|
INSERT NEEDLE BONE CAVITY
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
4864946
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Aetna of IA Commercial |
$340.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$340.20
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$283.50
|
| Rate for Payer: Medical Associates Commercial |
$283.50
|
| Rate for Payer: Midlands Choice Commercial |
$264.60
|
| Rate for Payer: United Healthcare Commercial |
$340.20
|
|
|
INSERT NON-TUNNEL CV CATH
|
Facility
|
IP
|
$1,881.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
4864939
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,316.70 |
| Max. Negotiated Rate |
$1,692.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,692.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,692.90
|
| Rate for Payer: Cash Price |
$1,504.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,410.75
|
| Rate for Payer: Medical Associates Commercial |
$1,410.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,316.70
|
| Rate for Payer: United Healthcare Commercial |
$1,692.90
|
|
|
INSERT NON-TUNNEL CV CATH
|
Facility
|
OP
|
$1,881.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
4864939
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$846.45 |
| Max. Negotiated Rate |
$3,010.76 |
| Rate for Payer: Aetna of IA Commercial |
$1,692.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,692.90
|
| Rate for Payer: Aetna of IA Medicare |
$1,072.17
|
| Rate for Payer: Amerigroup Medicaid |
$1,084.96
|
| Rate for Payer: Amerigroup Medicare |
$854.91
|
| Rate for Payer: Cash Price |
$1,504.80
|
| Rate for Payer: Cash Price |
$1,504.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,410.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$846.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,074.43
|
| Rate for Payer: Medical Associates Commercial |
$1,410.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$846.45
|
| Rate for Payer: Midlands Choice Commercial |
$1,316.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,090.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$973.42
|
| Rate for Payer: United Healthcare Commercial |
$1,692.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,109.79
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,733.20
|
| Rate for Payer: Wellmark IA PPO |
$3,010.76
|
|
|
INSERT TEMP BLADDER CATH
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
4863322
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$105.75 |
| Max. Negotiated Rate |
$267.88 |
| 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 |
$135.55
|
| Rate for Payer: Amerigroup Medicare |
$106.81
|
| 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 |
$105.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$134.23
|
| Rate for Payer: Medical Associates Commercial |
$176.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$105.75
|
| Rate for Payer: Midlands Choice Commercial |
$164.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$136.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$121.61
|
| Rate for Payer: United Healthcare Commercial |
$211.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$138.65
|
| Rate for Payer: Wellmark IA HMO WHPI |
$243.19
|
| Rate for Payer: Wellmark IA PPO |
$267.88
|
|
|
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 TUN IP CATH PERC
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
7982932
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.95 |
| Max. Negotiated Rate |
$7,454.65 |
| Rate for Payer: Aetna of IA Commercial |
$531.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$531.90
|
| Rate for Payer: Aetna of IA Medicare |
$336.87
|
| Rate for Payer: Amerigroup Medicaid |
$340.89
|
| Rate for Payer: Amerigroup Medicare |
$268.61
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$443.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$265.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$337.58
|
| Rate for Payer: Medical Associates Commercial |
$443.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$265.95
|
| Rate for Payer: Midlands Choice Commercial |
$413.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$342.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$305.84
|
| Rate for Payer: United Healthcare Commercial |
$531.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$348.69
|
| Rate for Payer: Wellmark IA HMO WHPI |
$6,767.41
|
| Rate for Payer: Wellmark IA PPO |
$7,454.65
|
|
|
INSERT TUN IP CATH PERC
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
7982932
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$413.70 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Aetna of IA Commercial |
$531.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$531.90
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$443.25
|
| Rate for Payer: Medical Associates Commercial |
$443.25
|
| Rate for Payer: Midlands Choice Commercial |
$413.70
|
| Rate for Payer: United Healthcare Commercial |
$531.90
|
|
|
insulin aspart-insulin aspart protamine 30 units-70 units/mL SubQ Susp 3 mL [VDMC]
|
Facility
|
OP
|
$117.81
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10396527
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.01 |
| Max. Negotiated Rate |
$221.80 |
| 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 |
