|
NEB TRT/MDI - SPUTUM INDUCTION
|
Facility
OP
|
$224.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4770831
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$111.96 |
| Max. Negotiated Rate |
$360.78 |
| Rate for Payer: Aetna of IA Commercial |
$201.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$201.60
|
| Rate for Payer: Aetna of IA Medicare |
$127.68
|
| Rate for Payer: Amerigroup Medicaid |
$113.05
|
| Rate for Payer: Amerigroup Medicare |
$113.12
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$168.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$112.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$111.96
|
| Rate for Payer: Medical Associates Commercial |
$168.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$112.00
|
| Rate for Payer: Midlands Choice Commercial |
$156.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$113.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$168.00
|
| Rate for Payer: United Healthcare Commercial |
$201.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$132.16
|
| Rate for Payer: Wellmark IA HMO |
$327.98
|
| Rate for Payer: Wellmark IA PPO |
$360.78
|
|
|
NECK ADJUSTMENT 4MM SLEEVE UNITRAX
|
Facility
OP
|
$1,952.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.61 |
| Max. Negotiated Rate |
$1,756.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,756.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,756.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,112.64
|
| Rate for Payer: Amerigroup Medicaid |
$985.17
|
| Rate for Payer: Amerigroup Medicare |
$985.76
|
| Rate for Payer: Cash Price |
$1,561.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,464.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$976.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$975.61
|
| Rate for Payer: Medical Associates Commercial |
$1,464.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$976.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,366.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$990.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,464.00
|
| Rate for Payer: United Healthcare Commercial |
$1,756.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,151.68
|
|
|
NECK ADJUSTMENT 4MM SLEEVE UNITRAX
|
Facility
IP
|
$1,952.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,366.40 |
| Max. Negotiated Rate |
$1,756.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,756.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,756.80
|
| Rate for Payer: Cash Price |
$1,561.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,464.00
|
| Rate for Payer: Medical Associates Commercial |
$1,464.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,366.40
|
| Rate for Payer: United Healthcare Commercial |
$1,756.80
|
|
|
NECK ADJUSTMENT 4MM SLEEVE UNITRAX-1
|
Facility
IP
|
$405.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
|
|
NECK ADJUSTMENT 4MM SLEEVE UNITRAX-1
|
Facility
OP
|
$405.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.42 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Aetna of IA Medicare |
$230.85
|
| Rate for Payer: Amerigroup Medicaid |
$204.40
|
| Rate for Payer: Amerigroup Medicare |
$204.52
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$202.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.42
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$205.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$303.75
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
|
NECK UNITRAK 5MM
|
Facility
IP
|
$367.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.90 |
| Max. Negotiated Rate |
$330.30 |
| Rate for Payer: Aetna of IA Commercial |
$330.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$330.30
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$275.25
|
| Rate for Payer: Medical Associates Commercial |
$275.25
|
| Rate for Payer: Midlands Choice Commercial |
$256.90
|
| Rate for Payer: United Healthcare Commercial |
$330.30
|
|
|
NECK UNITRAK 5MM
|
Facility
OP
|
$367.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.43 |
| Max. Negotiated Rate |
$330.30 |
| Rate for Payer: Aetna of IA Commercial |
$330.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$330.30
|
| Rate for Payer: Aetna of IA Medicare |
$209.19
|
| Rate for Payer: Amerigroup Medicaid |
$185.22
|
| Rate for Payer: Amerigroup Medicare |
$185.34
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$275.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$183.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$183.43
|
| Rate for Payer: Medical Associates Commercial |
$275.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$183.50
|
| Rate for Payer: Midlands Choice Commercial |
$256.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$186.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$275.25
|
| Rate for Payer: United Healthcare Commercial |
$330.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$216.53
|
|
|
NEEDLE LOCALIZATION BY XRAY
|
Facility
IP
|
$735.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
8015868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$514.50 |
| Max. Negotiated Rate |
$661.50 |
| Rate for Payer: Aetna of IA Commercial |
$661.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$661.50
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$551.25
|
| Rate for Payer: Medical Associates Commercial |
$551.25
|
