|
LENS ALCON 19.5
|
Facility
IP
|
$270.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8896431
|
|
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 ALCON 21.0
|
Facility
IP
|
$270.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8896433
|
|
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 ALCON 21.0
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8896433
|
|
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 ALCON 24.5
|
Facility
IP
|
$270.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
8896437
|
|
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 ALCON 24.5
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
8896437
|
|
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 ALCON 9.5
|
Facility
IP
|
$270.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8896435
|
|
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 ALCON 9.5
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8896435
|
|
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-PANOPTIX
|
Facility
IP
|
$845.00
|
|
|
Service Code
|
CPT V2788
|
| Hospital Charge Code |
8818765
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$591.50 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna of IA Commercial |
$760.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$760.50
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$633.75
|
| Rate for Payer: Medical Associates Commercial |
$633.75
|
| Rate for Payer: Midlands Choice Commercial |
$591.50
|
| Rate for Payer: United Healthcare Commercial |
$760.50
|
|
|
LENS-PANOPTIX
|
Facility
OP
|
$845.00
|
|
|
Service Code
|
CPT V2788
|
| Hospital Charge Code |
8818765
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$422.33 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna of IA Commercial |
$760.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$760.50
|
| Rate for Payer: Aetna of IA Medicare |
$481.65
|
| Rate for Payer: Amerigroup Medicaid |
$426.47
|
| Rate for Payer: Amerigroup Medicare |
$426.72
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$633.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$422.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$422.33
|
| Rate for Payer: Medical Associates Commercial |
$633.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$422.50
|
| Rate for Payer: Midlands Choice Commercial |
$591.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$428.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$633.75
|
| Rate for Payer: United Healthcare Commercial |
$760.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$498.55
|
|
|
LENS POSTERIOR 5.0
|
Facility
IP
|
$270.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8047351
|
|
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 POSTERIOR 5.0
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8047351
|
|
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 RESTORE
|
Facility
IP
|
$845.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8046977
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$591.50 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna of IA Commercial |
$760.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$760.50
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$633.75
|
| Rate for Payer: Medical Associates Commercial |
$633.75
|
| Rate for Payer: Midlands Choice Commercial |
$591.50
|
| Rate for Payer: United Healthcare Commercial |
$760.50
|
|
|
LENS RESTORE
|
Facility
OP
|
$845.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8046977
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$422.33 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna of IA Commercial |
$760.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$760.50
|
| Rate for Payer: Aetna of IA Medicare |
$481.65
|
| Rate for Payer: Amerigroup Medicaid |
$426.47
|
| Rate for Payer: Amerigroup Medicare |
$426.72
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$633.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$422.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$422.33
|
| Rate for Payer: Medical Associates Commercial |
$633.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$422.50
|
| Rate for Payer: Midlands Choice Commercial |
$591.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$428.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$633.75
|
| Rate for Payer: United Healthcare Commercial |
$760.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$498.55
|
|
|
LENS TORIC 13.5 SN6AT513.5D
|
Facility
OP
|
$891.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
8934816
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$445.32 |
| Max. Negotiated Rate |
$801.90 |
| Rate for Payer: Aetna of IA Commercial |
$801.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$801.90
|
| Rate for Payer: Aetna of IA Medicare |
$507.87
|
| Rate for Payer: Amerigroup Medicaid |
$449.69
|
| Rate for Payer: Amerigroup Medicare |
$449.96
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$668.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$445.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$445.32
|
| Rate for Payer: Medical Associates Commercial |
$668.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$445.50
|
| Rate for Payer: Midlands Choice Commercial |
$623.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$452.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$668.25
|
| Rate for Payer: United Healthcare Commercial |
$801.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$525.69
|
|
|
LENS TORIC 13.5 SN6AT513.5D
|
Facility
IP
|
$891.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
8934816
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$623.70 |
| Max. Negotiated Rate |
$801.90 |
| Rate for Payer: Aetna of IA Commercial |
$801.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$801.90
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$668.25
|
| Rate for Payer: Medical Associates Commercial |
$668.25
|
| Rate for Payer: Midlands Choice Commercial |
$623.70
|
| Rate for Payer: United Healthcare Commercial |
$801.90
|
|
|
LENS TORIC 14.0 SN6AT9+14.0D
|
Facility
OP
|
$584.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
8936672
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$291.88 |
| Max. Negotiated Rate |
$525.60 |
| Rate for Payer: Aetna of IA Commercial |
$525.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$525.60
