|
CREAT CLEARANCE
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
633609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.49 |
| 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 |
$51.91
|
| Rate for Payer: Amerigroup Medicare |
$40.90
|
| 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 |
$40.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.41
|
| Rate for Payer: Medical Associates Commercial |
$67.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.50
|
| Rate for Payer: Midlands Choice Commercial |
$63.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$46.58
|
| Rate for Payer: United Healthcare Commercial |
$81.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$53.10
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
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
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
4010820
|
|
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
|
|
|
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
|
|
|
Creatinine 24 Hour Urine
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
1634894
|
|
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
|
|
|
Creatinine Clearance 1
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
8788868
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.49 |
| 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 |
$51.91
|
| Rate for Payer: Amerigroup Medicare |
$40.90
|
| 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 |
$40.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.41
|
| Rate for Payer: Medical Associates Commercial |
$67.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.50
|
| Rate for Payer: Midlands Choice Commercial |
$63.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$46.58
|
| Rate for Payer: United Healthcare Commercial |
$81.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$53.10
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
Creatinine Clearance 1
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
8788868
|
|
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
|
|
|
Creatinine Urine.
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
8435061
|
|
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
|
|
|
Creatinine Urine.
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
8435061
|
|
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 Urine Random DMCL
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
8040998
|
|
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 Urine Random DMCL
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
8040998
|
|
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
|
|
|
CRISIS PHYCHOTHERAPY WITH EA ADDT’L 30 MIN
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
CPT 90840 AJ|HO
|
| Hospital Charge Code |
5492793
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$61.22 |
| Max. Negotiated Rate |
$109.04 |
| Rate for Payer: Amerigroup Medicaid |
$61.82
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.22
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$61.52
|
| Rate for Payer: Optum Behavioral Health |
$66.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.25
|
| Rate for Payer: United Healthcare Commercial |
$109.04
|
| Rate for Payer: Wellmark IA HMO WHPI |
$98.10
|
| Rate for Payer: Wellmark IA PPO |
$98.10
|
|
|
CRISIS PSYCHOTHERAPY
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
CPT 90832 AJ|HO
|
| Hospital Charge Code |
4919450
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$43.76 |
| Max. Negotiated Rate |
$135.75 |
| Rate for Payer: Amerigroup Medicaid |
$44.19
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.76
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.97
|
| Rate for Payer: Optum Behavioral Health |
$71.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.75
|
| Rate for Payer: United Healthcare Commercial |
$109.55
|
| Rate for Payer: Wellmark IA HMO WHPI |
$105.70
|
| Rate for Payer: Wellmark IA PPO |
$105.70
|
|
|
CRISIS PSYCHOTHERAPY
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
CPT 90832 AJ|HO
|
| Hospital Charge Code |
8052816
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$43.76 |
| Max. Negotiated Rate |
$135.75 |
| Rate for Payer: Amerigroup Medicaid |
$44.19
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.76
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.97
|
| Rate for Payer: Optum Behavioral Health |
$71.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.75
|
| Rate for Payer: United Healthcare Commercial |
$109.55
|
| Rate for Payer: Wellmark IA HMO WHPI |
$105.70
|
| Rate for Payer: Wellmark IA PPO |
$105.70
|
|
|
CRISIS PSYCHOTHERAPY
|
Professional
|
Both
|
$663.00
|
|
|
Service Code
|
CPT 90839 AJ|HO
|
| Hospital Charge Code |
5492792
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$127.99 |
| Max. Negotiated Rate |
$497.25 |
| Rate for Payer: Amerigroup Medicaid |
$129.24
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$127.99
|
| Rate for Payer: Medical Associates Commercial |
$497.25
|
| Rate for Payer: Midlands Choice Commercial |
$464.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.62
|
| Rate for Payer: Optum Behavioral Health |
$134.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$497.25
|
| Rate for Payer: United Healthcare Commercial |
$227.95
|
| Rate for Payer: Wellmark IA HMO WHPI |
$197.90
|
| Rate for Payer: Wellmark IA PPO |
$197.90
|
|
|
CRIT CARE 1ST 74 MINS
|
Facility
|
OP
|
$1,467.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
4864996
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$660.15 |
| Max. Negotiated Rate |
