|
etoposide 20 mg/mL 5ml MDV
|
Facility
IP
|
$84.68
|
|
|
Service Code
|
CPT J9181
|
| Hospital Charge Code |
43700495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$76.21 |
| Rate for Payer: Aetna of IA Commercial |
$76.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.21
|
| Rate for Payer: Cash Price |
$67.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.51
|
| Rate for Payer: Medical Associates Commercial |
$63.51
|
| Rate for Payer: Midlands Choice Commercial |
$59.28
|
| Rate for Payer: United Healthcare Commercial |
$76.21
|
|
|
Everolimus Level DMCL
|
Facility
OP
|
$240.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
8820559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna of IA Commercial |
$216.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$216.00
|
| Rate for Payer: Aetna of IA Medicare |
$136.80
|
| Rate for Payer: Amerigroup Medicaid |
$121.13
|
| Rate for Payer: Amerigroup Medicare |
$121.20
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$180.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$120.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$119.95
|
| Rate for Payer: Medical Associates Commercial |
$180.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$120.00
|
| Rate for Payer: Midlands Choice Commercial |
$168.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$121.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$180.00
|
| Rate for Payer: United Healthcare Commercial |
$216.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$141.60
|
| Rate for Payer: Wellmark IA HMO |
$49.60
|
| Rate for Payer: Wellmark IA PPO |
$54.56
|
|
|
Everolimus Level DMCL
|
Facility
IP
|
$240.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
8820559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna of IA Commercial |
$216.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$216.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$180.00
|
| Rate for Payer: Medical Associates Commercial |
$180.00
|
| Rate for Payer: Midlands Choice Commercial |
$168.00
|
| Rate for Payer: United Healthcare Commercial |
$216.00
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
IP
|
$1,014.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
4862821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$709.80 |
| Max. Negotiated Rate |
$912.60 |
| Rate for Payer: Aetna of IA Commercial |
$912.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$912.60
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$760.50
|
| Rate for Payer: Medical Associates Commercial |
$760.50
|
| Rate for Payer: Midlands Choice Commercial |
$709.80
|
| Rate for Payer: United Healthcare Commercial |
$912.60
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
OP
|
$1,014.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
4862821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.80 |
| Max. Negotiated Rate |
$1,451.30 |
| Rate for Payer: Aetna of IA Commercial |
$912.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$912.60
|
| Rate for Payer: Aetna of IA Medicare |
$577.98
|
| Rate for Payer: Amerigroup Medicaid |
$511.77
|
| Rate for Payer: Amerigroup Medicare |
$512.07
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$760.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$507.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$506.80
|
| Rate for Payer: Medical Associates Commercial |
$760.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$507.00
|
| Rate for Payer: Midlands Choice Commercial |
$709.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$514.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$760.50
|
| Rate for Payer: United Healthcare Commercial |
$912.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$598.26
|
| Rate for Payer: Wellmark IA HMO |
$1,319.36
|
| Rate for Payer: Wellmark IA PPO |
$1,451.30
|
|
|
EXCISE VAGINAL CYST OR TUMOR
|
Professional
|
$637.00
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
8069120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$171.23 |
| Max. Negotiated Rate |
$445.90 |
| Rate for Payer: Aetna of IA Medicare |
$171.23
|
| Rate for Payer: Amerigroup Medicaid |
$177.05
|
| Rate for Payer: Cash Price |
$509.60
|
| Rate for Payer: Cash Price |
$509.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$205.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$174.65
|
| Rate for Payer: Medical Associates Commercial |
$325.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$171.23
|
| Rate for Payer: Midlands Choice Commercial |
$445.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$256.84
|
| Rate for Payer: Wellmark IA HMO |
$361.00
|
| Rate for Payer: Wellmark IA PPO |
$423.00
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less
|
Facility
OP
|
$1,451.30
|
|
|
Service Code
|
CPT 11420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,319.36 |
| Max. Negotiated Rate |
$1,451.30 |
| Rate for Payer: Wellmark IA HMO |
$1,319.36
|
| Rate for Payer: Wellmark IA PPO |
$1,451.30
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm
|
Facility
OP
|
$1,451.30
|
|
|
Service Code
|
CPT 11422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,319.36 |
| Max. Negotiated Rate |
$1,451.30 |
| Rate for Payer: Wellmark IA HMO |
$1,319.36
|
| Rate for Payer: Wellmark IA PPO |
$1,451.30
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm
|
Facility
OP
|
$3,847.84
|
|
|
Service Code
|
CPT 11406
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,498.04 |
