|
IOP On-Site Group Therapy minimum 45 minutes
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS G0410
|
| Hospital Charge Code |
8300862
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of IA Commercial |
$198.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.90
|
| Rate for Payer: Aetna of IA Medicare |
$125.97
|
| Rate for Payer: Amerigroup Medicaid |
$127.47
|
| Rate for Payer: Amerigroup Medicare |
$100.44
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.24
|
| Rate for Payer: Medical Associates Commercial |
$165.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.45
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$114.37
|
| Rate for Payer: United Healthcare Commercial |
$198.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$148.18
|
| Rate for Payer: Wellmark IA PPO |
$163.23
|
|
|
IOP On-Site Group Therapy minimum 45 minutes
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
HCPCS G0410
|
| Hospital Charge Code |
8300862
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of IA Commercial |
$198.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.90
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.75
|
| Rate for Payer: Medical Associates Commercial |
$165.75
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: United Healthcare Commercial |
$198.90
|
|
|
IOP Psychotherapy - Family w/o Patient
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
8987983
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$123.90 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of IA Commercial |
$159.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$159.30
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.75
|
| Rate for Payer: Medical Associates Commercial |
$132.75
|
| Rate for Payer: Midlands Choice Commercial |
$123.90
|
| Rate for Payer: United Healthcare Commercial |
$159.30
|
|
|
IOP Psychotherapy - Family w/o Patient
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
8987983
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$79.65 |
| Max. Negotiated Rate |
$272.57 |
| Rate for Payer: Aetna of IA Commercial |
$159.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$159.30
|
| Rate for Payer: Aetna of IA Medicare |
$100.89
|
| Rate for Payer: Amerigroup Medicaid |
$102.09
|
| Rate for Payer: Amerigroup Medicare |
$80.45
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$79.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$101.10
|
| Rate for Payer: Medical Associates Commercial |
$132.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$79.65
|
| Rate for Payer: Midlands Choice Commercial |
$123.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$91.60
|
| Rate for Payer: United Healthcare Commercial |
$159.30
|
| Rate for Payer: Wellmark IA HMO WHPI |
$247.44
|
| Rate for Payer: Wellmark IA PPO |
$272.57
|
|
|
IOP Psychotherapy - Family w/ Patient
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
8987984
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$79.65 |
| Max. Negotiated Rate |
$272.57 |
| Rate for Payer: Aetna of IA Commercial |
$159.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$159.30
|
| Rate for Payer: Aetna of IA Medicare |
$100.89
|
| Rate for Payer: Amerigroup Medicaid |
$102.09
|
| Rate for Payer: Amerigroup Medicare |
$80.45
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$79.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$101.10
|
| Rate for Payer: Medical Associates Commercial |
$132.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$79.65
|
| Rate for Payer: Midlands Choice Commercial |
$123.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$91.60
|
| Rate for Payer: United Healthcare Commercial |
$159.30
|
| Rate for Payer: Wellmark IA HMO WHPI |
$247.44
|
| Rate for Payer: Wellmark IA PPO |
$272.57
|
|
|
IOP Psychotherapy - Family w/ Patient
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
8987984
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$123.90 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of IA Commercial |
$159.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$159.30
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.75
|
| Rate for Payer: Medical Associates Commercial |
$132.75
|
| Rate for Payer: Midlands Choice Commercial |
$123.90
|
| Rate for Payer: United Healthcare Commercial |
$159.30
|
|
|
IOP Psychotherapy - Individual 16-37 min
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
8987980
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Aetna of IA Medicare |
$103.17
|
| Rate for Payer: Amerigroup Medicaid |
$104.40
|
| Rate for Payer: Amerigroup Medicare |
$82.26
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$103.39
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.45
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.67
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$107.77
|
| Rate for Payer: Wellmark IA PPO |
$118.71
|
|
|
IOP Psychotherapy - Individual 16-37 min
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
8987980
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.75
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
|
|
IOP Psychotherapy - Individual 38-57 min
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
8987981
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$254.10 |
| Max. Negotiated Rate |
$326.70 |
| Rate for Payer: Aetna of IA Commercial |