$1,320.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,320.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,320.30
|
| Rate for Payer: Aetna of IA Medicare |
$836.19
|
| Rate for Payer: Amerigroup Medicaid |
$846.17
|
| Rate for Payer: Amerigroup Medicare |
$666.75
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,100.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$660.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$837.95
|
| Rate for Payer: Medical Associates Commercial |
$1,100.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$660.15
|
| Rate for Payer: Midlands Choice Commercial |
$1,026.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$850.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$759.17
|
| Rate for Payer: United Healthcare Commercial |
$1,320.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$865.53
|
|
|
CRIT CARE 1ST 74 MINS
|
Facility
|
IP
|
$1,467.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
4864996
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,026.90 |
| Max. Negotiated Rate |
$1,320.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,320.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,320.30
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,100.25
|
| Rate for Payer: Medical Associates Commercial |
$1,100.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,026.90
|
| Rate for Payer: United Healthcare Commercial |
$1,320.30
|
|
|
CRIT CARE EACH ADD'L 30MIN
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
4864997
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.60 |
| Max. Negotiated Rate |
$385.20 |
| Rate for Payer: Aetna of IA Commercial |
$385.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$385.20
|
| Rate for Payer: Aetna of IA Medicare |
$243.96
|
| Rate for Payer: Amerigroup Medicaid |
$246.87
|
| Rate for Payer: Amerigroup Medicare |
$194.53
|
| Rate for Payer: Cash Price |
$342.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$321.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$192.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$244.47
|
| Rate for Payer: Medical Associates Commercial |
$321.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$192.60
|
| Rate for Payer: Midlands Choice Commercial |
$299.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$248.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$221.49
|
| Rate for Payer: United Healthcare Commercial |
$385.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$252.52
|
|
|
CRIT CARE EACH ADD'L 30MIN
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
4864997
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$299.60 |
| Max. Negotiated Rate |
$385.20 |
| Rate for Payer: Aetna of IA Commercial |
$385.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$385.20
|
| Rate for Payer: Cash Price |
$342.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$321.00
|
| Rate for Payer: Medical Associates Commercial |
$321.00
|
| Rate for Payer: Midlands Choice Commercial |
$299.60
|
| Rate for Payer: United Healthcare Commercial |
$385.20
|
|
|
CRITICAL CARE 1ST 74 MINS
|
Professional
|
Both
|
$679.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
7982749
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$180.11 |
| Max. Negotiated Rate |
$509.25 |
| Rate for Payer: Amerigroup Medicaid |
$181.88
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$180.11
|
| Rate for Payer: Medical Associates Commercial |
$509.25
|
| Rate for Payer: Midlands Choice Commercial |
$475.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$180.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$509.25
|
| Rate for Payer: United Healthcare Commercial |
$306.36
|
| Rate for Payer: Wellmark IA HMO WHPI |
$428.80
|
| Rate for Payer: Wellmark IA PPO |
$428.80
|
|
|
CRITICAL CARE EA ADD'L 30 MINS
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
7982747
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$89.81 |
| Max. Negotiated Rate |
$255.75 |
| Rate for Payer: Amerigroup Medicaid |
$90.69
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.81
|
| Rate for Payer: Medical Associates Commercial |
$255.75
|
| Rate for Payer: Midlands Choice Commercial |
$238.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$90.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$255.75
|
| Rate for Payer: United Healthcare Commercial |
$135.85
|
| Rate for Payer: Wellmark IA HMO WHPI |
$187.70
|
| Rate for Payer: Wellmark IA PPO |
$187.70
|
|
|
Crypto Antigen
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
8059690
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
Crypto Antigen
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
8059690
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.03 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$65.76
|
| Rate for Payer: Amerigroup Medicare |
$51.81
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.12
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.30
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$59.00
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
|
Crypto Antigen
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
4022856
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.03 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$65.76
|
| Rate for Payer: Amerigroup Medicare |
$51.81
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.12
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.30
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$59.00
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
|
Crypto Antigen
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
4022856
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