$67.95
|
| Rate for Payer: Amerigroup Medicare |
$53.54
|
| Rate for Payer: Cash Price |
$94.25
|
| 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 |
$53.01
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.29
|
| Rate for Payer: Medical Associates Commercial |
$88.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$53.01
|
| Rate for Payer: Midlands Choice Commercial |
$82.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$60.97
|
| Rate for Payer: United Healthcare Commercial |
$106.03
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.51
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
insulin aspart-insulin aspart protamine 30 units-70 units/mL SubQ Susp 3 mL [VDMC]
|
Facility
|
IP
|
$117.81
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10396527
|
|
Hospital Revenue Code
|
259
|
| 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 [VDMC]
|
Facility
|
IP
|
$134.04
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10396598
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$93.83 |
| Max. Negotiated Rate |
$120.64 |
| Rate for Payer: Aetna of IA Commercial |
$120.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.64
|
| Rate for Payer: Cash Price |
$107.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.53
|
| Rate for Payer: Medical Associates Commercial |
$100.53
|
| Rate for Payer: Midlands Choice Commercial |
$93.83
|
| Rate for Payer: United Healthcare Commercial |
$120.64
|
|
|
insulin detemir 100 units/mL SC Sol [VDMC]
|
Facility
|
OP
|
$134.04
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10396598
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$60.32 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$120.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.64
|
| Rate for Payer: Aetna of IA Medicare |
$76.40
|
| Rate for Payer: Amerigroup Medicaid |
$77.31
|
| Rate for Payer: Amerigroup Medicare |
$60.92
|
| Rate for Payer: Cash Price |
$107.23
|
| Rate for Payer: Cash Price |
$107.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.53
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$60.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$76.56
|
| Rate for Payer: Medical Associates Commercial |
$100.53
|
| Rate for Payer: Medical Associates Managed Medicare |
$60.32
|
| Rate for Payer: Midlands Choice Commercial |
$93.83
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$77.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$69.37
|
| Rate for Payer: United Healthcare Commercial |
$120.64
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.08
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
insulin glargine 100 units/mL 3ml SDS [VDMC]
|
Facility
|
OP
|
$82.70
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
20222655
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.22 |
| Max. Negotiated Rate |
$221.80 |
| 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 |
$47.70
|
| Rate for Payer: Amerigroup Medicare |
$37.59
|
| Rate for Payer: Cash Price |
$66.16
|
| Rate for Payer: Cash Price |
$66.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$62.03
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$37.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.24
|
| Rate for Payer: Medical Associates Commercial |
$62.03
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.22
|
| Rate for Payer: Midlands Choice Commercial |
$57.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$47.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.80
|
| Rate for Payer: United Healthcare Commercial |
$74.43
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.80
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
insulin glargine 100 units/mL 3ml SDS [VDMC]
|
Facility
|
IP
|
$82.70
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
20222655
|
|
Hospital Revenue Code
|
259
|
| 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 |
$62.03
|
| Rate for Payer: Medical Associates Commercial |
$62.03
|
| Rate for Payer: Midlands Choice Commercial |
$57.89
|
| Rate for Payer: United Healthcare Commercial |
$74.43
|
|
|
insulin isophane (NPH) human recombinant 100 units/mL SubQ Inj [VDMC]
|
Facility
|
IP
|
$64.24
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10396740
|
|
Hospital Revenue Code
|
259
|
| 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 [VDMC]
|
Facility
|
OP
|
$64.24
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10396740
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$221.80 |
| 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 |
$37.05
|
| Rate for Payer: Amerigroup Medicare |
$29.20
|
| Rate for Payer: Cash Price |
$51.39
|
| 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 |
$28.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.69
|
| Rate for Payer: Medical Associates Commercial |
$48.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.91
|
| Rate for Payer: Midlands Choice Commercial |
$44.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.24
|
| Rate for Payer: United Healthcare Commercial |
$57.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
insulin isophane (NPH)-insulin regular human recombinant 70 units-30 units/mL SubQ Inj 3 mL [VDMC]
|
Facility
|
OP
|
$64.24
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10396874
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$221.80 |
