|
ipratropium 0.02% neb Sol 2.5 mL SDV
|
Facility
IP
|
$4.85
|
|
|
Service Code
|
CPT J7644
|
| Hospital Charge Code |
43714894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.40 |
| 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: Cash Price |
$3.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.64
|
| Rate for Payer: Medical Associates Commercial |
$3.64
|
| Rate for Payer: Midlands Choice Commercial |
$3.40
|
| Rate for Payer: United Healthcare Commercial |
$4.36
|
|
|
ipratropium Nasal 0.06% Spry
|
Facility
OP
|
$113.28
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.62 |
| Max. Negotiated Rate |
$101.95 |
| Rate for Payer: Aetna of IA Commercial |
$101.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$101.95
|
| Rate for Payer: Aetna of IA Medicare |
$64.57
|
| Rate for Payer: Amerigroup Medicaid |
$57.17
|
| Rate for Payer: Amerigroup Medicare |
$57.21
|
| Rate for Payer: Cash Price |
$90.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$84.96
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$56.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.62
|
| Rate for Payer: Medical Associates Commercial |
$84.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.64
|
| Rate for Payer: Midlands Choice Commercial |
$79.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$84.96
|
| Rate for Payer: United Healthcare Commercial |
$101.95
|
| Rate for Payer: United Healthcare Managed Medicare |
$66.84
|
|
|
ipratropium Nasal 0.06% Spry
|
Facility
IP
|
$113.28
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$101.95 |
| Rate for Payer: Aetna of IA Commercial |
$101.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$101.95
|
| Rate for Payer: Cash Price |
$90.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$84.96
|
| Rate for Payer: Medical Associates Commercial |
$84.96
|
| Rate for Payer: Midlands Choice Commercial |
$79.30
|
| Rate for Payer: United Healthcare Commercial |
$101.95
|
|
|
irbesartan 150 mg Tab
|
Facility
OP
|
$1.98
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706003
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna of IA Commercial |
$1.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.78
|
| Rate for Payer: Aetna of IA Medicare |
$1.13
|
| Rate for Payer: Amerigroup Medicaid |
$1.00
|
| Rate for Payer: Amerigroup Medicare |
$1.00
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.48
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.99
|
| Rate for Payer: Medical Associates Commercial |
$1.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.99
|
| Rate for Payer: Midlands Choice Commercial |
$1.39
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.48
|
| Rate for Payer: United Healthcare Commercial |
$1.78
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.17
|
|
|
irbesartan 150 mg Tab
|
Facility
IP
|
$1.98
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706003
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna of IA Commercial |
$1.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.78
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.48
|
| Rate for Payer: Medical Associates Commercial |
$1.48
|
| Rate for Payer: Midlands Choice Commercial |
$1.39
|
| Rate for Payer: United Healthcare Commercial |
$1.78
|
|
|
IREM F.B. COMPLICATED
|
Professional
|
$1,527.00
|
|
|
Service Code
|
CPT 54115
|
| Hospital Charge Code |
7982862
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$391.26 |
| Max. Negotiated Rate |
$1,068.90 |
| Rate for Payer: Aetna of IA Medicare |
$391.26
|
| Rate for Payer: Amerigroup Medicaid |
$404.56
|
| Rate for Payer: Cash Price |
$1,221.60
|
| Rate for Payer: Cash Price |
$1,221.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$469.51
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$399.09
|
| Rate for Payer: Medical Associates Commercial |
$743.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$391.26
|
| Rate for Payer: Midlands Choice Commercial |
$1,068.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$586.89
|
| Rate for Payer: Wellmark IA HMO |
$805.00
|
| Rate for Payer: Wellmark IA PPO |
$944.00
|
|
|
irinotecan 20 mg/mL 2ml vial
|
Facility
IP
|
$71.72
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
43700250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$64.55 |
| Rate for Payer: Aetna of IA Commercial |
$64.55
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.55
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.79
|
| Rate for Payer: Medical Associates Commercial |
$53.79
|
| Rate for Payer: Midlands Choice Commercial |
$50.20
|
| Rate for Payer: United Healthcare Commercial |
$64.55
|
|
|
irinotecan 20 mg/mL 2ml vial
|
Facility
OP
|
$71.72
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
43700250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$64.55 |
| Rate for Payer: Aetna of IA Commercial |
$64.55
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.55
|
| Rate for Payer: Aetna of IA Medicare |
$40.88
|
| Rate for Payer: Amerigroup Medicaid |
$36.20
|
| Rate for Payer: Amerigroup Medicare |
