|
morphine 4 mg/mL preservative-free Sol
|
Facility
OP
|
$45.45
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
43701148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$40.90 |
| Rate for Payer: Aetna of IA Commercial |
$40.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.90
|
| Rate for Payer: Aetna of IA Medicare |
$25.91
|
| Rate for Payer: Amerigroup Medicaid |
$22.94
|
| Rate for Payer: Amerigroup Medicare |
$22.95
|
| Rate for Payer: Cash Price |
$36.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.09
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.72
|
| Rate for Payer: Medical Associates Commercial |
$34.09
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.72
|
| Rate for Payer: Midlands Choice Commercial |
$31.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.09
|
| Rate for Payer: United Healthcare Commercial |
$40.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.82
|
|
|
morphine 4 mg/mL preservative-free Sol
|
Facility
IP
|
$45.45
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
43701148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$40.90 |
| Rate for Payer: Aetna of IA Commercial |
$40.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.90
|
| Rate for Payer: Cash Price |
$36.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.09
|
| Rate for Payer: Medical Associates Commercial |
$34.09
|
| Rate for Payer: Midlands Choice Commercial |
$31.82
|
| Rate for Payer: United Healthcare Commercial |
$40.90
|
|
|
morphine PCA 1 mg/mL PF 30 ml Inj Sol
|
Facility
IP
|
$76.80
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
43700265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.76 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna of IA Commercial |
$69.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.12
|
| Rate for Payer: Cash Price |
$61.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.60
|
| Rate for Payer: Medical Associates Commercial |
$57.60
|
| Rate for Payer: Midlands Choice Commercial |
$53.76
|
| Rate for Payer: United Healthcare Commercial |
$69.12
|
|
|
morphine PCA 1 mg/mL PF 30 ml Inj Sol
|
Facility
OP
|
$76.80
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
43700265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.38 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna of IA Commercial |
$69.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.12
|
| Rate for Payer: Aetna of IA Medicare |
$43.78
|
| Rate for Payer: Amerigroup Medicaid |
$38.76
|
| Rate for Payer: Amerigroup Medicare |
$38.78
|
| Rate for Payer: Cash Price |
$61.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.38
|
| Rate for Payer: Medical Associates Commercial |
$57.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.40
|
| Rate for Payer: Midlands Choice Commercial |
$53.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$57.60
|
| Rate for Payer: United Healthcare Commercial |
$69.12
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.31
|
|
|
Mouth Procedures With CC/MCC
|
Facility
IP
|
$9,294.20
|
|
|
Service Code
|
MS-DRG 137
|
| Hospital Charge Code |
17
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,294.20 |
| Rate for Payer: Amerigroup Medicaid |
$9,249.30
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9,159.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,294.20
|
|
|
Mouth Procedures Without CC/MCC
|
Facility
IP
|
$7,459.57
|
|
|
Service Code
|
MS-DRG 138
|
| Hospital Charge Code |
18
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,459.57 |
| Rate for Payer: Amerigroup Medicaid |
$7,423.53
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,351.46
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,459.57
|
|
|
moxifloxacin 0.5% Ophth Sol
|
Facility
IP
|
$44.04
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.83 |
| Max. Negotiated Rate |
$39.64 |
| Rate for Payer: Aetna of IA Commercial |
$39.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.64
|
| Rate for Payer: Cash Price |
$35.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.03
|
| Rate for Payer: Medical Associates Commercial |
$33.03
|
| Rate for Payer: Midlands Choice Commercial |
$30.83
|
| Rate for Payer: United Healthcare Commercial |
$39.64
|
|
|
moxifloxacin 0.5% Ophth Sol
|
Facility
OP
|
$44.04
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.01 |
| Max. Negotiated Rate |
$39.64 |
| Rate for Payer: Aetna of IA Commercial |
$39.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.64
|
| Rate for Payer: Aetna of IA Medicare |
$25.10
|
| Rate for Payer: Amerigroup Medicaid |
$22.23
|
| Rate for Payer: Amerigroup Medicare |
$22.24
|
| Rate for Payer: Cash Price |
$35.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.03
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.01
|
| Rate for Payer: Medical Associates Commercial |
$33.03
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.02
|
| Rate for Payer: Midlands Choice Commercial |
$30.83
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.03
|
| Rate for Payer: United Healthcare Commercial |
$39.64
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.98
|
|
|
Moxifloxacin 1.6 mg/1ml Opht Syringe
|
Facility
IP
|
$47.96
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700257
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$43.16 |
| Rate for Payer: Aetna of IA Commercial |
$43.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$43.16
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.97
|
| Rate for Payer: Medical Associates Commercial |
$35.97
|
| Rate for Payer: Midlands Choice Commercial |
$33.57
|
| Rate for Payer: United Healthcare Commercial |
$43.16
|
|
|
Moxifloxacin 1.6 mg/1ml Opht Syringe
|
Facility
OP
|
$47.96
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700257
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.97 |
| Max. Negotiated Rate |
$43.16 |
| Rate for Payer: Aetna of IA Commercial |
$43.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$43.16
|
| Rate for Payer: Aetna of IA Medicare |
$27.34
|
| Rate for Payer: Amerigroup Medicaid |
$24.21
|
| Rate for Payer: Amerigroup Medicare |
$24.22
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.97
|
| Rate for Payer: Medical Associates Commercial |
$35.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.98
|
| Rate for Payer: Midlands Choice Commercial |
$33.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$35.97
