|
Gastrointestinal Panel by PCR DMCL
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
8505666
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
Gastrointestinal Parasite Panel by PCR DMCL
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 87505
|
| Hospital Charge Code |
8984515
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna of IA Commercial |
$304.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$304.20
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$253.50
|
| Rate for Payer: Medical Associates Commercial |
$253.50
|
| Rate for Payer: Midlands Choice Commercial |
$236.60
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
|
|
Gastrointestinal Parasite Panel by PCR DMCL
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 87505
|
| Hospital Charge Code |
8984515
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$152.10 |
| Max. Negotiated Rate |
$317.09 |
| Rate for Payer: Aetna of IA Commercial |
$304.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$304.20
|
| Rate for Payer: Aetna of IA Medicare |
$192.66
|
| Rate for Payer: Amerigroup Medicaid |
$194.96
|
| Rate for Payer: Amerigroup Medicare |
$153.62
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$253.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$152.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$193.07
|
| Rate for Payer: Medical Associates Commercial |
$253.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$152.10
|
| Rate for Payer: Midlands Choice Commercial |
$236.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$195.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$174.92
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$199.42
|
| Rate for Payer: Wellmark IA HMO WHPI |
$287.85
|
| Rate for Payer: Wellmark IA PPO |
$317.09
|
|
|
Gastrointestinal Virus Panel by PCR DMCL
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 87505
|
| Hospital Charge Code |
8984518
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna of IA Commercial |
$304.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$304.20
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$253.50
|
| Rate for Payer: Medical Associates Commercial |
$253.50
|
| Rate for Payer: Midlands Choice Commercial |
$236.60
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
|
|
Gastrointestinal Virus Panel by PCR DMCL
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 87505
|
| Hospital Charge Code |
8984518
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$152.10 |
| Max. Negotiated Rate |
$317.09 |
| Rate for Payer: Aetna of IA Commercial |
$304.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$304.20
|
| Rate for Payer: Aetna of IA Medicare |
$192.66
|
| Rate for Payer: Amerigroup Medicaid |
$194.96
|
| Rate for Payer: Amerigroup Medicare |
$153.62
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$253.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$152.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$193.07
|
| Rate for Payer: Medical Associates Commercial |
$253.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$152.10
|
| Rate for Payer: Midlands Choice Commercial |
$236.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$195.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$174.92
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$199.42
|
| Rate for Payer: Wellmark IA HMO WHPI |
$287.85
|
| Rate for Payer: Wellmark IA PPO |
$317.09
|
|
|
Gastroscope Biopsy Charge
|
Facility
|
IP
|
$95.00
|
|
| Hospital Charge Code |
8051947
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
|
|
Gastroscope Biopsy Charge
|
Facility
|
OP
|
$95.00
|
|
| Hospital Charge Code |
8051947
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Aetna of IA Medicare |
$54.15
|
| Rate for Payer: Amerigroup Medicaid |
$54.80
|
| Rate for Payer: Amerigroup Medicare |
$43.18
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.26
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.75
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.16
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.05
|
|
|
Gastroscopy
|
Facility
|
OP
|
$2,615.00
|
|
| Hospital Charge Code |
7745193
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,176.75 |
| Max. Negotiated Rate |
$2,353.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,353.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,353.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,490.55
|
| Rate for Payer: Amerigroup Medicaid |
$1,508.33
|
| Rate for Payer: Amerigroup Medicare |
$1,188.52
|
| Rate for Payer: Cash Price |
$2,092.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,961.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,176.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,493.69
|
| Rate for Payer: Medical Associates Commercial |
$1,961.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,176.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,830.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,515.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,353.26
|
| Rate for Payer: United Healthcare Commercial |
$2,353.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,542.85
|
|
|
Gastroscopy
|
Facility
|
IP
|
$2,615.00
|
|
| Hospital Charge Code |
7745193
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,830.50 |
| Max. Negotiated Rate |
$2,353.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,353.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,353.50
|
| Rate for Payer: Cash Price |
$2,092.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,961.25
|
| Rate for Payer: Medical Associates Commercial |
$1,961.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,830.50
|
| Rate for Payer: United Healthcare Commercial |
$2,353.50
|
|
|
Gastroscopy Dilat Esophag Dial
|
Facility
|
OP
|
$2,615.00
|
|
| Hospital Charge Code |
7745192
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,176.75 |
| Max. Negotiated Rate |