$36.22
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.79
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.85
|
| Rate for Payer: Medical Associates Commercial |
$53.79
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.86
|
| Rate for Payer: Midlands Choice Commercial |
$50.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.79
|
| Rate for Payer: United Healthcare Commercial |
$64.55
|
| Rate for Payer: United Healthcare Managed Medicare |
$42.31
|
|
|
irinotecan 20 mg/mL 5ml vial
|
Facility
IP
|
$100.20
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
43700245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.14 |
| Max. Negotiated Rate |
$90.18 |
| Rate for Payer: Aetna of IA Commercial |
$90.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.18
|
| Rate for Payer: Cash Price |
$80.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.15
|
| Rate for Payer: Medical Associates Commercial |
$75.15
|
| Rate for Payer: Midlands Choice Commercial |
$70.14
|
| Rate for Payer: United Healthcare Commercial |
$90.18
|
|
|
irinotecan 20 mg/mL 5ml vial
|
Facility
OP
|
$100.20
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
43700245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.08 |
| Max. Negotiated Rate |
$90.18 |
| Rate for Payer: Aetna of IA Commercial |
$90.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.18
|
| Rate for Payer: Aetna of IA Medicare |
$57.11
|
| Rate for Payer: Amerigroup Medicaid |
$50.57
|
| Rate for Payer: Amerigroup Medicare |
$50.60
|
| Rate for Payer: Cash Price |
$80.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.15
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$50.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$50.08
|
| Rate for Payer: Medical Associates Commercial |
$75.15
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.10
|
| Rate for Payer: Midlands Choice Commercial |
$70.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.15
|
| Rate for Payer: United Healthcare Commercial |
$90.18
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.12
|
|
|
IRIS RETRACTOR
|
Facility
IP
|
$124.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8026386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna of IA Commercial |
$111.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$111.60
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.00
|
| Rate for Payer: Medical Associates Commercial |
$93.00
|
| Rate for Payer: Midlands Choice Commercial |
$86.80
|
| Rate for Payer: United Healthcare Commercial |
$111.60
|
|
|
IRIS RETRACTOR
|
Facility
OP
|
$124.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8026386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.98 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna of IA Commercial |
$111.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$111.60
|
| Rate for Payer: Aetna of IA Medicare |
$70.68
|
| Rate for Payer: Amerigroup Medicaid |
$62.58
|
| Rate for Payer: Amerigroup Medicare |
$62.62
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$62.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.98
|
| Rate for Payer: Medical Associates Commercial |
$93.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.00
|
| Rate for Payer: Midlands Choice Commercial |
$86.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.00
|
| Rate for Payer: United Healthcare Commercial |
$111.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$73.16
|
|
|
IRON
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
633765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Aetna of IA Medicare |
$40.47
|
| Rate for Payer: Amerigroup Medicaid |
$35.83
|
| Rate for Payer: Amerigroup Medicare |
$35.86
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.49
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.25
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.89
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
IRON
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
633765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
|
|
IRON IRON BINDING
|
Facility
OP
|
$72.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
4018195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of IA Commercial |
$64.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.80
|
| Rate for Payer: Aetna of IA Medicare |
$41.04
|
| Rate for Payer: Amerigroup Medicaid |
$36.34
|
| Rate for Payer: Amerigroup Medicare |
$36.36
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.99
|
| Rate for Payer: Medical Associates Commercial |
$54.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.00
|
| Rate for Payer: Midlands Choice Commercial |
$50.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.00
|
| Rate for Payer: United Healthcare Commercial |
$64.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$42.48
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
IRON IRON BINDING
|
Facility
IP
|
$72.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
4018195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of IA Commercial |
$64.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.80