|
| Rate for Payer: United Healthcare Commercial |
$43.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$28.30
|
|
|
MRA Abdomen
|
Facility
IP
|
$1,594.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
1168633
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,115.80 |
| Max. Negotiated Rate |
$1,434.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,434.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,434.60
|
| Rate for Payer: Cash Price |
$1,275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,195.50
|
| Rate for Payer: Medical Associates Commercial |
$1,195.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,115.80
|
| Rate for Payer: United Healthcare Commercial |
$1,434.60
|
|
|
MRA Abdomen
|
Facility
OP
|
$1,594.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
1168633
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$675.80 |
| Max. Negotiated Rate |
$1,434.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,434.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,434.60
|
| Rate for Payer: Aetna of IA Medicare |
$908.58
|
| Rate for Payer: Amerigroup Medicaid |
$804.49
|
| Rate for Payer: Amerigroup Medicare |
$804.97
|
| Rate for Payer: Cash Price |
$1,275.20
|
| Rate for Payer: Cash Price |
$1,275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,195.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$797.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$796.68
|
| Rate for Payer: Medical Associates Commercial |
$1,195.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$797.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,115.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$808.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,195.50
|
| Rate for Payer: United Healthcare Commercial |
$1,434.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$940.46
|
| Rate for Payer: Wellmark IA HMO |
$675.80
|
| Rate for Payer: Wellmark IA PPO |
$743.38
|
|
|
MRA Chest
|
Facility
IP
|
$905.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
1168641
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$633.50 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Aetna of IA Commercial |
$814.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$814.50
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$678.75
|
| Rate for Payer: Medical Associates Commercial |
$678.75
|
| Rate for Payer: Midlands Choice Commercial |
$633.50
|
| Rate for Payer: United Healthcare Commercial |
$814.50
|
|
|
MRA Chest
|
Facility
OP
|
$905.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
1168641
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$452.32 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Aetna of IA Commercial |
$814.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$814.50
|
| Rate for Payer: Aetna of IA Medicare |
$515.85
|
| Rate for Payer: Amerigroup Medicaid |
$456.75
|
| Rate for Payer: Amerigroup Medicare |
$457.02
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$678.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$452.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$452.32
|
| Rate for Payer: Medical Associates Commercial |
$678.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$452.50
|
| Rate for Payer: Midlands Choice Commercial |
$633.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$459.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$678.75
|
| Rate for Payer: United Healthcare Commercial |
$814.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$533.95
|
| Rate for Payer: Wellmark IA HMO |
$675.80
|
| Rate for Payer: Wellmark IA PPO |
$743.38
|
|
|
MRA Head w/ Contrast
|
Facility
OP
|
$1,147.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
1168651
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$573.27 |
| Max. Negotiated Rate |
$1,032.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,032.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,032.30
|
| Rate for Payer: Aetna of IA Medicare |
$653.79
|
| Rate for Payer: Amerigroup Medicaid |
$578.89
|
| Rate for Payer: Amerigroup Medicare |
$579.24
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$860.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$573.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$573.27
|
| Rate for Payer: Medical Associates Commercial |
$860.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$573.50
|
| Rate for Payer: Midlands Choice Commercial |
$802.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$582.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$860.25
|
| Rate for Payer: United Healthcare Commercial |
$1,032.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$676.73
|
| Rate for Payer: Wellmark IA HMO |
$675.80
|
| Rate for Payer: Wellmark IA PPO |
$743.38
|
|
|
MRA Head w/ Contrast
|
Facility
IP
|
$1,147.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
1168651
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$802.90 |
| Max. Negotiated Rate |
$1,032.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,032.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,032.30
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$860.25
|
| Rate for Payer: Medical Associates Commercial |
$860.25
|
| Rate for Payer: Midlands Choice Commercial |
$802.90
|
| Rate for Payer: United Healthcare Commercial |
$1,032.30
|
|
|
MRA Head w/o Contrast
|
Facility
OP
|
$1,070.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
1168653
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$534.79 |
| Max. Negotiated Rate |
$963.00 |
| Rate for Payer: Aetna of IA Commercial |
$963.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$963.00
|
| Rate for Payer: Aetna of IA Medicare |
$609.90
|
| Rate for Payer: Amerigroup Medicaid |
$540.03
|
| Rate for Payer: Amerigroup Medicare |
$540.35
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$802.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$535.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$534.79
|
| Rate for Payer: Medical Associates Commercial |
$802.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$535.00
|
| Rate for Payer: Midlands Choice Commercial |
$749.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$543.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$802.50
|
| Rate for Payer: United Healthcare Commercial |
$963.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$631.30
