|
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: Molina Healthcare Managed Medicare |
$372.79
|
| Rate for Payer: Oscar Health of IA Commercial |
$551.25
|
| 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
|
|
|
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
|
|
|
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: Molina Healthcare Managed Medicare |
$134.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$199.50
|
| 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
|
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 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: Molina Healthcare Managed Medicare |
$104.48
|
| Rate for Payer: Oscar Health of IA Commercial |
$154.50
|
| 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 [VDMC]
|
Facility
|
OP
|
$3.38
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11511562
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$1.71
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.54
|
| 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 500 mg Tab [VDMC]
|
Facility
|
IP
|
$3.38
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11511562
|
|
Hospital Revenue Code
|
259
|
| 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/polymyxin B/gramicidin Ophth 10 ml Sol [VDMC]
|
Facility
|
OP
|
$182.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10392728
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$92.78
|
| Rate for Payer: Oscar Health of IA Commercial |
$137.19
|
| 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
|
|
|
neomycin/polymyxin B/gramicidin Ophth 10 ml Sol [VDMC]
|
Facility
|
IP
|
$182.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10392728
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
|
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: Molina Healthcare Managed Medicare |
$70.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$104.25
|
| 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
|
|
|
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
|
|
|
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 |
$2,364.81 |
| Max. Negotiated Rate |
$2,399.59 |
| Rate for Payer: Amerigroup Medicaid |
$2,387.99
|
| 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 |
$3,220.32 |
| Max. Negotiated Rate |
$3,267.68 |
| Rate for Payer: Amerigroup Medicaid |
$3,251.90
|
| 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 [VDMC]
|
Facility
|
IP
|
$34.64
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
11224533
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
|
neostigmine 1 mg/mL 10ml Sol [VDMC]
|
Facility
|
OP
|
$34.64
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
11224533
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$17.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$25.98
|
| 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
|
|
|
Nervous System Neoplasms With MCC
|
Facility
|
IP
|
$8,669.20
|
|
|
Service Code
|
MS-DRG 054
|
| Hospital Charge Code |
734
|
| Min. Negotiated Rate |
$8,543.56 |
| Max. Negotiated Rate |
$8,669.20 |
| Rate for Payer: Amerigroup Medicaid |
$8,627.32
|
| 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 |
$8,543.56 |
| Max. Negotiated Rate |
$8,669.20 |
| Rate for Payer: Amerigroup Medicaid |
$8,627.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,543.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,669.20
|
|
|
Neurological Eye Disorders
|
Facility
|
IP
|
$8,433.97
|
|
|
Service Code
|
MS-DRG 123
|
| Hospital Charge Code |
12
|
| Min. Negotiated Rate |
$8,311.74 |
| Max. Negotiated Rate |
$8,433.97 |
| Rate for Payer: Amerigroup Medicaid |
$8,393.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,311.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,433.97
|
|
|
NEUROMUSCULAR ED PER 15 MIN
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 97112 GO
|
| Hospital Charge Code |
750905
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
NEUROMUSCULAR ED PER 15 MIN
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 97112 GO
|
| Hospital Charge Code |
750905
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$56.98 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$57.54
|
| Rate for Payer: Amerigroup Medicare |
$57.57
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.98
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.86
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$57.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$85.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
|
|
NEUROMUSCULAR RE-ED 15 MIN
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97112 GN
|
| Hospital Charge Code |
7697845
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.75
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
|
|
NEUROMUSCULAR RE-ED 15 MIN
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 97112 GP
|
| Hospital Charge Code |
1373913
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$56.98 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$57.54
|
| Rate for Payer: Amerigroup Medicare |
$57.57
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.98
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.86
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$57.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$85.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
|
|
NEUROMUSCULAR RE-ED 15 MIN
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97112 GN
|
| Hospital Charge Code |
7697845
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$90.46 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Aetna of IA Medicare |
$103.17
|
| Rate for Payer: Amerigroup Medicaid |
$91.35
|
| Rate for Payer: Amerigroup Medicare |
$91.40
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.46
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.50
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.86
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$91.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$135.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.75
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.79
|
|
|
NEUROMUSCULAR RE-ED 15 MIN
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 97112 GP
|
| Hospital Charge Code |
1373913
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
