|
INSERTION OF CHEST TUBE
|
Professional
|
$490.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
7982779
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$137.97 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Aetna of IA Medicare |
$137.97
|
| Rate for Payer: Amerigroup Medicaid |
$142.66
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$140.73
|
| Rate for Payer: Medical Associates Commercial |
$262.14
|
| Rate for Payer: Medical Associates Managed Medicare |
$137.97
|
| Rate for Payer: Midlands Choice Commercial |
$343.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$206.96
|
| Rate for Payer: Wellmark IA HMO |
$292.00
|
| Rate for Payer: Wellmark IA PPO |
$342.00
|
|
|
Insertion of PICC venous access device with subcutaneous port; over 5 yr old
|
Professional
|
$4,023.00
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
8069111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.40 |
| Max. Negotiated Rate |
$2,816.10 |
| Rate for Payer: Aetna of IA Medicare |
$276.40
|
| Rate for Payer: Amerigroup Medicaid |
$285.80
|
| Rate for Payer: Cash Price |
$3,218.40
|
| Rate for Payer: Cash Price |
$3,218.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$331.68
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$281.93
|
| Rate for Payer: Medical Associates Commercial |
$525.16
|
| Rate for Payer: Medical Associates Managed Medicare |
$276.40
|
| Rate for Payer: Midlands Choice Commercial |
$2,816.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$414.60
|
| Rate for Payer: Wellmark IA HMO |
$589.00
|
| Rate for Payer: Wellmark IA PPO |
$691.00
|
|
|
Insertion of PICC w/o port w/o imaging ages 5+
|
Professional
|
$828.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
8068991
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$84.49 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Aetna of IA Medicare |
$84.49
|
| Rate for Payer: Amerigroup Medicaid |
$87.36
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.39
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$86.18
|
| Rate for Payer: Medical Associates Commercial |
$160.53
|
| Rate for Payer: Medical Associates Managed Medicare |
$84.49
|
| Rate for Payer: Midlands Choice Commercial |
$579.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$126.74
|
| Rate for Payer: Wellmark IA HMO |
$175.00
|
| Rate for Payer: Wellmark IA PPO |
$206.00
|
|
|
Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older
|
Facility
OP
|
$4,784.23
|
|
|
Service Code
|
CPT 36561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,349.30 |
| Max. Negotiated Rate |
$4,784.23 |
| Rate for Payer: Wellmark IA HMO |
$4,349.30
|
| Rate for Payer: Wellmark IA PPO |
$4,784.23
|
|
|
INSERT LOCKING AXSOS 3.0MM
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of IA Commercial |
$51.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.30
|
| Rate for Payer: Aetna of IA Medicare |
$32.49
|
| Rate for Payer: Amerigroup Medicaid |
$28.77
|
| Rate for Payer: Amerigroup Medicare |
$28.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.49
|
| Rate for Payer: Medical Associates Commercial |
$42.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.50
|
| Rate for Payer: Midlands Choice Commercial |
$39.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.75
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.63
|
|
|
INSERT LOCKING AXSOS 3.0MM
|
Facility
IP
|
$57.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of IA Commercial |
$51.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.30
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.75
|
| Rate for Payer: Medical Associates Commercial |
$42.75
|
| Rate for Payer: Midlands Choice Commercial |
$39.90
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
|
|
INSERT LOCKING AXSOS 4.0MM
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of IA Commercial |
$51.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.30
|
| Rate for Payer: Aetna of IA Medicare |
$32.49
|
| Rate for Payer: Amerigroup Medicaid |
$28.77
|
| Rate for Payer: Amerigroup Medicare |
$28.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.49
|
| Rate for Payer: Medical Associates Commercial |
$42.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.50
|
| Rate for Payer: Midlands Choice Commercial |
$39.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.75
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.63
|
|
|
INSERT LOCKING AXSOS 4.0MM
|
Facility
IP
|
$57.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of IA Commercial |
$51.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.30
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.75
|
| Rate for Payer: Medical Associates Commercial |
$42.75
|
| Rate for Payer: Midlands Choice Commercial |
$39.90
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
|
|
INSERT TEMP BLADDER CATH
|
Facility
IP
|
$235.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
4863322
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna of IA Commercial |
$211.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$211.50
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$176.25
|
| Rate for Payer: Medical Associates Commercial |
$176.25
|
| Rate for Payer: Midlands Choice Commercial |
$164.50
|
| Rate for Payer: United Healthcare Commercial |
$211.50
|
|
|
INSERT TEMP BLADDER CATH
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
4863322
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$117.45 |
| Max. Negotiated Rate |
$403.74 |
| Rate for Payer: Aetna of IA Commercial |
$211.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$211.50
|
| Rate for Payer: Aetna of IA Medicare |
$133.95
|
| Rate for Payer: Amerigroup Medicaid |
$118.60
|
| Rate for Payer: Amerigroup Medicare |
$118.68
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$176.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$117.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$117.45
|
| Rate for Payer: Medical Associates Commercial |
