LENS 23.0
|
Facility
OP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8047330
|
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 23.0 CNA0T023
|
Facility
IP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8896900
|
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 23.0 CNA0T023
|
Facility
OP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8896900
|
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 23.5
|
Facility
IP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8047331
|
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 23.5
|
Facility
OP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8047331
|
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 23.5 CNA0T0+23.5D
|
Facility
OP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8910636
|
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 23.5 CNA0T0+23.5D
|
Facility
IP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8910636
|
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 23.5 MN60AC23.5D
|
Facility
IP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8925574
|
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 23.5 MN60AC23.5D
|
Facility
OP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8925574
|
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 23.5 SN60WF235
|
Facility
IP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8896449
|
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 23.5 SN60WF235
|
Facility
OP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8896449
|
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 23.5 SN6AT323.5D
|
Facility
IP
|
$375.00
|
|
Service Code
|
CPT V2787
|
Hospital Charge Code |
8910640
|
Hospital Revenue Code
|
276
|
Min. Negotiated Rate |
$262.50 |
Max. Negotiated Rate |
$337.50 |
Rate for Payer: Aetna of IA Commercial |
$337.50
|
Rate for Payer: Aetna of IA Medical Rental Products |
$337.50
|
Rate for Payer: Cash Price |
$300.00
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$281.25
|
Rate for Payer: Medical Associates Commercial |
$281.25
|
Rate for Payer: Midlands Choice Commercial |
$262.50
|
Rate for Payer: United Healthcare Commercial |
$337.50
|
|
LENS 23.5 SN6AT323.5D
|
Facility
OP
|
$375.00
|
|
Service Code
|
CPT V2787
|
Hospital Charge Code |
8910640
|
Hospital Revenue Code
|
276
|
Min. Negotiated Rate |
$187.42 |
Max. Negotiated Rate |
$337.50 |
Rate for Payer: Aetna of IA Commercial |
$337.50
|
Rate for Payer: Aetna of IA Medical Rental Products |
$337.50
|
Rate for Payer: Aetna of IA Medicare |
$213.75
|
Rate for Payer: Amerigroup Medicaid |
$189.26
|
Rate for Payer: Amerigroup Medicare |
$189.38
|
Rate for Payer: Cash Price |
$300.00
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$281.25
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$187.50
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$187.42
|
Rate for Payer: Medical Associates Commercial |
$281.25
|
Rate for Payer: Medical Associates Managed Medicare |
$187.50
|
Rate for Payer: Midlands Choice Commercial |
$262.50
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$190.31
|
Rate for Payer: Partners Health Alliance Commercial |
$281.25
|
Rate for Payer: United Healthcare Commercial |
$337.50
|
Rate for Payer: United Healthcare Managed Medicare |
$221.25
|
|
LENS 24.0
|
Facility
OP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8047332
|
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 24.0
|
Facility
IP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8047332
|
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 24.0 CNA0T024.0D
|
Facility
IP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8900233
|
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 24.0 CNA0T024.0D
|
Facility
OP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8900233
|
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 24.5
|
Facility
OP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8047333
|
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 24.5
|
Facility
IP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8047333
|
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 24.5 CNA0T024.5D
|
Facility
IP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8909074
|
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 24.5 CNA0T024.5D
|
Facility
OP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8909074
|
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 24.5 SN60WF245
|
Facility
IP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8896906
|
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 24.5 SN60WF245
|
Facility
OP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8896906
|
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 25.0
|
Facility
OP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8047334
|
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 25.0
|
Facility
IP
|
$270.00
|
|
Service Code
|
CPT V2632
|
Hospital Charge Code |
8047334
|
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
|
|