|
| Rate for Payer: Wellmark IA HMO |
$675.80
|
| Rate for Payer: Wellmark IA PPO |
$743.38
|
|
|
MRA Head w/o Contrast
|
Facility
IP
|
$1,070.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
1168653
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$749.00 |
| Max. Negotiated Rate |
$963.00 |
| Rate for Payer: Aetna of IA Commercial |
$963.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$963.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$802.50
|
| Rate for Payer: Medical Associates Commercial |
$802.50
|
| Rate for Payer: Midlands Choice Commercial |
$749.00
|
| Rate for Payer: United Healthcare Commercial |
$963.00
|
|
|
MRA Head w/ + w/o Contrast
|
Facility
OP
|
$1,147.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
1168649
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$573.27 |
| Max. Negotiated Rate |
$1,032.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,032.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,032.30
|
| Rate for Payer: Aetna of IA Medicare |
$653.79
|
| Rate for Payer: Amerigroup Medicaid |
$578.89
|
| Rate for Payer: Amerigroup Medicare |
$579.24
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$860.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$573.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$573.27
|
| Rate for Payer: Medical Associates Commercial |
$860.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$573.50
|
| Rate for Payer: Midlands Choice Commercial |
$802.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$582.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$860.25
|
| Rate for Payer: United Healthcare Commercial |
$1,032.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$676.73
|
| Rate for Payer: Wellmark IA HMO |
$675.80
|
| Rate for Payer: Wellmark IA PPO |
$743.38
|
|
|
MRA Head w/ + w/o Contrast
|
Facility
IP
|
$1,147.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
1168649
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$802.90 |
| Max. Negotiated Rate |
$1,032.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,032.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,032.30
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$860.25
|
| Rate for Payer: Medical Associates Commercial |
$860.25
|
| Rate for Payer: Midlands Choice Commercial |
$802.90
|
| Rate for Payer: United Healthcare Commercial |
$1,032.30
|
|
|
MRA Neck w/ Contrast
|
Facility
IP
|
$1,147.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
1168681
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$802.90 |
| Max. Negotiated Rate |
$1,032.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,032.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,032.30
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$860.25
|
| Rate for Payer: Medical Associates Commercial |
$860.25
|
| Rate for Payer: Midlands Choice Commercial |
$802.90
|
| Rate for Payer: United Healthcare Commercial |
$1,032.30
|
|
|
MRA Neck w/ Contrast
|
Facility
OP
|
$1,147.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
1168681
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$573.27 |
| Max. Negotiated Rate |
$1,032.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,032.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,032.30
|
| Rate for Payer: Aetna of IA Medicare |
$653.79
|
| Rate for Payer: Amerigroup Medicaid |
$578.89
|
| Rate for Payer: Amerigroup Medicare |
$579.24
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$860.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$573.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$573.27
|
| Rate for Payer: Medical Associates Commercial |
$860.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$573.50
|
| Rate for Payer: Midlands Choice Commercial |
$802.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$582.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$860.25
|
| Rate for Payer: United Healthcare Commercial |
$1,032.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$676.73
|
| Rate for Payer: Wellmark IA HMO |
$675.80
|
| Rate for Payer: Wellmark IA PPO |
$743.38
|
|
|
MRA Neck w/o Contrast
|
Facility
IP
|
$1,070.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
1168683
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$749.00 |
| Max. Negotiated Rate |
$963.00 |
| Rate for Payer: Aetna of IA Commercial |
$963.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$963.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$802.50
|
| Rate for Payer: Medical Associates Commercial |
$802.50
|
| Rate for Payer: Midlands Choice Commercial |
$749.00
|
| Rate for Payer: United Healthcare Commercial |
$963.00
|
|
|
MRA Neck w/o Contrast
|
Facility
OP
|
$1,070.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
1168683
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$534.79 |
| Max. Negotiated Rate |
$963.00 |
| Rate for Payer: Aetna of IA Commercial |
$963.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$963.00
|
| Rate for Payer: Aetna of IA Medicare |
$609.90
|
| Rate for Payer: Amerigroup Medicaid |
$540.03
|
| Rate for Payer: Amerigroup Medicare |
$540.35
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$802.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$535.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$534.79
|
| Rate for Payer: Medical Associates Commercial |
$802.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$535.00
|
| Rate for Payer: Midlands Choice Commercial |
$749.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$543.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$802.50
|
| Rate for Payer: United Healthcare Commercial |
$963.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$631.30
|
| Rate for Payer: Wellmark IA HMO |
$675.80
|
| Rate for Payer: Wellmark IA PPO |
$743.38
|
|
|
MRA Neck w/ + w/o Contrast
|
Facility
IP
|
$1,147.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
1168679
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$802.90 |
| Max. Negotiated Rate |
$1,032.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,032.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,032.30
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$860.25
|
| Rate for Payer: Medical Associates Commercial |
$860.25
|
| Rate for Payer: Midlands Choice Commercial |
$802.90
|
| Rate for Payer: United Healthcare Commercial |
$1,032.30
|
|