| Rate for Payer: Midlands Choice Commercial |
$514.50
|
| Rate for Payer: United Healthcare Commercial |
$661.50
|
|
|
NEEDLE LOCALIZATION BY XRAY
|
Facility
OP
|
$735.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
8015868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$367.35 |
| Max. Negotiated Rate |
$720.87 |
| Rate for Payer: Aetna of IA Commercial |
$661.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$661.50
|
| Rate for Payer: Aetna of IA Medicare |
$418.95
|
| Rate for Payer: Amerigroup Medicaid |
$370.95
|
| Rate for Payer: Amerigroup Medicare |
$371.18
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$551.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$367.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$367.35
|
| Rate for Payer: Medical Associates Commercial |
$551.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$367.50
|
| Rate for Payer: Midlands Choice Commercial |
$514.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$373.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$551.25
|
| Rate for Payer: United Healthcare Commercial |
$661.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$433.65
|
| Rate for Payer: Wellmark IA HMO |
$655.34
|
| Rate for Payer: Wellmark IA PPO |
$720.87
|
|
|
NEG PRESSURE WOUND THERAPY > 50 CM
|
Facility
IP
|
$266.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
7450784
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$186.20 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Aetna of IA Commercial |
$239.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$239.40
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$199.50
|
| Rate for Payer: Medical Associates Commercial |
$199.50
|
| Rate for Payer: Midlands Choice Commercial |
$186.20
|
| Rate for Payer: United Healthcare Commercial |
$239.40
|
|
|
NEG PRESSURE WOUND THERAPY > 50 CM
|
Facility
OP
|
$266.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
7450784
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.95 |
| Max. Negotiated Rate |
$598.11 |
| Rate for Payer: Aetna of IA Commercial |
$239.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$239.40
|
| Rate for Payer: Aetna of IA Medicare |
$151.62
|
| Rate for Payer: Amerigroup Medicaid |
$134.25
|
| Rate for Payer: Amerigroup Medicare |
$134.33
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$199.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$133.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$132.95
|
| Rate for Payer: Medical Associates Commercial |
$199.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$133.00
|
| Rate for Payer: Midlands Choice Commercial |
$186.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$135.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$199.50
|
| Rate for Payer: United Healthcare Commercial |
$239.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$156.94
|
| Rate for Payer: Wellmark IA HMO |
$543.74
|
| Rate for Payer: Wellmark IA PPO |
$598.11
|
|
|
NEG PRESSURE WOUND THERAPY 50 CM OR LESS
|
Facility
IP
|
$206.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
7450783
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.20 |
| Max. Negotiated Rate |
$185.40 |
| Rate for Payer: Aetna of IA Commercial |
$185.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$185.40
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$154.50
|
| Rate for Payer: Medical Associates Commercial |
$154.50
|
| Rate for Payer: Midlands Choice Commercial |
$144.20
|
| Rate for Payer: United Healthcare Commercial |
$185.40
|
|
|
NEG PRESSURE WOUND THERAPY 50 CM OR LESS
|
Facility
OP
|
$206.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
7450783
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.96 |
| Max. Negotiated Rate |
$598.11 |
| Rate for Payer: Aetna of IA Commercial |
$185.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$185.40
|
| Rate for Payer: Aetna of IA Medicare |
$117.42
|
| Rate for Payer: Amerigroup Medicaid |
$103.97
|
| Rate for Payer: Amerigroup Medicare |
$104.03
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$154.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$103.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$102.96
|
| Rate for Payer: Medical Associates Commercial |
$154.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$103.00
|
| Rate for Payer: Midlands Choice Commercial |
$144.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$154.50
|
| Rate for Payer: United Healthcare Commercial |
$185.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$121.54
|
| Rate for Payer: Wellmark IA HMO |
$543.74
|
| Rate for Payer: Wellmark IA PPO |
$598.11
|
|
|
neomycin 500 mg Tab
|
Facility
IP
|
$3.38
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702488
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna of IA Commercial |
$3.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.04
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.54
|
| Rate for Payer: Medical Associates Commercial |
$2.54
|
| Rate for Payer: Midlands Choice Commercial |
$2.37
|
| Rate for Payer: United Healthcare Commercial |
$3.04
|
|
|
neomycin 500 mg Tab
|
Facility
OP
|
$3.38
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702488
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna of IA Commercial |
$3.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.04
|
| Rate for Payer: Aetna of IA Medicare |
$1.93
|
