|
INTMD RPR S/A/T/EXT 2.5 CM/<
|
Professional
|
$530.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
7982834
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$137.69 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: Aetna of IA Medicare |
$137.69
|
| Rate for Payer: Amerigroup Medicaid |
$142.37
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.23
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$140.44
|
| Rate for Payer: Medical Associates Commercial |
$261.61
|
| Rate for Payer: Medical Associates Managed Medicare |
$137.69
|
| Rate for Payer: Midlands Choice Commercial |
$371.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$206.54
|
| Rate for Payer: Wellmark IA HMO |
$287.00
|
| Rate for Payer: Wellmark IA PPO |
$337.00
|
|
|
INTMD RPR S/A/T/EXT 2.6-7.5
|
Professional
|
$800.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
7982833
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$173.25 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of IA Medicare |
$173.25
|
| Rate for Payer: Amerigroup Medicaid |
$179.14
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$207.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$176.72
|
| Rate for Payer: Medical Associates Commercial |
$329.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$173.25
|
| Rate for Payer: Midlands Choice Commercial |
$560.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$259.88
|
| Rate for Payer: Wellmark IA HMO |
$359.00
|
| Rate for Payer: Wellmark IA PPO |
$422.00
|
|
|
INTMD RPR S/TR/EXT 7.6-12.5
|
Professional
|
$1,033.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
7982832
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$186.35 |
| Max. Negotiated Rate |
$723.10 |
| Rate for Payer: Aetna of IA Medicare |
$186.35
|
| Rate for Payer: Amerigroup Medicaid |
$192.69
|
| Rate for Payer: Cash Price |
$826.40
|
| Rate for Payer: Cash Price |
$826.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$223.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$190.08
|
| Rate for Payer: Medical Associates Commercial |
$354.06
|
| Rate for Payer: Medical Associates Managed Medicare |
$186.35
|
| Rate for Payer: Midlands Choice Commercial |
$723.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$279.52
|
| Rate for Payer: Wellmark IA HMO |
$389.00
|
| Rate for Payer: Wellmark IA PPO |
$456.00
|
|
|
Intracranial Hemorrhage or Cerebral Infarction With CC or TPA in 24 Hours
|
Facility
IP
|
$10,056.00
|
|
|
Service Code
|
MS-DRG 065
|
| Hospital Charge Code |
745
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$10,056.00 |
| Rate for Payer: Amerigroup Medicaid |
$10,007.42
|
| 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 |
$9,910.26
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,056.00
|
|
|
Intracranial Hemorrhage or Cerebral Infarction With MCC
|
Facility
IP
|
$16,964.38
|
|
|
Service Code
|
MS-DRG 064
|
| Hospital Charge Code |
744
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$16,964.38 |
| Rate for Payer: Amerigroup Medicaid |
$16,882.43
|
| 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 |
$16,718.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16,964.38
|
|
|
Intracranial Hemorrhage or Cerebral Infarction Without CC/MCC
|
Facility
IP
|
$6,471.39
|
|
|
Service Code
|
MS-DRG 066
|
| Hospital Charge Code |
746
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,471.39 |
| Rate for Payer: Amerigroup Medicaid |
$6,440.13
|
| 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 |
$6,377.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,471.39
|
|
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With CC
|
Facility
IP
|
$66,120.36
|
|
|
Service Code
|
MS-DRG 021
|
| Hospital Charge Code |
710
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$66,120.36 |
| Rate for Payer: Amerigroup Medicaid |
$65,800.94
|
| 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 |
$65,162.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66,120.36
|
|
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With MCC
|
Facility
IP
|
$83,960.72
|
|
|
Service Code
|
MS-DRG 020
|
| Hospital Charge Code |
709
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$83,960.72 |
| Rate for Payer: Amerigroup Medicaid |
$83,555.11
|
| 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 |
$82,743.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$83,960.72
|
|
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without CC/MCC
|
Facility
IP
|
$47,843.00
|
|
|
Service Code
|
MS-DRG 022
|
| Hospital Charge Code |
711
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$47,843.00 |
| Rate for Payer: Amerigroup Medicaid |
$47,611.87
|
| 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 |
$47,149.62
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$47,843.00
|
|
|
Intraocular Procedures With CC/MCC
|
Facility
IP
|
$12,674.08
|
|
|
Service Code
|
MS-DRG 116
|
| Hospital Charge Code |
8
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$12,674.08 |
| Rate for Payer: Amerigroup Medicaid |
$12,612.85
|
| 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 |
$12,490.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,674.08
|
|
|
Intraocular Procedures Without CC/MCC
|
Facility
IP
|
$12,674.08
|
|
|
Service Code