$326.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$326.70
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$272.25
|
| Rate for Payer: Medical Associates Commercial |
$272.25
|
| Rate for Payer: Midlands Choice Commercial |
$254.10
|
| Rate for Payer: United Healthcare Commercial |
$326.70
|
|
|
IOP Psychotherapy - Individual 38-57 min
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
8987981
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$163.35 |
| Max. Negotiated Rate |
$326.70 |
| Rate for Payer: Aetna of IA Commercial |
$326.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$326.70
|
| Rate for Payer: Aetna of IA Medicare |
$206.91
|
| Rate for Payer: Amerigroup Medicaid |
$209.38
|
| Rate for Payer: Amerigroup Medicare |
$164.98
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$272.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$163.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$207.35
|
| Rate for Payer: Medical Associates Commercial |
$272.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$163.35
|
| Rate for Payer: Midlands Choice Commercial |
$254.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$210.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$187.85
|
| Rate for Payer: United Healthcare Commercial |
$326.70
|
| Rate for Payer: Wellmark IA HMO WHPI |
$247.44
|
| Rate for Payer: Wellmark IA PPO |
$272.57
|
|
|
IOP Psychotherapy - Individual 58 min or more
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
8987982
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$254.10 |
| Max. Negotiated Rate |
$326.70 |
| Rate for Payer: Aetna of IA Commercial |
$326.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$326.70
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$272.25
|
| Rate for Payer: Medical Associates Commercial |
$272.25
|
| Rate for Payer: Midlands Choice Commercial |
$254.10
|
| Rate for Payer: United Healthcare Commercial |
$326.70
|
|
|
IOP Psychotherapy - Individual 58 min or more
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
8987982
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$163.35 |
| Max. Negotiated Rate |
$326.70 |
| Rate for Payer: Aetna of IA Commercial |
$326.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$326.70
|
| Rate for Payer: Aetna of IA Medicare |
$206.91
|
| Rate for Payer: Amerigroup Medicaid |
$209.38
|
| Rate for Payer: Amerigroup Medicare |
$164.98
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$272.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$163.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$207.35
|
| Rate for Payer: Medical Associates Commercial |
$272.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$163.35
|
| Rate for Payer: Midlands Choice Commercial |
$254.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$210.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$187.85
|
| Rate for Payer: United Healthcare Commercial |
$326.70
|
| Rate for Payer: Wellmark IA HMO WHPI |
$247.44
|
| Rate for Payer: Wellmark IA PPO |
$272.57
|
|
|
IOP Train and Educate
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
HCPCS G0177
|
| Hospital Charge Code |
8300863
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of IA Commercial |
$198.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.90
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.75
|
| Rate for Payer: Medical Associates Commercial |
$165.75
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: United Healthcare Commercial |
$198.90
|
|
|
IOP Train and Educate
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS G0177
|
| Hospital Charge Code |
8300863
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of IA Commercial |
$198.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.90
|
| Rate for Payer: Aetna of IA Medicare |
$125.97
|
| Rate for Payer: Amerigroup Medicaid |
$127.47
|
| Rate for Payer: Amerigroup Medicare |
$100.44
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.24
|
| Rate for Payer: Medical Associates Commercial |
$165.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.45
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$114.37
|
| Rate for Payer: United Healthcare Commercial |
$198.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$130.39
|
| Rate for Payer: Wellmark IA HMO WHPI |
$124.78
|
| Rate for Payer: Wellmark IA PPO |
$137.46
|
|
|
ipratropium 0.02% neb Sol 2.5 mL SDV [VDMC]
|
Facility
|
IP
|
$4.85
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
10397361
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna of IA Commercial |
$4.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.37
|
| 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 |
$4.37
|
|
|
ipratropium 0.02% neb Sol 2.5 mL SDV [VDMC]
|
Facility
|
OP
|
$4.85
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
10397361
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$4.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.37
|
| Rate for Payer: Aetna of IA Medicare |
$2.77
|
| Rate for Payer: Amerigroup Medicaid |
$2.80
|
| Rate for Payer: Amerigroup Medicare |
$2.21
|
| Rate for Payer: Cash Price |
$3.88
|
| 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 |
$2.18
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.77
|
| Rate for Payer: Medical Associates Commercial |
$3.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.18
|
| Rate for Payer: Midlands Choice Commercial |