|
| Rate for Payer: Aetna of IA Medicare |
$332.88
|
| Rate for Payer: Amerigroup Medicaid |
$294.74
|
| Rate for Payer: Amerigroup Medicare |
$294.92
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$438.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$292.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$291.88
|
| Rate for Payer: Medical Associates Commercial |
$438.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$292.00
|
| Rate for Payer: Midlands Choice Commercial |
$408.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$296.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$438.00
|
| Rate for Payer: United Healthcare Commercial |
$525.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$344.56
|
|
|
LENS TORIC 14.0 SN6AT9+14.0D
|
Facility
IP
|
$584.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
8936672
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$408.80 |
| Max. Negotiated Rate |
$525.60 |
| Rate for Payer: Aetna of IA Commercial |
$525.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$525.60
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$438.00
|
| Rate for Payer: Medical Associates Commercial |
$438.00
|
| Rate for Payer: Midlands Choice Commercial |
$408.80
|
| Rate for Payer: United Healthcare Commercial |
$525.60
|
|
|
LENS TORIC 18.5 SN6AT418.5D
|
Facility
IP
|
$891.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8931527
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$623.70 |
| Max. Negotiated Rate |
$801.90 |
| Rate for Payer: Aetna of IA Commercial |
$801.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$801.90
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$668.25
|
| Rate for Payer: Medical Associates Commercial |
$668.25
|
| Rate for Payer: Midlands Choice Commercial |
$623.70
|
| Rate for Payer: United Healthcare Commercial |
$801.90
|
|
|
LENS TORIC 18.5 SN6AT418.5D
|
Facility
OP
|
$891.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8931527
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$445.32 |
| Max. Negotiated Rate |
$801.90 |
| Rate for Payer: Aetna of IA Commercial |
$801.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$801.90
|
| Rate for Payer: Aetna of IA Medicare |
$507.87
|
| Rate for Payer: Amerigroup Medicaid |
$449.69
|
| Rate for Payer: Amerigroup Medicare |
$449.96
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$668.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$445.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$445.32
|
| Rate for Payer: Medical Associates Commercial |
$668.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$445.50
|
| Rate for Payer: Midlands Choice Commercial |
$623.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$452.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$668.25
|
| Rate for Payer: United Healthcare Commercial |
$801.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$525.69
|
|
|
LENS TORIC 21.0 SN6AT421.0D
|
Facility
IP
|
$584.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
8936670
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$408.80 |
| Max. Negotiated Rate |
$525.60 |
| Rate for Payer: Aetna of IA Commercial |
$525.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$525.60
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$438.00
|
| Rate for Payer: Medical Associates Commercial |
$438.00
|
| Rate for Payer: Midlands Choice Commercial |
$408.80
|
| Rate for Payer: United Healthcare Commercial |
$525.60
|
|
|
LENS TORIC 21.0 SN6AT421.0D
|
Facility
OP
|
$584.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
8936670
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$291.88 |
| Max. Negotiated Rate |
$525.60 |
| Rate for Payer: Aetna of IA Commercial |
$525.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$525.60
|
| Rate for Payer: Aetna of IA Medicare |
$332.88
|
| Rate for Payer: Amerigroup Medicaid |
$294.74
|
| Rate for Payer: Amerigroup Medicare |
$294.92
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$438.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$292.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$291.88
|
| Rate for Payer: Medical Associates Commercial |
$438.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$292.00
|
| Rate for Payer: Midlands Choice Commercial |
$408.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$296.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$438.00
|
| Rate for Payer: United Healthcare Commercial |
$525.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$344.56
|
|
|
LENS TORIC ASTIGMATISM-OR TO PROVIDE REF
|
Facility
IP
|
$375.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
8046975
|
|
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 TORIC ASTIGMATISM-OR TO PROVIDE REF
|
Facility
OP
|
$375.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
8046975
|
|
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
|
|
|
letrozole 2.5 mg Tab
|
Facility
OP
|
$85.85
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700380
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.91 |
| Max. Negotiated Rate |
$77.26 |
| Rate for Payer: Aetna of IA Commercial |
$77.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.26
|
| Rate for Payer: Aetna of IA Medicare |
$48.93
|
| Rate for Payer: Amerigroup Medicaid |
$43.33
|
| Rate for Payer: Amerigroup Medicare |
$43.35
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.39
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.91
|
| Rate for Payer: Medical Associates Commercial |
$64.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.92
|
| Rate for Payer: Midlands Choice Commercial |
$60.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.39
|
| Rate for Payer: United Healthcare Commercial |
$77.26
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.65
|
|
|
letrozole 2.5 mg Tab
|
Facility
IP
|
$85.85
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700380
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.10 |
| Max. Negotiated Rate |
$77.26 |
| Rate for Payer: Aetna of IA Commercial |
$77.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.26
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.39
|
| Rate for Payer: Medical Associates Commercial |
$64.39
|
| Rate for Payer: Midlands Choice Commercial |
$60.10
|
| Rate for Payer: United Healthcare Commercial |
$77.26
|
|