|
MS-DRG 117
|
| Hospital Charge Code |
9
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$12,674.08 |
| Rate for Payer: Amerigroup Medicaid |
$12,612.85
|
| 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 |
$12,490.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,674.08
|
|
|
INTRAPLEURAL INSERTION CHARGE
|
Facility
OP
|
$213.00
|
|
| Hospital Charge Code |
8059077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$106.46 |
| Max. Negotiated Rate |
$191.70 |
| Rate for Payer: Aetna of IA Commercial |
$191.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$191.70
|
| Rate for Payer: Aetna of IA Medicare |
$121.41
|
| Rate for Payer: Amerigroup Medicaid |
$107.50
|
| Rate for Payer: Amerigroup Medicare |
$107.56
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$159.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$106.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$106.46
|
| Rate for Payer: Medical Associates Commercial |
$159.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$106.50
|
| Rate for Payer: Midlands Choice Commercial |
$149.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$108.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$159.75
|
| Rate for Payer: United Healthcare Commercial |
$191.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$125.67
|
|
|
INTRAPLEURAL INSERTION CHARGE
|
Facility
IP
|
$213.00
|
|
| Hospital Charge Code |
8059077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$191.70 |
| Rate for Payer: Aetna of IA Commercial |
$191.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$191.70
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$159.75
|
| Rate for Payer: Medical Associates Commercial |
$159.75
|
| Rate for Payer: Midlands Choice Commercial |
$149.10
|
| Rate for Payer: United Healthcare Commercial |
$191.70
|
|
|
Intubation, endotracheal, emergency procedure
|
Facility
OP
|
$1,815.48
|
|
|
Service Code
|
CPT 31500
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,650.44 |
| Max. Negotiated Rate |
$1,815.48 |
| Rate for Payer: Wellmark IA HMO |
$1,650.44
|
| Rate for Payer: Wellmark IA PPO |
$1,815.48
|
|
|
INVASIVE BUNION PLATE LEFT
|
Facility
IP
|
$2,592.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8788813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,814.40 |
| Max. Negotiated Rate |
$2,332.80 |
| Rate for Payer: Aetna of IA Commercial |
$2,332.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,332.80
|
| Rate for Payer: Cash Price |
$2,073.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,944.00
|
| Rate for Payer: Medical Associates Commercial |
$1,944.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,814.40
|
| Rate for Payer: United Healthcare Commercial |
$2,332.80
|
|
|
INVASIVE BUNION PLATE LEFT
|
Facility
OP
|
$2,592.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8788813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,295.48 |
| Max. Negotiated Rate |
$2,332.80 |
| Rate for Payer: Aetna of IA Commercial |
$2,332.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,332.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,477.44
|
| Rate for Payer: Amerigroup Medicaid |
$1,308.18
|
| Rate for Payer: Amerigroup Medicare |
$1,308.96
|
| Rate for Payer: Cash Price |
$2,073.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,944.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,296.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,295.48
|
| Rate for Payer: Medical Associates Commercial |
$1,944.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,296.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,814.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,315.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,944.00
|
| Rate for Payer: United Healthcare Commercial |
$2,332.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,529.28
|
|
|
iohexol 300 mg/mL
|
Facility
OP
|
$172.76
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
43701007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.35 |
| Max. Negotiated Rate |
$155.48 |
| Rate for Payer: Aetna of IA Commercial |
$155.48
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$155.48
|
| Rate for Payer: Aetna of IA Medicare |
$98.47
|
| Rate for Payer: Amerigroup Medicaid |
$87.19
|
| Rate for Payer: Amerigroup Medicare |
$87.24
|
| Rate for Payer: Cash Price |
$138.21
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$129.57
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$86.38
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$86.35
|
| Rate for Payer: Medical Associates Commercial |
$129.57
|
| Rate for Payer: Medical Associates Managed Medicare |
$86.38
|
| Rate for Payer: Midlands Choice Commercial |
$120.93
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$87.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$129.57
|
| Rate for Payer: United Healthcare Commercial |
$155.48
|
| Rate for Payer: United Healthcare Managed Medicare |
$101.93
|
|
|
iohexol 300 mg/mL
|
Facility
IP
|
$172.76
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
43701007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.93 |
| Max. Negotiated Rate |
$155.48 |
| Rate for Payer: Aetna of IA Commercial |
$155.48
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$155.48