$3.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.51
|
| Rate for Payer: United Healthcare Commercial |
$4.37
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.86
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
ipratropium Nasal 0.06% Spry [VDMC]
|
Facility
|
OP
|
$68.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10397432
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.82 |
| Max. Negotiated Rate |
$61.63 |
| Rate for Payer: Aetna of IA Commercial |
$61.63
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$61.63
|
| Rate for Payer: Aetna of IA Medicare |
$39.03
|
| Rate for Payer: Amerigroup Medicaid |
$39.50
|
| Rate for Payer: Amerigroup Medicare |
$31.13
|
| Rate for Payer: Cash Price |
$54.79
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$39.12
|
| Rate for Payer: Medical Associates Commercial |
$51.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.82
|
| Rate for Payer: Midlands Choice Commercial |
$47.94
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$35.44
|
| Rate for Payer: United Healthcare Commercial |
$61.63
|
| Rate for Payer: United Healthcare Managed Medicare |
$40.40
|
|
|
ipratropium Nasal 0.06% Spry [VDMC]
|
Facility
|
IP
|
$68.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10397432
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$61.63 |
| Rate for Payer: Aetna of IA Commercial |
$61.63
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$61.63
|
| Rate for Payer: Cash Price |
$54.79
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.36
|
| Rate for Payer: Medical Associates Commercial |
$51.36
|
| Rate for Payer: Midlands Choice Commercial |
$47.94
|
| Rate for Payer: United Healthcare Commercial |
$61.63
|
|
|
irbesartan 150 mg Tab [VDMC]
|
Facility
|
OP
|
$1.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10397497
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Aetna of IA Commercial |
$1.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.69
|
| Rate for Payer: Aetna of IA Medicare |
$1.07
|
| Rate for Payer: Amerigroup Medicaid |
$1.08
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.84
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.07
|
| Rate for Payer: Medical Associates Commercial |
$1.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.84
|
| Rate for Payer: Midlands Choice Commercial |
$1.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.97
|
| Rate for Payer: United Healthcare Commercial |
$1.69
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.11
|
|
|
irbesartan 150 mg Tab [VDMC]
|
Facility
|
IP
|
$1.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10397497
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Aetna of IA Commercial |
$1.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.69
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.41
|
| Rate for Payer: Medical Associates Commercial |
$1.41
|
| Rate for Payer: Midlands Choice Commercial |
$1.31
|
| Rate for Payer: United Healthcare Commercial |
$1.69
|
|
|
IREM F.B. COMPLICATED
|
Professional
|
Both
|
$1,527.00
|
|
|
Service Code
|
CPT 54115
|
| Hospital Charge Code |
7982862
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$466.27 |
| Max. Negotiated Rate |
$1,145.25 |
| Rate for Payer: Amerigroup Medicaid |
$470.84
|
| Rate for Payer: Cash Price |
$1,221.60
|
| Rate for Payer: Cash Price |
$1,221.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$466.27
|
| Rate for Payer: Medical Associates Commercial |
$1,145.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,068.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$468.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,145.25
|
| Rate for Payer: United Healthcare Commercial |
$700.34
|
| Rate for Payer: Wellmark IA HMO WHPI |
$868.60
|
| Rate for Payer: Wellmark IA PPO |
$1,021.90
|
|
|
IRIS RETRACTOR
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
8026386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.80 |
| 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: Aetna of IA Medicare |
$70.68
|
| Rate for Payer: Amerigroup Medicaid |
$71.52
|
| Rate for Payer: Amerigroup Medicare |
$56.36
|
| 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 |
$55.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$70.83
|
| Rate for Payer: Medical Associates Commercial |
$93.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.80
|
| Rate for Payer: Midlands Choice Commercial |
$86.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.17
|
| Rate for Payer: United Healthcare Commercial |
$111.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$73.16
|
|
|
IRIS RETRACTOR
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 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
|
|
|
IRON
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
633765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.49 |
| 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 |
$40.95
|
| Rate for Payer: Amerigroup Medicare |
$32.27
|
| 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 |
$31.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.56
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.95
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$36.74
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.89
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
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
|
|