| 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 |
$37.05
|
| Rate for Payer: Amerigroup Medicare |
$29.20
|
| Rate for Payer: Cash Price |
$51.39
|
| 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 |
$28.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.69
|
| Rate for Payer: Medical Associates Commercial |
$48.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.91
|
| Rate for Payer: Midlands Choice Commercial |
$44.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.24
|
| Rate for Payer: United Healthcare Commercial |
$57.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
insulin isophane (NPH)-insulin regular human recombinant 70 units-30 units/mL SubQ Inj 3 mL [VDMC]
|
Facility
|
IP
|
$64.24
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10396874
|
|
Hospital Revenue Code
|
259
|
| 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 Level DMCL
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
8037720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.05 |
| 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 |
$62.87
|
| Rate for Payer: Amerigroup Medicare |
$49.54
|
| 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 |
$49.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$62.26
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.05
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$63.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.41
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.31
|
| Rate for Payer: Wellmark IA HMO WHPI |
$49.63
|
| Rate for Payer: Wellmark IA PPO |
$54.67
|
|
|
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 lispro 100 units/mL SubQ Inj 3 ml [VDMC]
|
Facility
|
OP
|
$86.65
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10397021
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.99 |
| Max. Negotiated Rate |
$221.80 |
| 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 |
$49.98
|
| Rate for Payer: Amerigroup Medicare |
$39.38
|
| Rate for Payer: Cash Price |
$69.32
|
| 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 |
$38.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.49
|
| Rate for Payer: Medical Associates Commercial |
$64.99
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.99
|
| Rate for Payer: Midlands Choice Commercial |
$60.65
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.84
|
| Rate for Payer: United Healthcare Commercial |
$77.98
|
| Rate for Payer: United Healthcare Managed Medicare |
$51.12
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
insulin lispro 100 units/mL SubQ Inj 3 ml [VDMC]
|
Facility
|
IP
|
$86.65
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10397021
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$60.65 |
| 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 |
$60.65
|
| Rate for Payer: United Healthcare Commercial |
$77.98
|
|
|
insulin regular human recombinant 100 units/mL 3 ML Inj Sol [VDMC]
|
Facility
|
IP
|
$31.51
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10397231
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$28.36 |
| Rate for Payer: Aetna of IA Commercial |
$28.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.36
|
| Rate for Payer: Cash Price |
$25.21
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.63
|
| Rate for Payer: Medical Associates Commercial |
$23.63
|
| Rate for Payer: Midlands Choice Commercial |
$22.06
|
| Rate for Payer: United Healthcare Commercial |
$28.36
|
|
|
insulin regular human recombinant 100 units/mL 3 ML Inj Sol [VDMC]
|
Facility
|
OP
|
$31.51
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10397231
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.36
|
| Rate for Payer: Aetna of IA Medicare |
$17.96
|
| Rate for Payer: Amerigroup Medicaid |
$18.18
|
| Rate for Payer: Amerigroup Medicare |
$14.32
|
| Rate for Payer: Cash Price |
$25.21
|
| Rate for Payer: Cash Price |
$25.21
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.63
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.18
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.00
|
| Rate for Payer: Medical Associates Commercial |
$23.63
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.18
|
| Rate for Payer: Midlands Choice Commercial |
$22.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.31
|
| Rate for Payer: United Healthcare Commercial |
$28.36
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.59
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
INTEGRATIVE MEDICINE 30 MINUTES
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
CPT 99999
|
| Hospital Charge Code |
8431964
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Medical Associates Commercial |
$56.25
|
| Rate for Payer: Midlands Choice Commercial |
$52.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.25
|
| Rate for Payer: Wellmark IA HMO WHPI |
$82.00
|
| Rate for Payer: Wellmark IA PPO |
$82.00
|
|
|
INTEGRATIVE MEDICINE 60 MINUTES
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
CPT 99999
|
| Hospital Charge Code |
8431965
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Medical Associates Commercial |
$112.50
|
| Rate for Payer: Midlands Choice Commercial |
$105.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$112.50
|
| Rate for Payer: Wellmark IA HMO WHPI |
$82.00
|
| Rate for Payer: Wellmark IA PPO |
$82.00
|
|