$176.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$117.50
|
| Rate for Payer: Midlands Choice Commercial |
$164.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$119.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$176.25
|
| Rate for Payer: United Healthcare Commercial |
$211.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$138.65
|
| Rate for Payer: Wellmark IA HMO |
$367.04
|
| Rate for Payer: Wellmark IA PPO |
$403.74
|
|
|
insulin aspart-insulin aspart protamine 30 units-70 units/mL
|
Facility
OP
|
$117.81
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
43781331
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.88 |
| Max. Negotiated Rate |
$106.03 |
| Rate for Payer: Aetna of IA Commercial |
$106.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$106.03
|
| Rate for Payer: Aetna of IA Medicare |
$67.15
|
| Rate for Payer: Amerigroup Medicaid |
$59.46
|
| Rate for Payer: Amerigroup Medicare |
$59.49
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$88.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$58.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$58.88
|
| Rate for Payer: Medical Associates Commercial |
$88.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.90
|
| Rate for Payer: Midlands Choice Commercial |
$82.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$59.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$88.36
|
| Rate for Payer: United Healthcare Commercial |
$106.03
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.51
|
|
|
insulin aspart-insulin aspart protamine 30 units-70 units/mL
|
Facility
IP
|
$117.81
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
43781331
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.47 |
| Max. Negotiated Rate |
$106.03 |
| Rate for Payer: Aetna of IA Commercial |
$106.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$106.03
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$88.36
|
| Rate for Payer: Medical Associates Commercial |
$88.36
|
| Rate for Payer: Midlands Choice Commercial |
$82.47
|
| Rate for Payer: United Healthcare Commercial |
$106.03
|
|
|
insulin detemir 100 units/mL SC Sol
|
Facility
OP
|
$278.90
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
43718551
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$139.39 |
| Max. Negotiated Rate |
$251.01 |
| Rate for Payer: Aetna of IA Commercial |
$251.01
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$251.01
|
| Rate for Payer: Aetna of IA Medicare |
$158.97
|
| Rate for Payer: Amerigroup Medicaid |
$140.76
|
| Rate for Payer: Amerigroup Medicare |
$140.84
|
| Rate for Payer: Cash Price |
$223.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$209.18
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$139.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$139.39
|
| Rate for Payer: Medical Associates Commercial |
$209.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$139.45
|
| Rate for Payer: Midlands Choice Commercial |
$195.23
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$141.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$209.18
|
| Rate for Payer: United Healthcare Commercial |
$251.01
|
| Rate for Payer: United Healthcare Managed Medicare |
$164.55
|
|
|
insulin detemir 100 units/mL SC Sol
|
Facility
IP
|
$278.90
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
43718551
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.23 |
| Max. Negotiated Rate |
$251.01 |
| Rate for Payer: Aetna of IA Commercial |
$251.01
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$251.01
|
| Rate for Payer: Cash Price |
$223.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$209.18
|
| Rate for Payer: Medical Associates Commercial |
$209.18
|
| Rate for Payer: Midlands Choice Commercial |
$195.23
|
| Rate for Payer: United Healthcare Commercial |
$251.01
|
|
|
insulin glargine 100 units/mL 3ml SDS
|
Facility
IP
|
$82.70
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
43709978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.89 |
| Max. Negotiated Rate |
$74.43 |
| Rate for Payer: Aetna of IA Commercial |
$74.43
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$74.43
|
| Rate for Payer: Cash Price |
$66.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$62.02
|
| Rate for Payer: Medical Associates Commercial |
$62.02
|
| Rate for Payer: Midlands Choice Commercial |
$57.89
|
| Rate for Payer: United Healthcare Commercial |
$74.43
|
|
|
insulin glargine 100 units/mL 3ml SDS
|
Facility
OP
|
$82.70
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
43709978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.33 |
| Max. Negotiated Rate |
$74.43 |
| Rate for Payer: Aetna of IA Commercial |
$74.43
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$74.43
|
| Rate for Payer: Aetna of IA Medicare |
$47.14
|
| Rate for Payer: Amerigroup Medicaid |
$41.74
|
| Rate for Payer: Amerigroup Medicare |
$41.76
|
| Rate for Payer: Cash Price |
$66.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$62.02
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$41.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.33
|
| Rate for Payer: Medical Associates Commercial |
$62.02
|
| Rate for Payer: Medical Associates Managed Medicare |
$41.35
|
| Rate for Payer: Midlands Choice Commercial |
$57.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$62.02
|
| Rate for Payer: United Healthcare Commercial |
$74.43
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.79
|
|
|
insulin isophane (NPH) human recombinant 100 units/mL SubQ Inj
|
Facility
IP
|
$64.24
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
43706015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.97 |
| Max. Negotiated Rate |
$57.82 |
| Rate for Payer: Aetna of IA Commercial |
$57.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.82
|
| Rate for Payer: Cash Price |
$51.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.18
|
| Rate for Payer: Medical Associates Commercial |
$48.18
|
| Rate for Payer: Midlands Choice Commercial |
