3,851.25
|
|
|
Craniotomy and Endovascular Intracranial Procedures With CC
|
Facility
IP
|
$27,102.08
|
|
|
Service Code
|
MS-DRG 026
|
| Hospital Charge Code |
715
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$27,102.08 |
| Rate for Payer: Amerigroup Medicaid |
$26,971.15
|
| 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 |
$26,709.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27,102.08
|
|
|
Craniotomy and Endovascular Intracranial Procedures With MCC
|
Facility
IP
|
$37,081.30
|
|
|
Service Code
|
MS-DRG 025
|
| Hospital Charge Code |
714
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$37,081.30 |
| Rate for Payer: Amerigroup Medicaid |
$36,902.16
|
| 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 |
$36,543.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37,081.30
|
|
|
Craniotomy and Endovascular Intracranial Procedures Without CC/MCC
|
Facility
IP
|
$20,124.79
|
|
|
Service Code
|
MS-DRG 027
|
| Hospital Charge Code |
716
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$20,124.79 |
| Rate for Payer: Amerigroup Medicaid |
$20,027.57
|
| 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 |
$19,833.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20,124.79
|
|
|
Craniotomy for Multiple Significant Trauma
|
Facility
IP
|
$54,733.67
|
|
|
Service Code
|
MS-DRG 955
|
| Hospital Charge Code |
658
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$54,733.67 |
| Rate for Payer: Amerigroup Medicaid |
$54,469.25
|
| 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 |
$53,940.43
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$54,733.67
|
|
|
Craniotomy With Major Device Implant or Acute Complex CNS Principal Diagnosis With MCC or Chemotherapy Implant or Epilepsy With Neurostimulator
|
Facility
IP
|
$52,852.78
|
|
|
Service Code
|
MS-DRG 023
|
| Hospital Charge Code |
712
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$52,852.78 |
| Rate for Payer: Amerigroup Medicaid |
$52,597.45
|
| 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 |
$52,086.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52,852.78
|
|
|
Craniotomy With Major Device Implant or Acute Complex CNS Principal Diagnosis Without MCC
|
Facility
IP
|
$33,727.99
|
|
|
Service Code
|
MS-DRG 024
|
| Hospital Charge Code |
713
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$33,727.99 |
| Rate for Payer: Amerigroup Medicaid |
$33,565.05
|
| 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 |
$33,239.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33,727.99
|
|
|
C-REACTIVE PROTEIN-HIGH SENS
|
Facility
OP
|
$123.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
7934763
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna of IA Commercial |
$110.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$110.70
|
| Rate for Payer: Aetna of IA Medicare |
$70.11
|
| Rate for Payer: Amerigroup Medicaid |
$62.08
|
| Rate for Payer: Amerigroup Medicare |
$62.12
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$61.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.48
|
| Rate for Payer: Medical Associates Commercial |
$92.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$61.50
|
| Rate for Payer: Midlands Choice Commercial |
$86.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$110.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$72.57
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
C-REACTIVE PROTEIN-HIGH SENS
|
Facility
OP
|
$83.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
1628890
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna of IA Commercial |
$74.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$74.70
|
| Rate for Payer: Aetna of IA Medicare |
$47.31
|
| Rate for Payer: Amerigroup Medicaid |
$41.89
|
| Rate for Payer: Amerigroup Medicare |
$41.92
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$62.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$41.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.48
|
| Rate for Payer: Medical Associates Commercial |
$62.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$41.50
|
| Rate for Payer: Midlands Choice Commercial |
$58.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$62.25
|
| Rate for Payer: United Healthcare Commercial |
$74.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.97
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
C-REACTIVE PROTEIN-HIGH SENS
|
Facility
IP
|
$123.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
7934763
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna of IA Commercial |
$110.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$110.70
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.25
|
| Rate for Payer: Medical Associates Commercial |
$92.25
|
| Rate for Payer: Midlands Choice Commercial |
$86.10
|
| Rate for Payer: United Healthcare Commercial |
$110.70
|
|
|
C-REACTIVE PROTEIN-HIGH SENS
|
Facility
IP
|
$83.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
1628890
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna of IA Commercial |
$74.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$74.70
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$62.25
|
| Rate for Payer: Medical Associates Commercial |
$62.25
|
| Rate for Payer: Midlands Choice Commercial |
$58.10
|
| Rate for Payer: United Healthcare Commercial |
$74.70
|
|
|
C-Reactive Protein HS
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
8519232
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.70 |
| 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: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
C-Reactive Protein HS
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
8519232
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.49 |
| 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 |
$30.79
|
| Rate for Payer: Amerigroup Medicare |
$30.80
|
| 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 |
$30.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.49
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.50
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
CREAT CLEARANCE
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
633609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of IA Commercial |
$81.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$67.50
|
| Rate for Payer: Medical Associates Commercial |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$63.00
|
| Rate for Payer: United Healthcare Commercial |
$81.00
|
|
|
CREAT CLEARANCE
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
633609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of IA Commercial |
$81.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.00
|
| Rate for Payer: Aetna of IA Medicare |
$51.30
|
| Rate for Payer: Amerigroup Medicaid |
$45.42
|
| Rate for Payer: Amerigroup Medicare |
$45.45
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$67.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$45.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$44.98
|
| Rate for Payer: Medical Associates Commercial |
$67.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$45.00
|
| Rate for Payer: Midlands Choice Commercial |
$63.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$45.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$67.50
|
| Rate for Payer: United Healthcare Commercial |
$81.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$53.10
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
CREATININE
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
4010820
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| 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 |
$30.79
|
| Rate for Payer: Amerigroup Medicare |
$30.80
|
| 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 |
$30.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.49
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.50
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
CREATININE
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
4010820
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| 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: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
Creatinine 24 Hour Urine
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
1634894
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| 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: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
