|
L-carnitine 500mg Tab
|
Facility
OP
|
$2.22
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700335
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna of IA Commercial |
$2.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.00
|
| Rate for Payer: Aetna of IA Medicare |
$1.27
|
| Rate for Payer: Amerigroup Medicaid |
$1.12
|
| Rate for Payer: Amerigroup Medicare |
$1.12
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.66
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.11
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.11
|
| Rate for Payer: Medical Associates Commercial |
$1.66
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.11
|
| Rate for Payer: Midlands Choice Commercial |
$1.55
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.13
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.66
|
| Rate for Payer: United Healthcare Commercial |
$2.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.31
|
|
|
LD COMP W/FORC/VAC/3RD-4TH DEG LAC EPIS
|
Facility
IP
|
$2,505.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
7984736
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,753.50 |
| Max. Negotiated Rate |
$2,254.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,254.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,254.50
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,878.75
|
| Rate for Payer: Medical Associates Commercial |
$1,878.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,753.50
|
| Rate for Payer: United Healthcare Commercial |
$2,254.50
|
|
|
LD COMP W/FORC/VAC/3RD-4TH DEG LAC EPIS
|
Facility
OP
|
$2,505.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
7984736
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,252.00 |
| Max. Negotiated Rate |
$4,441.18 |
| Rate for Payer: Aetna of IA Commercial |
$2,254.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,254.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,427.85
|
| Rate for Payer: Amerigroup Medicaid |
$1,264.27
|
| Rate for Payer: Amerigroup Medicare |
$1,265.02
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,878.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,252.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,252.00
|
| Rate for Payer: Medical Associates Commercial |
$1,878.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,252.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,753.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,271.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,878.75
|
| Rate for Payer: United Healthcare Commercial |
$2,254.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,477.95
|
| Rate for Payer: Wellmark IA HMO |
$4,037.44
|
| Rate for Payer: Wellmark IA PPO |
$4,441.18
|
|
|
LDH
|
Facility
OP
|
$58.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
4022826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Aetna of IA Medicare |
$33.06
|
| Rate for Payer: Amerigroup Medicaid |
$29.27
|
| Rate for Payer: Amerigroup Medicare |
$29.29
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.99
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.00
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.22
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
LDH
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
633770
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
|
|
LDH
|
Facility
OP
|
$58.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
633770
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Aetna of IA Medicare |
$33.06
|
| Rate for Payer: Amerigroup Medicaid |
$29.27
|
| Rate for Payer: Amerigroup Medicare |
$29.29
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.99
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.00
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.22
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
LDH
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
4022826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
|
|
LD W/O COMPLICATIONS 1ST-2ND DEG LAC
|
Facility
OP
|
$1,490.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
7984737
|
|
Hospital Revenue Code
|
722
|
| Min. Negotiated Rate |
$744.70 |
| Max. Negotiated Rate |
$4,441.18 |
| Rate for Payer: Aetna of IA Commercial |
$1,341.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,341.00
|
| Rate for Payer: Aetna of IA Medicare |
$849.30
|
| Rate for Payer: Amerigroup Medicaid |
$752.00
|
| Rate for Payer: Amerigroup Medicare |
$752.45
|
| Rate for Payer: Cash Price |
$1,192.00
|
| Rate for Payer: Cash Price |
$1,192.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,117.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$745.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$744.70
|
| Rate for Payer: Medical Associates Commercial |
$1,117.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$745.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,043.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$756.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,117.50
|
| Rate for Payer: United Healthcare Commercial |
$1,341.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$879.10
|
| Rate for Payer: Wellmark IA HMO |
$4,037.44
|
| Rate for Payer: Wellmark IA PPO |
$4,441.18
|
|
|
LD W/O COMPLICATIONS 1ST-2ND DEG LAC
|
Facility
IP
|
$1,490.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
7984737
|
|
Hospital Revenue Code
|
722
|
| Min. Negotiated Rate |
$1,043.00 |
| Max. Negotiated Rate |
$1,341.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,341.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,341.00
|
| Rate for Payer: Cash Price |
$1,192.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,117.50
|
| Rate for Payer: Medical Associates Commercial |
$1,117.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,043.00
|
| Rate for Payer: United Healthcare Commercial |
$1,341.00
|
|
|
LEAD
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
8094268
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of IA Commercial |
$73.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.80
|
| Rate for Payer: Aetna of IA Medicare |
$46.74
|
| Rate for Payer: Amerigroup Medicaid |
$41.39
|
| Rate for Payer: Amerigroup Medicare |
$41.41
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$41.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.98
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$41.00
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$61.50
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.38
|
| Rate for Payer: Wellmark IA HMO |
$37.20
|
| Rate for Payer: Wellmark IA PPO |
$40.92
|
|
|
LEAD
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
8094268
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of IA Commercial |
$73.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.50
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
|
|