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.00
|
| Rate for Payer: Medical Associates Commercial |
$54.00
|
| Rate for Payer: Midlands Choice Commercial |
$50.40
|
| Rate for Payer: United Healthcare Commercial |
$64.80
|
|
|
iron sucrose 20 mg/mL IV 5 ml SDV Sol
|
Facility
IP
|
$140.90
|
|
|
Service Code
|
CPT J1756
|
| Hospital Charge Code |
43748410
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.63 |
| Max. Negotiated Rate |
$126.81 |
| Rate for Payer: Aetna of IA Commercial |
$126.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.81
|
| Rate for Payer: Cash Price |
$112.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.68
|
| Rate for Payer: Medical Associates Commercial |
$105.68
|
| Rate for Payer: Midlands Choice Commercial |
$98.63
|
| Rate for Payer: United Healthcare Commercial |
$126.81
|
|
|
iron sucrose 20 mg/mL IV 5 ml SDV Sol
|
Facility
OP
|
$140.90
|
|
|
Service Code
|
CPT J1756
|
| Hospital Charge Code |
43748410
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.42 |
| Max. Negotiated Rate |
$126.81 |
| Rate for Payer: Aetna of IA Commercial |
$126.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.81
|
| Rate for Payer: Aetna of IA Medicare |
$80.31
|
| Rate for Payer: Amerigroup Medicaid |
$71.11
|
| Rate for Payer: Amerigroup Medicare |
$71.15
|
| Rate for Payer: Cash Price |
$112.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.68
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$70.42
|
| Rate for Payer: Medical Associates Commercial |
$105.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.45
|
| Rate for Payer: Midlands Choice Commercial |
$98.63
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$105.68
|
| Rate for Payer: United Healthcare Commercial |
$126.81
|
| Rate for Payer: United Healthcare Managed Medicare |
$83.13
|
|
|
IRRIG DRUG DELIVERY DEVICE
|
Facility
OP
|
$157.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
4866826
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$78.47 |
| Max. Negotiated Rate |
$403.74 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Aetna of IA Medicare |
$89.49
|
| Rate for Payer: Amerigroup Medicaid |
$79.24
|
| Rate for Payer: Amerigroup Medicare |
$79.28
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$78.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$78.47
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$78.50
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$117.75
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.63
|
| Rate for Payer: Wellmark IA HMO |
$367.04
|
| Rate for Payer: Wellmark IA PPO |
$403.74
|
|
|
IRRIG DRUG DELIVERY DEVICE
|
Facility
IP
|
$157.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
4866826
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
|
|
IRRIG DRUG DELIVERY DEVICE
|
Facility
OP
|
$157.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
8398094
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$78.47 |
| Max. Negotiated Rate |
$403.74 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Aetna of IA Medicare |
$89.49
|
| Rate for Payer: Amerigroup Medicaid |
$79.24
|
| Rate for Payer: Amerigroup Medicare |
$79.28
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$78.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$78.47
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$78.50
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$117.75
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.63
|
| Rate for Payer: Wellmark IA HMO |
$367.04
|
| Rate for Payer: Wellmark IA PPO |
$403.74
|
|
|
IRRIG DRUG DELIVERY DEVICE
|
Facility
IP
|
$157.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
8398094
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
|
|
Ischemic Stroke, Precerebral Occlusion or Transient Ischemia With Thrombolytic Agent With CC
|
Facility
IP
|
$19,925.96
|
|
|
Service Code
|
MS-DRG 062
|
| Hospital Charge Code |
742
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$19,925.96 |
| Rate for Payer: Amerigroup Medicaid |
$19,829.70
|
| 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 |
$19,637.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19,925.96
|
|
|
Ischemic Stroke, Precerebral Occlusion or Transient Ischemia With Thrombolytic Agent With MCC
|
Facility
IP
|
$23,987.94
|
|
|
Service Code
|
MS-DRG 061
|
| Hospital Charge Code |
741
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$23,987.94 |
| Rate for Payer: Amerigroup Medicaid |
$23,872.05
|
| 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 |
$23,640.28
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23,987.94
|
|
|
Ischemic Stroke, Precerebral Occlusion or Transient Ischemia With Thrombolytic Agent Without CC/MCC
|
Facility
IP
|
$17,694.69
|
|
|
Service Code
|
MS-DRG 063
|
| Hospital Charge Code |
743
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$17,694.69 |
| Rate for Payer: Amerigroup Medicaid |
$17,609.21
|
| 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 |
$17,438.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17,694.69
|
|