$2,353.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,353.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,353.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,490.55
|
| Rate for Payer: Amerigroup Medicaid |
$1,508.33
|
| Rate for Payer: Amerigroup Medicare |
$1,188.52
|
| Rate for Payer: Cash Price |
$2,092.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,961.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,176.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,493.69
|
| Rate for Payer: Medical Associates Commercial |
$1,961.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,176.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,830.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,515.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,353.26
|
| Rate for Payer: United Healthcare Commercial |
$2,353.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,542.85
|
|
|
Gastroscopy Dilat Esophag Dial
|
Facility
|
IP
|
$2,615.00
|
|
| Hospital Charge Code |
7745192
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,830.50 |
| Max. Negotiated Rate |
$2,353.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,353.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,353.50
|
| Rate for Payer: Cash Price |
$2,092.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,961.25
|
| Rate for Payer: Medical Associates Commercial |
$1,961.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,830.50
|
| Rate for Payer: United Healthcare Commercial |
$2,353.50
|
|
|
Gastroscopy with Biopsy
|
Facility
|
OP
|
$2,615.00
|
|
| Hospital Charge Code |
8055105
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,176.75 |
| Max. Negotiated Rate |
$2,353.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,353.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,353.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,490.55
|
| Rate for Payer: Amerigroup Medicaid |
$1,508.33
|
| Rate for Payer: Amerigroup Medicare |
$1,188.52
|
| Rate for Payer: Cash Price |
$2,092.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,961.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,176.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,493.69
|
| Rate for Payer: Medical Associates Commercial |
$1,961.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,176.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,830.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,515.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,353.26
|
| Rate for Payer: United Healthcare Commercial |
$2,353.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,542.85
|
|
|
Gastroscopy with Biopsy
|
Facility
|
IP
|
$2,615.00
|
|
| Hospital Charge Code |
8055105
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,830.50 |
| Max. Negotiated Rate |
$2,353.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,353.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,353.50
|
| Rate for Payer: Cash Price |
$2,092.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,961.25
|
| Rate for Payer: Medical Associates Commercial |
$1,961.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,830.50
|
| Rate for Payer: United Healthcare Commercial |
$2,353.50
|
|
|
GC PROBE
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
8093934
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna of IA Commercial |
$115.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$115.20
|
| Rate for Payer: Aetna of IA Medicare |
$72.96
|
| Rate for Payer: Amerigroup Medicaid |
$73.83
|
| Rate for Payer: Amerigroup Medicare |
$58.18
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.11
|
| Rate for Payer: Medical Associates Commercial |
$96.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.60
|
| Rate for Payer: Midlands Choice Commercial |
$89.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$66.24
|
| Rate for Payer: United Healthcare Commercial |
$115.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$75.52
|
| Rate for Payer: Wellmark IA HMO WHPI |
$86.50
|
| Rate for Payer: Wellmark IA PPO |
$95.28
|
|
|
GC PROBE
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
8093934
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna of IA Commercial |
$115.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$115.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.00
|
| Rate for Payer: Medical Associates Commercial |
$96.00
|
| Rate for Payer: Midlands Choice Commercial |
$89.60
|
| Rate for Payer: United Healthcare Commercial |
$115.20
|
|
|
gemfibrozil 600 mg Tab [VDMC]
|
Facility
|
OP
|
$1.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10391618
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Aetna of IA Commercial |
$1.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.69
|
| Rate for Payer: Aetna of IA Medicare |
$1.07
|
| Rate for Payer: Amerigroup Medicaid |
$1.08
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.07
|
| Rate for Payer: Medical Associates Commercial |
$1.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.85
|
| Rate for Payer: Midlands Choice Commercial |
$1.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.97
|
| Rate for Payer: United Healthcare Commercial |
$1.69
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.11
|
|
|
gemfibrozil 600 mg Tab [VDMC]
|
Facility
|
IP
|
$1.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10391618
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Aetna of IA Commercial |
$1.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.69
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.41
|
| Rate for Payer: Medical Associates Commercial |
$1.41
|
| Rate for Payer: Midlands Choice Commercial |
$1.32
|
| Rate for Payer: United Healthcare Commercial |
$1.69
|
|
|
GENERAL ANESTHESIA I
|
Facility
|
OP
|
$926.00
|
|
| Hospital Charge Code |
8059074
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$416.70 |
| Max. Negotiated Rate |
$833.40 |
| Rate for Payer: Aetna of IA Commercial |
$833.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$833.40
|
| Rate for Payer: Aetna of IA Medicare |
