|
MRI UE Non Joint w/ + w/o Contrast Left
|
Facility
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
1169108
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$819.67 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,476.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,476.00
|
| Rate for Payer: Aetna of IA Medicare |
$934.80
|
| Rate for Payer: Amerigroup Medicaid |
$827.71
|
| Rate for Payer: Amerigroup Medicare |
$828.20
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,230.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$820.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$819.67
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$820.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$832.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,230.00
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$967.60
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI UE Non Joint w/ + w/o Contrast Left
|
Facility
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
1169108
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,148.00 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,476.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,476.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
|
|
MRI UE Non Joint w/ + w/o Contrast Right
|
Facility
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
1169110
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$819.67 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,476.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,476.00
|
| Rate for Payer: Aetna of IA Medicare |
$934.80
|
| Rate for Payer: Amerigroup Medicaid |
$827.71
|
| Rate for Payer: Amerigroup Medicare |
$828.20
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,230.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$820.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$819.67
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$820.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$832.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,230.00
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$967.60
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI UE Non Joint w/ + w/o Contrast Right
|
Facility
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
1169110
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,148.00 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,476.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,476.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,230.00
|
| Rate for Payer: Medical Associates Commercial |
$1,230.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,148.00
|
| Rate for Payer: United Healthcare Commercial |
$1,476.00
|
|
|
MRI Wrist w/ Contrast Left
|
Facility
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
1169134
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$717.50 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
|
|
MRI Wrist w/ Contrast Left
|
Facility
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
1169134
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$512.30 |
| Max. Negotiated Rate |
$1,357.18 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Aetna of IA Medicare |
$584.25
|
| Rate for Payer: Amerigroup Medicaid |
$517.32
|
| Rate for Payer: Amerigroup Medicare |
$517.62
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$512.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$512.30
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$512.50
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$520.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$768.75
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$604.75
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI Wrist w/ Contrast Right
|
Facility
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
1169136
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$717.50 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
|
|
MRI Wrist w/ Contrast Right
|
Facility
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
1169136
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$512.30 |
| Max. Negotiated Rate |
$1,357.18 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Aetna of IA Medicare |
$584.25
|
| Rate for Payer: Amerigroup Medicaid |
$517.32
|
| Rate for Payer: Amerigroup Medicare |
$517.62
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$512.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$512.30
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$512.50
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$520.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$768.75
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$604.75
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI Wrist w/o Contrast Left
|
Facility
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
1169140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$510.30 |
| Max. Negotiated Rate |
$1,081.65 |
| Rate for Payer: Aetna of IA Commercial |
$918.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$918.90
|
| Rate for Payer: Aetna of IA Medicare |
$581.97
|
| Rate for Payer: Amerigroup Medicaid |
$515.30
|
| Rate for Payer: Amerigroup Medicare |
$515.60
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$765.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$510.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$510.30
|
| Rate for Payer: Medical Associates Commercial |
$765.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$510.50
|
| Rate for Payer: Midlands Choice Commercial |
$714.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$518.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$765.75
|
| Rate for Payer: United Healthcare Commercial |
$918.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$602.39
|
| Rate for Payer: Wellmark IA HMO |
$983.32
|
| Rate for Payer: Wellmark IA PPO |
$1,081.65
|
|
|
MRI Wrist w/o Contrast Left
|
Facility
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
1169140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$714.70 |
| Max. Negotiated Rate |
$918.90 |
| Rate for Payer: Aetna of IA Commercial |
$918.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$918.90
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$765.75
|
| Rate for Payer: Medical Associates Commercial |
$765.75
|
| Rate for Payer: Midlands Choice Commercial |
$714.70
|
| Rate for Payer: United Healthcare Commercial |
$918.90
|
|
|
MRI Wrist w/o Contrast Right
|
Facility
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
1169142
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$510.30 |
| Max. Negotiated Rate |
$1,081.65 |
| Rate for Payer: Aetna of IA Commercial |
$918.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$918.90
|
| Rate for Payer: Aetna of IA Medicare |
$581.97
|
| Rate for Payer: Amerigroup Medicaid |
$515.30
|
| Rate for Payer: Amerigroup Medicare |
$515.60
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$765.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$510.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$510.30
|
| Rate for Payer: Medical Associates Commercial |
$765.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$510.50
|
| Rate for Payer: Midlands Choice Commercial |
$714.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$518.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$765.75
|
| Rate for Payer: United Healthcare Commercial |
$918.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$602.39
|
| Rate for Payer: Wellmark IA HMO |
