|
exenatide 5 mcg/0.02 mL SC Sol
|
Facility
IP
|
$1,774.62
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43709991
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,242.23 |
| 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: Cash Price |
$1,419.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,330.96
|
| Rate for Payer: Medical Associates Commercial |
$1,330.96
|
| Rate for Payer: Midlands Choice Commercial |
$1,242.23
|
| Rate for Payer: United Healthcare Commercial |
$1,597.16
|
|
|
Extensive Burns or Full Thickness Burns With MV >96 Hours Without Skin Graft
|
Facility
IP
|
$22,226.14
|
|
|
Service Code
|
MS-DRG 933
|
| Hospital Charge Code |
645
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$22,226.14 |
| Rate for Payer: Amerigroup Medicaid |
$22,118.77
|
| 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 |
$21,904.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22,226.14
|
|
|
Extensive Burns or Full Thickness Burns With MV >96 Hours With Skin Graft
|
Facility
IP
|
$207,048.00
|
|
|
Service Code
|
MS-DRG 927
|
| Hospital Charge Code |
642
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$207,048.00 |
| Rate for Payer: Amerigroup Medicaid |
$206,047.77
|
| 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 |
$204,047.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$207,048.00
|
|
|
Extensive O.R. Procedures Unrelated to Principal Diagnosis With CC
|
Facility
IP
|
$15,682.90
|
|
|
Service Code
|
MS-DRG 982
|
| Hospital Charge Code |
673
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$15,682.90 |
| Rate for Payer: Amerigroup Medicaid |
$15,607.14
|
| 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 |
$15,455.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15,682.90
|
|
|
Extensive O.R. Procedures Unrelated to Principal Diagnosis With MCC
|
Facility
IP
|
$40,819.45
|
|
|
Service Code
|
MS-DRG 981
|
| Hospital Charge Code |
672
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$40,819.45 |
| Rate for Payer: Amerigroup Medicaid |
$40,622.25
|
| 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 |
$40,227.86
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$40,819.45
|
|
|
Extensive O.R. Procedures Unrelated to Principal Diagnosis Without CC/MCC
|
Facility
IP
|
$11,898.49
|
|
|
Service Code
|
MS-DRG 983
|
| Hospital Charge Code |
674
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$11,898.49 |
| Rate for Payer: Amerigroup Medicaid |
$11,841.01
|
| 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 |
$11,726.05
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11,898.49
|
|
|
EXTERNAL CEPHALIC VERSION
|
Facility
IP
|
$3,594.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
7984752
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$2,515.80 |
| Max. Negotiated Rate |
$3,234.60 |
| Rate for Payer: Aetna of IA Commercial |
$3,234.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,234.60
|
| Rate for Payer: Cash Price |
$2,875.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,695.50
|
| Rate for Payer: Medical Associates Commercial |
$2,695.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,515.80
|
| Rate for Payer: United Healthcare Commercial |
$3,234.60
|
|
|
EXTERNAL CEPHALIC VERSION
|
Facility
OP
|
$3,594.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
7984752
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$1,796.28 |
| Max. Negotiated Rate |
$3,234.60 |
| Rate for Payer: Aetna of IA Commercial |
$3,234.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,234.60
|
| Rate for Payer: Aetna of IA Medicare |
$2,048.58
|
| Rate for Payer: Amerigroup Medicaid |
$1,813.89
|
| Rate for Payer: Amerigroup Medicare |
$1,814.97
|
| Rate for Payer: Cash Price |
$2,875.20
|
| Rate for Payer: Cash Price |
$2,875.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,695.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,797.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,796.28
|
| Rate for Payer: Medical Associates Commercial |
$2,695.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,797.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,515.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,823.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,695.50
|
| Rate for Payer: United Healthcare Commercial |
$3,234.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,120.46
|
| Rate for Payer: Wellmark IA HMO |
$2,127.22
|
| Rate for Payer: Wellmark IA PPO |
$2,339.94
|
|
|
EXTRA ATTENDANT- SAFETY REASONS
|
Facility
OP
|
$84.00
|
|
|
Service Code
|
CPT A0424 QN
|
| Hospital Charge Code |
7932764
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of IA Commercial |
$75.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$75.60
|
| Rate for Payer: Aetna of IA Medicare |
$47.88
|
| Rate for Payer: Amerigroup Medicaid |
$42.39
|
| Rate for Payer: Amerigroup Medicare |
$42.42
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.98
|
| Rate for Payer: Medical Associates Commercial |
$63.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.00
|
| Rate for Payer: Midlands Choice Commercial |
$58.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$63.00
|
| Rate for Payer: United Healthcare Commercial |
$75.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$71.40
|
|
|
EXTRA ATTENDANT- SAFETY REASONS
|
Facility
IP
|
$84.00
|
|
|
Service Code
|
CPT A0424 QN
|
| Hospital Charge Code |
7932764
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of IA Commercial |
$75.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$75.60
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.00
|
| Rate for Payer: Medical Associates Commercial |
$63.00
|
| Rate for Payer: Midlands Choice Commercial |
$58.80
|