| Max. Negotiated Rate |
$3,847.84 |
| Rate for Payer: Wellmark IA HMO |
$3,498.04
|
| Rate for Payer: Wellmark IA PPO |
$3,847.84
|
|
|
Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); toe(s), each
|
Facility
OP
|
$4,658.74
|
|
|
Service Code
|
CPT 28092
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,235.22 |
| Max. Negotiated Rate |
$4,658.74 |
| Rate for Payer: Wellmark IA HMO |
$4,235.22
|
| Rate for Payer: Wellmark IA PPO |
$4,658.74
|
|
|
EXCISION OF NAIL FOLD TOE
|
Professional
|
$553.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
7982845
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$85.69 |
| Max. Negotiated Rate |
$387.10 |
| Rate for Payer: Aetna of IA Medicare |
$85.69
|
| Rate for Payer: Amerigroup Medicaid |
$88.60
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$102.83
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$87.40
|
| Rate for Payer: Medical Associates Commercial |
$162.81
|
| Rate for Payer: Medical Associates Managed Medicare |
$85.69
|
| Rate for Payer: Midlands Choice Commercial |
$387.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$128.54
|
| Rate for Payer: Wellmark IA HMO |
$175.00
|
| Rate for Payer: Wellmark IA PPO |
$205.00
|
|
|
EXCISION OF TONGUE LESION
|
Facility
OP
|
$1,663.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
7982949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$831.17 |
| Max. Negotiated Rate |
$3,851.25 |
| Rate for Payer: Aetna of IA Commercial |
$1,496.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,496.70
|
| Rate for Payer: Aetna of IA Medicare |
$947.91
|
| Rate for Payer: Amerigroup Medicaid |
$839.32
|
| Rate for Payer: Amerigroup Medicare |
$839.82
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,247.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$831.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$831.17
|
| Rate for Payer: Medical Associates Commercial |
$1,247.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$831.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,164.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$843.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,247.25
|
| Rate for Payer: United Healthcare Commercial |
$1,496.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$981.17
|
| Rate for Payer: Wellmark IA HMO |
$3,501.14
|
| Rate for Payer: Wellmark IA PPO |
$3,851.25
|
|
|
EXCISION OF TONGUE LESION
|
Facility
IP
|
$1,663.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
7982949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,164.10 |
| Max. Negotiated Rate |
$1,496.70 |
| Rate for Payer: Aetna of IA Commercial |
$1,496.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,496.70
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,247.25
|
| Rate for Payer: Medical Associates Commercial |
$1,247.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,164.10
|
| Rate for Payer: United Healthcare Commercial |
$1,496.70
|
|
|
Excision, tumor, soft tissue of leg or ankle area, subcutaneous; 3 cm or greater
|
Facility
OP
|
$6,163.92
|
|
|
Service Code
|
CPT 27632
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,603.56 |
| Max. Negotiated Rate |
$6,163.92 |
| Rate for Payer: Wellmark IA HMO |
$5,603.56
|
| Rate for Payer: Wellmark IA PPO |
$6,163.92
|
|
|
EXC LESION 2.1-3 ER CHARGE
|
Professional
|
$483.00
|
|
| Hospital Charge Code |
8069183
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$338.10 |
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$338.10
|
|
|
EXC LESION < 2 ER CHARGE
|
Professional
|
$483.00
|
|
| Hospital Charge Code |
8069031
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$338.10 |
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$338.10
|
|
|
EXC LESION > 3.1 ER CHARGE
|
Professional
|
$809.00
|
|
| Hospital Charge Code |
8069046
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$566.30 |
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$566.30
|
|
|
EXC MAL LESION TRUNK ARMS LEGS 3.1-4.0 CM
|
Professional
|
$1,529.00
|
|
|
Service Code
|
CPT 11604
|
| Hospital Charge Code |
8825542
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$192.60 |
| Max. Negotiated Rate |
$1,070.30 |
| Rate for Payer: Aetna of IA Medicare |
$192.60
|
| Rate for Payer: Amerigroup Medicaid |
$199.15
|
| Rate for Payer: Cash Price |
$1,223.20
|
| Rate for Payer: Cash Price |
$1,223.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$231.12
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$196.45
|
| Rate for Payer: Medical Associates Commercial |
$365.94
|
| Rate for Payer: Medical Associates Managed Medicare |
$192.60
|
| Rate for Payer: Midlands Choice Commercial |
$1,070.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$288.90
|
| Rate for Payer: Wellmark IA HMO |
$378.00
|
| Rate for Payer: Wellmark IA PPO |
$444.00
|
|
|
EXC TR-EXT B9+MARG 0.6-1 CM
|
Professional
|
$493.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
7982851
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$96.62 |
| Max. Negotiated Rate |
$345.10 |
| Rate for Payer: Aetna of IA Medicare |
$96.62
|
| Rate for Payer: Amerigroup Medicaid |
$99.91
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$115.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.55
|
| Rate for Payer: Medical Associates Commercial |
$183.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$96.62
|
| Rate for Payer: Midlands Choice Commercial |