$983.32
|
| Rate for Payer: Wellmark IA PPO |
$1,081.65
|
|
|
MRI Wrist w/o Contrast Right
|
Facility
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
1169142
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$714.70 |
| Max. Negotiated Rate |
$918.90 |
| Rate for Payer: Aetna of IA Commercial |
$918.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$918.90
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$765.75
|
| Rate for Payer: Medical Associates Commercial |
$765.75
|
| Rate for Payer: Midlands Choice Commercial |
$714.70
|
| Rate for Payer: United Healthcare Commercial |
$918.90
|
|
|
MRI Wrist w/ + w/o Contrast Left
|
Facility
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
1169128
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$512.30 |
| Max. Negotiated Rate |
$1,357.18 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Aetna of IA Medicare |
$584.25
|
| Rate for Payer: Amerigroup Medicaid |
$517.32
|
| Rate for Payer: Amerigroup Medicare |
$517.62
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$512.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$512.30
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$512.50
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$520.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$768.75
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$604.75
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRI Wrist w/ + w/o Contrast Left
|
Facility
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
1169128
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$717.50 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
|
|
MRI Wrist w/ + w/o Contrast Right
|
Facility
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
1169130
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$717.50 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
|
|
MRI Wrist w/ + w/o Contrast Right
|
Facility
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
1169130
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$512.30 |
| Max. Negotiated Rate |
$1,357.18 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Aetna of IA Medicare |
$584.25
|
| Rate for Payer: Amerigroup Medicaid |
$517.32
|
| Rate for Payer: Amerigroup Medicare |
$517.62
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$512.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$512.30
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$512.50
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$520.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$768.75
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$604.75
|
| Rate for Payer: Wellmark IA HMO |
$1,233.80
|
| Rate for Payer: Wellmark IA PPO |
$1,357.18
|
|
|
MRSA SCREENING
|
Facility
OP
|
$56.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
4022875
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Aetna of IA Medicare |
$31.92
|
| Rate for Payer: Amerigroup Medicaid |
$28.26
|
| Rate for Payer: Amerigroup Medicare |
$28.28
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.99
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.00
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.04
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
MRSA SCREENING
|
Facility
IP
|
$56.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
4022875
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
|
|
MULTIPLE PATIENT TRANSPORT
|
Facility
IP
|
$310.00
|
|
|
Service Code
|
CPT A0999 QN
|
| Hospital Charge Code |
7932765
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$217.00 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna of IA Commercial |
$279.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$279.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$232.50
|
| Rate for Payer: Medical Associates Commercial |
$232.50
|
| Rate for Payer: Midlands Choice Commercial |
$217.00
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
|
|
MULTIPLE PATIENT TRANSPORT
|
Facility
OP
|
$310.00
|
|
|
Service Code
|
CPT A0999 QN
|
| Hospital Charge Code |
7932765
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$154.94 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna of IA Commercial |
$279.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$279.00
|
| Rate for Payer: Aetna of IA Medicare |
$176.70
|
| Rate for Payer: Amerigroup Medicaid |
$156.46
|
| Rate for Payer: Amerigroup Medicare |
$156.55
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$232.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$155.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$154.94
|
| Rate for Payer: Medical Associates Commercial |
$232.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$155.00
|
| Rate for Payer: Midlands Choice Commercial |
$217.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$157.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$232.50
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$263.50
|
|
|
Multiple Sclerosis and Cerebellar Ataxia With CC
|
Facility
IP
|
$11,014.65
|
|
|
Service Code
|
MS-DRG 059
|
| Hospital Charge Code |
739
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$11,014.65 |
| Rate for Payer: Amerigroup Medicaid |
$10,961.44
|
| 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 |
$10,855.01
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11,014.65
|
|
|
Multiple Sclerosis and Cerebellar Ataxia With MCC
|
Facility
IP
|
$17,097.26
|
|
|
Service Code
|
MS-DRG 058
|
| Hospital Charge Code |
738
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$17,097.26 |
| Rate for Payer: Amerigroup Medicaid |
$17,014.66
|
| 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 |
$16,849.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17,097.26
|
|
|
Multiple Sclerosis and Cerebellar Ataxia Without CC/MCC
|
Facility
IP
|
$7,386.73
|
|
|
Service Code
|
MS-DRG 060
|
| Hospital Charge Code |
740
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,386.73 |
| Rate for Payer: Amerigroup Medicaid |
$7,351.05
|
| 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 |
$7,279.68
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,386.73
|
|
|
Multiple Vitamins with Minerals Oral Liq 236 mL
|
Facility
IP
|
$19.92
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$17.93 |
| Rate for Payer: Aetna of IA Commercial |
$17.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.93
|
| Rate for Payer: Cash Price |
$15.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.94
|
| Rate for Payer: Medical Associates Commercial |
$14.94
|
| Rate for Payer: Midlands Choice Commercial |
$13.94
|
| Rate for Payer: United Healthcare Commercial |
$17.93
|
|
|
Multiple Vitamins with Minerals Oral Liq 236 mL
|
Facility
OP
|
$19.92
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$17.93 |
| Rate for Payer: Aetna of IA Commercial |
$17.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.93
|
| Rate for Payer: Aetna of IA Medicare |
$11.35
|
| Rate for Payer: Amerigroup Medicaid |
$10.05
|
| Rate for Payer: Amerigroup Medicare |
$10.06
|
| Rate for Payer: Cash Price |
$15.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.94
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9.96
|
| Rate for Payer: Medical Associates Commercial |
$14.94
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.96
|
| Rate for Payer: Midlands Choice Commercial |
$13.94
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.94
|
| Rate for Payer: United Healthcare Commercial |
$17.93
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.75
|
|