| Rate for Payer: United Healthcare Commercial |
$75.60
|
|
|
Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation
|
Facility
OP
|
$4,535.30
|
|
|
Service Code
|
CPT 66982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,123.00 |
| Max. Negotiated Rate |
$4,535.30 |
| Rate for Payer: Wellmark IA HMO |
$4,123.00
|
| Rate for Payer: Wellmark IA PPO |
$4,535.30
|
|
|
Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation
|
Facility
OP
|
$4,535.30
|
|
|
Service Code
|
CPT 66984
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,123.00 |
| Max. Negotiated Rate |
$4,535.30 |
| Rate for Payer: Wellmark IA HMO |
$4,123.00
|
| Rate for Payer: Wellmark IA PPO |
$4,535.30
|
|
|
Extracranial Procedures With CC
|
Facility
IP
|
$12,042.19
|
|
|
Service Code
|
MS-DRG 038
|
| Hospital Charge Code |
727
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$12,042.19 |
| Rate for Payer: Amerigroup Medicaid |
$11,984.02
|
| 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 |
$11,867.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,042.19
|
|
|
Extracranial Procedures With MCC
|
Facility
IP
|
$20,499.78
|
|
|
Service Code
|
MS-DRG 037
|
| Hospital Charge Code |
726
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$20,499.78 |
| Rate for Payer: Amerigroup Medicaid |
$20,400.75
|
| 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 |
$20,202.68
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20,499.78
|
|
|
Extracranial Procedures Without CC/MCC
|
Facility
IP
|
$8,014.68
|
|
|
Service Code
|
MS-DRG 039
|
| Hospital Charge Code |
728
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,014.68 |
| Rate for Payer: Amerigroup Medicaid |
$7,975.96
|
| 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 |
$7,898.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,014.68
|
|
|
Extractable Nuclear Antigen Ab DMCL
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
8037843
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| 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 |
$57.54
|
| Rate for Payer: Amerigroup Medicare |
$57.57
|
| 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 |
$57.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.98
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Extractable Nuclear Antigen Ab DMCL
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
8037843
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
EXTRACTABLE NUCLEAR ANTIGEN OR ANTIBODY
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
8093932
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
EXTRACTABLE NUCLEAR ANTIGEN OR ANTIBODY
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
8093932
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| 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 |
$57.54
|
| Rate for Payer: Amerigroup Medicare |
$57.57
|
| 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 |
$57.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.98
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Extraocular Procedures Except Orbit
|
Facility
IP
|
$11,599.29
|
|
|
Service Code
|
MS-DRG 115
|
| Hospital Charge Code |
7
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$11,599.29 |
| Rate for Payer: Amerigroup Medicaid |
$11,543.25
|
| 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 |
$11,431.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11,599.29
|
|
|
Extreme Immaturity or Respiratory Distress Syndrome, Neonate
|
Facility
IP
|
$37,846.06
|
|
|
Service Code
|
MS-DRG 790
|
| Hospital Charge Code |
532
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$37,846.06 |
| Rate for Payer: Amerigroup Medicaid |
$37,663.23
|
| 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 |
$37,297.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37,846.06
|
|
|
ezetimibe 10 mg Tab
|
Facility
OP
|
$1.49
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna of IA Commercial |
$1.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.34
|
| Rate for Payer: Aetna of IA Medicare |
$0.85
|
| Rate for Payer: Amerigroup Medicaid |
$0.75
|
| Rate for Payer: Amerigroup Medicare |
$0.75
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.74
|
| Rate for Payer: Medical Associates Commercial |
$1.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.75
|
| Rate for Payer: Midlands Choice Commercial |
$1.04
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.12
|
| Rate for Payer: United Healthcare Commercial |
$1.34
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.88
|
|
|
ezetimibe 10 mg Tab
|
Facility
IP
|
$1.49
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna of IA Commercial |
$1.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.34
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.12
|
| Rate for Payer: Medical Associates Commercial |
$1.12
|
| Rate for Payer: Midlands Choice Commercial |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.34
|
|
|
Factor V Leiden DMCL
|
Facility
IP
|
$220.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
8037844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
|
|
Factor V Leiden DMCL
|
Facility
OP
|
$220.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
8037844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.96 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$111.03
|
| Rate for Payer: Amerigroup Medicare |
$111.10
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$110.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$109.96
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$110.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$111.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
| Rate for Payer: Wellmark IA HMO |
$143.22
|
| Rate for Payer: Wellmark IA PPO |
$157.54
|
|