$345.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$144.93
|
| Rate for Payer: Wellmark IA HMO |
$190.00
|
| Rate for Payer: Wellmark IA PPO |
$223.00
|
|
|
EXC TR-EXT B9+MARG 2.1-3CM/<
|
Facility
IP
|
$750.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
7982982
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna of IA Commercial |
$675.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$675.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$562.50
|
| Rate for Payer: Medical Associates Commercial |
$562.50
|
| Rate for Payer: Midlands Choice Commercial |
$525.00
|
| Rate for Payer: United Healthcare Commercial |
$675.00
|
|
|
EXC TR-EXT B9+MARG 2.1-3CM/<
|
Facility
OP
|
$750.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
7982982
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$374.85 |
| Max. Negotiated Rate |
$1,451.30 |
| Rate for Payer: Aetna of IA Commercial |
$675.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$675.00
|
| Rate for Payer: Aetna of IA Medicare |
$427.50
|
| Rate for Payer: Amerigroup Medicaid |
$378.52
|
| Rate for Payer: Amerigroup Medicare |
$378.75
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$562.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$375.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$374.85
|
| Rate for Payer: Medical Associates Commercial |
$562.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$375.00
|
| Rate for Payer: Midlands Choice Commercial |
$525.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$380.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$562.50
|
| Rate for Payer: United Healthcare Commercial |
$675.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$442.50
|
| Rate for Payer: Wellmark IA HMO |
$1,319.36
|
| Rate for Payer: Wellmark IA PPO |
$1,451.30
|
|
|
EXC TR-EXT MAL+MARG > 4 CM
|
Professional
|
$1,494.00
|
|
|
Service Code
|
CPT 11606
|
| Hospital Charge Code |
8069148
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$284.12 |
| Max. Negotiated Rate |
$1,045.80 |
| Rate for Payer: Aetna of IA Medicare |
$284.12
|
| Rate for Payer: Amerigroup Medicaid |
$293.78
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$340.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$289.80
|
| Rate for Payer: Medical Associates Commercial |
$539.83
|
| Rate for Payer: Medical Associates Managed Medicare |
$284.12
|
| Rate for Payer: Midlands Choice Commercial |
$1,045.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$426.18
|
| Rate for Payer: Wellmark IA HMO |
$562.00
|
| Rate for Payer: Wellmark IA PPO |
$659.00
|
|
|
exenatide 10 mcg/0.04 mL SC Sol
|
Facility
IP
|
$1,406.50
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43709990
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$984.55 |
| Max. Negotiated Rate |
$1,265.85 |
| Rate for Payer: Aetna of IA Commercial |
$1,265.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,265.85
|
| Rate for Payer: Cash Price |
$1,125.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,054.88
|
| Rate for Payer: Medical Associates Commercial |
$1,054.88
|
| Rate for Payer: Midlands Choice Commercial |
$984.55
|
| Rate for Payer: United Healthcare Commercial |
$1,265.85
|
|
|
exenatide 10 mcg/0.04 mL SC Sol
|
Facility
OP
|
$1,406.50
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43709990
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$702.97 |
| Max. Negotiated Rate |
$1,265.85 |
| Rate for Payer: Aetna of IA Commercial |
$1,265.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,265.85
|
| Rate for Payer: Aetna of IA Medicare |
$801.70
|
| Rate for Payer: Amerigroup Medicaid |
$709.86
|
| Rate for Payer: Amerigroup Medicare |
$710.28
|
| Rate for Payer: Cash Price |
$1,125.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,054.88
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$703.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$702.97
|
| Rate for Payer: Medical Associates Commercial |
$1,054.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$703.25
|
| Rate for Payer: Midlands Choice Commercial |
$984.55
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$713.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,054.88
|
| Rate for Payer: United Healthcare Commercial |
$1,265.85
|
| Rate for Payer: United Healthcare Managed Medicare |
$829.84
|
|
|
exenatide 5 mcg/0.02 mL SC Sol
|
Facility
OP
|
$1,774.62
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43709991
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$886.96 |
| Max. Negotiated Rate |
$1,597.16 |
| Rate for Payer: Aetna of IA Commercial |
$1,597.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,597.16
|
| Rate for Payer: Aetna of IA Medicare |
$1,011.53
|
| Rate for Payer: Amerigroup Medicaid |
$895.65
|
| Rate for Payer: Amerigroup Medicare |
$896.18
|
| Rate for Payer: Cash Price |
$1,419.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,330.96
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$887.31
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$886.96
|
| Rate for Payer: Medical Associates Commercial |
$1,330.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$887.31
|
| Rate for Payer: Midlands Choice Commercial |
$1,242.23
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$900.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,330.96
|
| Rate for Payer: United Healthcare Commercial |
$1,597.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,047.03
|
|