|
| Rate for Payer: Cash Price |
$138.21
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$129.57
|
| Rate for Payer: Medical Associates Commercial |
$129.57
|
| Rate for Payer: Midlands Choice Commercial |
$120.93
|
| Rate for Payer: United Healthcare Commercial |
$155.48
|
|
|
IONTOPHORESIS APPLICATION PER 15 MIN
|
Facility
IP
|
$134.00
|
|
|
Service Code
|
CPT 97033 GO
|
| Hospital Charge Code |
1373443
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna of IA Commercial |
$120.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.60
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.50
|
| Rate for Payer: Medical Associates Commercial |
$100.50
|
| Rate for Payer: Midlands Choice Commercial |
$93.80
|
| Rate for Payer: United Healthcare Commercial |
$120.60
|
|
|
IONTOPHORESIS APPLICATION PER 15 MIN
|
Facility
OP
|
$134.00
|
|
|
Service Code
|
CPT 97033 GO
|
| Hospital Charge Code |
1373443
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna of IA Commercial |
$120.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.60
|
| Rate for Payer: Aetna of IA Medicare |
$76.38
|
| Rate for Payer: Amerigroup Medicaid |
$67.63
|
| Rate for Payer: Amerigroup Medicare |
$67.67
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$66.97
|
| Rate for Payer: Medical Associates Commercial |
$100.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.00
|
| Rate for Payer: Midlands Choice Commercial |
$93.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$100.50
|
| Rate for Payer: United Healthcare Commercial |
$120.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.06
|
|
|
IONTOPHORESIS APPLICATION PER 15 MIN
|
Facility
IP
|
$134.00
|
|
|
Service Code
|
CPT 97033 GP
|
| Hospital Charge Code |
1373909
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna of IA Commercial |
$120.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.60
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.50
|
| Rate for Payer: Medical Associates Commercial |
$100.50
|
| Rate for Payer: Midlands Choice Commercial |
$93.80
|
| Rate for Payer: United Healthcare Commercial |
$120.60
|
|
|
IONTOPHORESIS APPLICATION PER 15 MIN
|
Facility
OP
|
$134.00
|
|
|
Service Code
|
CPT 97033 GP
|
| Hospital Charge Code |
1373909
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna of IA Commercial |
$120.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.60
|
| Rate for Payer: Aetna of IA Medicare |
$76.38
|
| Rate for Payer: Amerigroup Medicaid |
$67.63
|
| Rate for Payer: Amerigroup Medicare |
$67.67
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$66.97
|
| Rate for Payer: Medical Associates Commercial |
$100.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.00
|
| Rate for Payer: Midlands Choice Commercial |
$93.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$100.50
|
| Rate for Payer: United Healthcare Commercial |
$120.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.06
|
|
|
iopamidol 41% Sol
|
Facility
IP
|
$57.58
|
|
|
Service Code
|
CPT Q9966
|
| Hospital Charge Code |
43700475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.31 |
| Max. Negotiated Rate |
$51.82 |
| Rate for Payer: Aetna of IA Commercial |
$51.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.82
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.18
|
| Rate for Payer: Medical Associates Commercial |
$43.18
|
| Rate for Payer: Midlands Choice Commercial |
$40.31
|
| Rate for Payer: United Healthcare Commercial |
$51.82
|
|
|
iopamidol 41% Sol
|
Facility
OP
|
$57.58
|
|
|
Service Code
|
CPT Q9966
|
| Hospital Charge Code |
43700475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.78 |
| Max. Negotiated Rate |
$51.82 |
| Rate for Payer: Aetna of IA Commercial |
$51.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.82
|
| Rate for Payer: Aetna of IA Medicare |
$32.82
|
| Rate for Payer: Amerigroup Medicaid |
$29.06
|
| Rate for Payer: Amerigroup Medicare |
$29.08
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.18
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.79
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.78
|
| Rate for Payer: Medical Associates Commercial |
$43.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.79
|
| Rate for Payer: Midlands Choice Commercial |
$40.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.18
|
| Rate for Payer: United Healthcare Commercial |
$51.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.97
|
|
|
ipratropium 0.02% neb Sol 2.5 mL SDV
|
Facility
OP
|
$4.85
|
|
|
Service Code
|
CPT J7644
|
| Hospital Charge Code |
43714894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna of IA Commercial |
$4.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.36
|
| Rate for Payer: Aetna of IA Medicare |
$2.76
|
| Rate for Payer: Amerigroup Medicaid |
$2.45
|
| Rate for Payer: Amerigroup Medicare |
$2.45
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.42
|
| Rate for Payer: Medical Associates Commercial |
$3.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.42
|
| Rate for Payer: Midlands Choice Commercial |
$3.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.64
|
| Rate for Payer: United Healthcare Commercial |
$4.36
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.86
|
|