| Rate for Payer: Amerigroup Medicaid |
$1.71
|
| Rate for Payer: Amerigroup Medicare |
$1.71
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.54
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.69
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.69
|
| Rate for Payer: Medical Associates Commercial |
$2.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.69
|
| Rate for Payer: Midlands Choice Commercial |
$2.37
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.54
|
| Rate for Payer: United Healthcare Commercial |
$3.04
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.99
|
|
|
neomycin/polymyxin B/gramicidin Ophth 10 ml Sol
|
Facility
IP
|
$182.92
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$164.63 |
| Rate for Payer: Aetna of IA Commercial |
$164.63
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$164.63
|
| Rate for Payer: Cash Price |
$146.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$137.19
|
| Rate for Payer: Medical Associates Commercial |
$137.19
|
| Rate for Payer: Midlands Choice Commercial |
$128.04
|
| Rate for Payer: United Healthcare Commercial |
$164.63
|
|
|
neomycin/polymyxin B/gramicidin Ophth 10 ml Sol
|
Facility
OP
|
$182.92
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.42 |
| Max. Negotiated Rate |
$164.63 |
| Rate for Payer: Aetna of IA Commercial |
$164.63
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$164.63
|
| Rate for Payer: Aetna of IA Medicare |
$104.26
|
| Rate for Payer: Amerigroup Medicaid |
$92.32
|
| Rate for Payer: Amerigroup Medicare |
$92.37
|
| Rate for Payer: Cash Price |
$146.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$137.19
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$91.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$91.42
|
| Rate for Payer: Medical Associates Commercial |
$137.19
|
| Rate for Payer: Medical Associates Managed Medicare |
$91.46
|
| Rate for Payer: Midlands Choice Commercial |
$128.04
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$137.19
|
| Rate for Payer: United Healthcare Commercial |
$164.63
|
| Rate for Payer: United Healthcare Managed Medicare |
$107.92
|
|
|
Neonatal Screen Ref
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 82775
|
| Hospital Charge Code |
7822382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
Neonatal Screen Ref
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 82775
|
| Hospital Charge Code |
7822382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Neonates, Died or Transferred to Another Acute Care Facility
|
Facility
IP
|
$2,399.59
|
|
|
Service Code
|
MS-DRG 789
|
| Hospital Charge Code |
531
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$2,399.59 |
| Rate for Payer: Amerigroup Medicaid |
$2,387.99
|
| 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 |
$2,364.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,399.59
|
|
|
Neonate With Other Significant Problems
|
Facility
IP
|
$3,267.68
|
|
|
Service Code
|
MS-DRG 794
|
| Hospital Charge Code |
536
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$3,267.68 |
| Rate for Payer: Amerigroup Medicaid |
$3,251.90
|
| 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 |
$3,220.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,267.68
|
|
|
neostigmine 1 mg/mL 10ml Sol
|
Facility
OP
|
$34.64
|
|
|
Service Code
|
CPT J2710
|
| Hospital Charge Code |
43771004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$31.18 |
| Rate for Payer: Aetna of IA Commercial |
$31.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.18
|
| Rate for Payer: Aetna of IA Medicare |
$19.74
|
| Rate for Payer: Amerigroup Medicaid |
$17.48
|
| Rate for Payer: Amerigroup Medicare |
$17.49
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.98
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.31
|
| Rate for Payer: Medical Associates Commercial |
$25.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.32
|
| Rate for Payer: Midlands Choice Commercial |
$24.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$25.98
|
| Rate for Payer: United Healthcare Commercial |
$31.18
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.44
|
|
|
neostigmine 1 mg/mL 10ml Sol
|
Facility
IP
|
$34.64
|
|
|
Service Code
|
CPT J2710
|
| Hospital Charge Code |
43771004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$31.18 |
| Rate for Payer: Aetna of IA Commercial |
$31.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.18
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.98
|
| Rate for Payer: Medical Associates Commercial |
$25.98
|
| Rate for Payer: Midlands Choice Commercial |
$24.25
|
| Rate for Payer: United Healthcare Commercial |
$31.18
|
|
|
Nervous System Neoplasms With MCC
|
Facility
IP
|
$8,669.20
|
|
|
Service Code
|
MS-DRG 054
|
| Hospital Charge Code |
734
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,669.20 |
| Rate for Payer: Amerigroup Medicaid |
$8,627.32
|
| 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 |
$8,543.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,669.20
|
|
|
Nervous System Neoplasms Without MCC
|
Facility
IP
|
$8,669.20
|
|
|
Service Code
|
MS-DRG 055
|
| Hospital Charge Code |
735
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,669.20 |
| Rate for Payer: Amerigroup Medicaid |
$8,627.32
|
| 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 |
$8,543.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,669.20
|
|