$44.97
|
| Rate for Payer: United Healthcare Commercial |
$57.82
|
|
|
insulin isophane (NPH) human recombinant 100 units/mL SubQ Inj
|
Facility
OP
|
$64.24
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
43706015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.11 |
| Max. Negotiated Rate |
$57.82 |
| Rate for Payer: Aetna of IA Commercial |
$57.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.82
|
| Rate for Payer: Aetna of IA Medicare |
$36.62
|
| Rate for Payer: Amerigroup Medicaid |
$32.42
|
| Rate for Payer: Amerigroup Medicare |
$32.44
|
| Rate for Payer: Cash Price |
$51.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.18
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.12
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.11
|
| Rate for Payer: Medical Associates Commercial |
$48.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.12
|
| Rate for Payer: Midlands Choice Commercial |
$44.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.18
|
| Rate for Payer: United Healthcare Commercial |
$57.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.90
|
|
|
insulin isophane (NPH)-insulin regular human recombinant 70 units-30 units/mL
|
Facility
OP
|
$68.53
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
43706011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.25 |
| Max. Negotiated Rate |
$61.68 |
| Rate for Payer: Aetna of IA Commercial |
$61.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$61.68
|
| Rate for Payer: Aetna of IA Medicare |
$39.06
|
| Rate for Payer: Amerigroup Medicaid |
$34.59
|
| Rate for Payer: Amerigroup Medicare |
$34.61
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.40
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.26
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.25
|
| Rate for Payer: Medical Associates Commercial |
$51.40
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.26
|
| Rate for Payer: Midlands Choice Commercial |
$47.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.40
|
| Rate for Payer: United Healthcare Commercial |
$61.68
|
| Rate for Payer: United Healthcare Managed Medicare |
$40.43
|
|
|
insulin isophane (NPH)-insulin regular human recombinant 70 units-30 units/mL
|
Facility
IP
|
$68.53
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
43706011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.97 |
| Max. Negotiated Rate |
$61.68 |
| Rate for Payer: Aetna of IA Commercial |
$61.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$61.68
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.40
|
| Rate for Payer: Medical Associates Commercial |
$51.40
|
| Rate for Payer: Midlands Choice Commercial |
$47.97
|
| Rate for Payer: United Healthcare Commercial |
$61.68
|
|
|
Insulin Level DMCL
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
8037720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of IA Commercial |
$98.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$98.10
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.75
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
|
|
Insulin Level DMCL
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
8037720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of IA Commercial |
$98.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$98.10
|
| Rate for Payer: Aetna of IA Medicare |
$62.13
|
| Rate for Payer: Amerigroup Medicaid |
$55.01
|
| Rate for Payer: Amerigroup Medicare |
$55.04
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$54.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.48
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$54.50
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.75
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.31
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
insulin lispro 100 units/mL SubQ Inj 3 ml
|
Facility
OP
|
$86.65
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
43706010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.31 |
| Max. Negotiated Rate |
$77.98 |
| Rate for Payer: Aetna of IA Commercial |
$77.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.98
|
| Rate for Payer: Aetna of IA Medicare |
$49.39
|
| Rate for Payer: Amerigroup Medicaid |
$43.73
|
| Rate for Payer: Amerigroup Medicare |
$43.76
|
| Rate for Payer: Cash Price |
$69.32
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.99
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$43.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.31
|
| Rate for Payer: Medical Associates Commercial |
$64.99
|
| Rate for Payer: Medical Associates Managed Medicare |
$43.32
|
| Rate for Payer: Midlands Choice Commercial |
$60.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.99
|
| Rate for Payer: United Healthcare Commercial |
$77.98
|
| Rate for Payer: United Healthcare Managed Medicare |
$51.12
|
|
|
insulin lispro 100 units/mL SubQ Inj 3 ml
|
Facility
IP
|
$86.65
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
43706010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.66 |
| Max. Negotiated Rate |
$77.98 |
| Rate for Payer: Aetna of IA Commercial |
$77.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.98
|
| Rate for Payer: Cash Price |
$69.32
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.99
|
| Rate for Payer: Medical Associates Commercial |
$64.99
|
| Rate for Payer: Midlands Choice Commercial |
$60.66
|
| Rate for Payer: United Healthcare Commercial |
$77.98
|
|
|
insulin lispro-insulin lispro protamine 25 units-75 units/mL
|
Facility
IP
|
$92.93
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
43700083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$83.64 |
| Rate for Payer: Aetna of IA Commercial |
$83.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$83.64
|
| Rate for Payer: Cash Price |
$74.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$69.70
|
| Rate for Payer: Medical Associates Commercial |
$69.70
|
| Rate for Payer: Midlands Choice Commercial |
$65.05
|
| Rate for Payer: United Healthcare Commercial |
$83.64
|
|