$527.82
|
| Rate for Payer: Amerigroup Medicaid |
$534.12
|
| Rate for Payer: Amerigroup Medicare |
$420.87
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$694.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$416.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$528.93
|
| Rate for Payer: Medical Associates Commercial |
$694.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$416.70
|
| Rate for Payer: Midlands Choice Commercial |
$648.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$536.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$479.20
|
| Rate for Payer: United Healthcare Commercial |
$833.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$546.34
|
|
|
GENERAL ANESTHESIA I
|
Facility
|
IP
|
$926.00
|
|
| Hospital Charge Code |
8059074
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$648.20 |
| Max. Negotiated Rate |
$833.40 |
| Rate for Payer: Aetna of IA Commercial |
$833.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$833.40
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$694.50
|
| Rate for Payer: Medical Associates Commercial |
$694.50
|
| Rate for Payer: Midlands Choice Commercial |
$648.20
|
| Rate for Payer: United Healthcare Commercial |
$833.40
|
|
|
GENERAL ANESTHESIA II
|
Facility
|
OP
|
$795.00
|
|
| Hospital Charge Code |
8059075
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$357.75 |
| Max. Negotiated Rate |
$715.50 |
| Rate for Payer: Aetna of IA Commercial |
$715.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$715.50
|
| Rate for Payer: Aetna of IA Medicare |
$453.15
|
| Rate for Payer: Amerigroup Medicaid |
$458.56
|
| Rate for Payer: Amerigroup Medicare |
$361.33
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$596.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$357.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$454.10
|
| Rate for Payer: Medical Associates Commercial |
$596.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$357.75
|
| Rate for Payer: Midlands Choice Commercial |
$556.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$460.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$411.41
|
| Rate for Payer: United Healthcare Commercial |
$715.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$469.05
|
|
|
GENERAL ANESTHESIA II
|
Facility
|
IP
|
$795.00
|
|
| Hospital Charge Code |
8059075
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$715.50 |
| Rate for Payer: Aetna of IA Commercial |
$715.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$715.50
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$596.25
|
| Rate for Payer: Medical Associates Commercial |
$596.25
|
| Rate for Payer: Midlands Choice Commercial |
$556.50
|
| Rate for Payer: United Healthcare Commercial |
$715.50
|
|
|
GENERAL ANESTHESIA III
|
Facility
|
OP
|
$888.00
|
|
| Hospital Charge Code |
8059591
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$399.60 |
| Max. Negotiated Rate |
$799.20 |
| Rate for Payer: Aetna of IA Commercial |
$799.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$799.20
|
| Rate for Payer: Aetna of IA Medicare |
$506.16
|
| Rate for Payer: Amerigroup Medicaid |
$512.20
|
| Rate for Payer: Amerigroup Medicare |
$403.60
|
| Rate for Payer: Cash Price |
$710.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$666.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$399.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$507.23
|
| Rate for Payer: Medical Associates Commercial |
$666.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$399.60
|
| Rate for Payer: Midlands Choice Commercial |
$621.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$514.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$459.54
|
| Rate for Payer: United Healthcare Commercial |
$799.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$523.92
|
|
|
GENERAL ANESTHESIA III
|
Facility
|
IP
|
$888.00
|
|
| Hospital Charge Code |
8059591
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$621.60 |
| Max. Negotiated Rate |
$799.20 |
| Rate for Payer: Aetna of IA Commercial |
$799.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$799.20
|
| Rate for Payer: Cash Price |
$710.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$666.00
|
| Rate for Payer: Medical Associates Commercial |
$666.00
|
| Rate for Payer: Midlands Choice Commercial |
$621.60
|
| Rate for Payer: United Healthcare Commercial |
$799.20
|
|
|
GENERAL ANESTHESIA IV
|
Facility
|
OP
|
$712.00
|
|
| Hospital Charge Code |
8059076
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$320.40 |
| Max. Negotiated Rate |
$640.80 |
| Rate for Payer: Aetna of IA Commercial |
$640.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$640.80
|
| Rate for Payer: Aetna of IA Medicare |
$405.84
|
| Rate for Payer: Amerigroup Medicaid |
$410.68
|
| Rate for Payer: Amerigroup Medicare |
$323.60
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$534.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$320.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$406.69
|
| Rate for Payer: Medical Associates Commercial |
$534.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$320.40
|
| Rate for Payer: Midlands Choice Commercial |
$498.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$412.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$368.46
|
| Rate for Payer: United Healthcare Commercial |
$640.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$420.08
|
|
|
GENERAL ANESTHESIA IV
|
Facility
|
IP
|
$712.00
|
|
| Hospital Charge Code |
8059076
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$498.40 |
| Max. Negotiated Rate |
$640.80 |
| Rate for Payer: Aetna of IA Commercial |
$640.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$640.80
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$534.00
|
| Rate for Payer: Medical Associates Commercial |
$534.00
|
| Rate for Payer: Midlands Choice Commercial |
$498.40
|
| Rate for Payer: United Healthcare Commercial |
$640.80
|
|