Lead Level Screen
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
8487747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of IA Commercial |
$73.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.80
|
| Rate for Payer: Aetna of IA Medicare |
$46.74
|
| Rate for Payer: Amerigroup Medicaid |
$41.39
|
| Rate for Payer: Amerigroup Medicare |
$41.41
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$41.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.98
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$41.00
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$61.50
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.38
|
| Rate for Payer: Wellmark IA HMO |
$37.20
|
| Rate for Payer: Wellmark IA PPO |
$40.92
|
|
|
Lead Level Screen
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
8487747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of IA Commercial |
$73.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.50
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
|
|
Lead Level Screen DMCL
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
8037723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of IA Commercial |
$73.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.80
|
| Rate for Payer: Aetna of IA Medicare |
$46.74
|
| Rate for Payer: Amerigroup Medicaid |
$41.39
|
| Rate for Payer: Amerigroup Medicare |
$41.41
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$41.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.98
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$41.00
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$61.50
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.38
|
| Rate for Payer: Wellmark IA HMO |
$37.20
|
| Rate for Payer: Wellmark IA PPO |
$40.92
|
|
|
Lead Level Screen DMCL
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
8037723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of IA Commercial |
$73.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.50
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
|
|
leflunomide 20 mg Tab
|
Facility
IP
|
$2.92
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43729751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Aetna of IA Commercial |
$2.63
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.63
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.19
|
| Rate for Payer: Medical Associates Commercial |
$2.19
|
| Rate for Payer: Midlands Choice Commercial |
$2.04
|
| Rate for Payer: United Healthcare Commercial |
$2.63
|
|
|
leflunomide 20 mg Tab
|
Facility
OP
|
$2.92
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43729751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Aetna of IA Commercial |
$2.63
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.63
|
| Rate for Payer: Aetna of IA Medicare |
$1.66
|
| Rate for Payer: Amerigroup Medicaid |
$1.47
|
| Rate for Payer: Amerigroup Medicare |
$1.47
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.19
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.46
|
| Rate for Payer: Medical Associates Commercial |
$2.19
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.46
|
| Rate for Payer: Midlands Choice Commercial |
$2.04
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.19
|
| Rate for Payer: United Healthcare Commercial |
$2.63
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.72
|
|
|
Legionella Antigen DMCL
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
8037724
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.00 |
| 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 |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
Legionella Antigen DMCL
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
8037724
|
|
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
|
|
|
LENS 10.0
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8047304
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$134.95 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Aetna of IA Medicare |
$153.90
|
| Rate for Payer: Amerigroup Medicaid |
$136.27
|
| Rate for Payer: Amerigroup Medicare |
$136.35
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$135.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$134.95
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$137.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$202.50
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.30
|
|
|
LENS 10.0
|
Facility
IP
|
$270.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8047304
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
|
|
LENS 10.0 CNA0T010.0D
|
Facility
IP
|
$585.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8940655
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Aetna of IA Commercial |
$526.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$526.50
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$438.75
|
| Rate for Payer: Medical Associates Commercial |
$438.75
|
| Rate for Payer: Midlands Choice Commercial |
$409.50
|
| Rate for Payer: United Healthcare Commercial |
$526.50
|
|
|
LENS 10.0 CNA0T010.0D
|
Facility
OP
|
$585.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8940655
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$292.38 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Aetna of IA Commercial |
$526.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$526.50
|
| Rate for Payer: Aetna of IA Medicare |
$333.45
|
| Rate for Payer: Amerigroup Medicaid |
$295.25
|
| Rate for Payer: Amerigroup Medicare |
$295.42
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$438.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$292.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$292.38
|
| Rate for Payer: Medical Associates Commercial |
$438.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$292.50
|
| Rate for Payer: Midlands Choice Commercial |
$409.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$296.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$438.75
|
| Rate for Payer: United Healthcare Commercial |
$526.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$345.15
|
|
|
LENS 10.5
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8047305
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$134.95 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Aetna of IA Medicare |
$153.90
|
| Rate for Payer: Amerigroup Medicaid |
$136.27
|
| Rate for Payer: Amerigroup Medicare |
$136.35
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$135.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$134.95
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$137.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$202.50
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.30
|
|
|
LENS 10.5
|
Facility
IP
|
$270.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8047305
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
|
