|
Non-malignant Breast Disorders Without CC/MCC
|
Facility
IP
|
$3,800.16
|
|
|
Service Code
|
MS-DRG 601
|
| Hospital Charge Code |
399
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$3,800.16 |
| Rate for Payer: Amerigroup Medicaid |
$3,781.80
|
| 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 |
$3,745.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,800.16
|
|
|
Nonspecific Cerebrovascular Disorders With CC
|
Facility
IP
|
$8,016.64
|
|
|
Service Code
|
MS-DRG 071
|
| Hospital Charge Code |
751
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,016.64 |
| Rate for Payer: Amerigroup Medicaid |
$7,977.92
|
| 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 |
$7,900.46
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,016.64
|
|
|
Nonspecific Cerebrovascular Disorders With MCC
|
Facility
IP
|
$15,404.36
|
|
|
Service Code
|
MS-DRG 070
|
| Hospital Charge Code |
750
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$15,404.36 |
| Rate for Payer: Amerigroup Medicaid |
$15,329.94
|
| 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 |
$15,181.11
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15,404.36
|
|
|
Nonspecific Cerebrovascular Disorders Without CC/MCC
|
Facility
IP
|
$6,501.90
|
|
|
Service Code
|
MS-DRG 072
|
| Hospital Charge Code |
752
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,501.90 |
| Rate for Payer: Amerigroup Medicaid |
$6,470.49
|
| 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 |
$6,407.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,501.90
|
|
|
Nonspecific CVA and Precerebral Occlusion Without Infarction With MCC
|
Facility
IP
|
$14,021.51
|
|
|
Service Code
|
MS-DRG 067
|
| Hospital Charge Code |
747
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$14,021.51 |
| Rate for Payer: Amerigroup Medicaid |
$13,953.77
|
| 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 |
$13,818.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14,021.51
|
|
|
Nonspecific CVA and Precerebral Occlusion Without Infarction Without MCC
|
Facility
IP
|
$9,575.69
|
|
|
Service Code
|
MS-DRG 068
|
| Hospital Charge Code |
748
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,575.69 |
| Rate for Payer: Amerigroup Medicaid |
$9,529.43
|
| 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 |
$9,436.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,575.69
|
|
|
NON-STERILE SNIPER STAPLE IMPLANTS 20X20X20
|
Facility
OP
|
$1,629.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8837859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$814.17 |
| Max. Negotiated Rate |
$1,466.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,466.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,466.10
|
| Rate for Payer: Aetna of IA Medicare |
$928.53
|
| Rate for Payer: Amerigroup Medicaid |
$822.16
|
| Rate for Payer: Amerigroup Medicare |
$822.64
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,221.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$814.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$814.17
|
| Rate for Payer: Medical Associates Commercial |
$1,221.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$814.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,140.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$826.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,221.75
|
| Rate for Payer: United Healthcare Commercial |
$1,466.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$961.11
|
|
|
NON-STERILE SNIPER STAPLE IMPLANTS 20X20X20
|
Facility
IP
|
$1,629.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8837859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.30 |
| Max. Negotiated Rate |
$1,466.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,466.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,466.10
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,221.75
|
| Rate for Payer: Medical Associates Commercial |
$1,221.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,140.30
|
| Rate for Payer: United Healthcare Commercial |
$1,466.10
|
|
|
NON-STERILE SNIPER STAPLE IMPLANTS 8X8X8
|
Facility
IP
|
$1,368.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8830151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.60 |
| Max. Negotiated Rate |
$1,231.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,231.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,026.00
|
| Rate for Payer: Medical Associates Commercial |
$1,026.00
|
| Rate for Payer: Midlands Choice Commercial |
$957.60
|
| Rate for Payer: United Healthcare Commercial |
$1,231.20
|
|
|
NON-STERILE SNIPER STAPLE IMPLANTS 8X8X8
|
Facility
OP
|
$1,368.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8830151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.73 |
| Max. Negotiated Rate |
$1,231.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,231.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,231.20
|
| Rate for Payer: Aetna of IA Medicare |
$779.76
|
| Rate for Payer: Amerigroup Medicaid |
$690.43
|
| Rate for Payer: Amerigroup Medicare |
$690.84
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,026.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$684.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$683.73
|
| Rate for Payer: Medical Associates Commercial |
$1,026.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$684.00
|
| Rate for Payer: Midlands Choice Commercial |
$957.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$694.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,026.00
|
| Rate for Payer: United Healthcare Commercial |
$1,231.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$807.12
|
|
|
NON-STRES TEST (COB)
|
Facility
IP
|
$461.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
4096783
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$322.70 |
| Max. Negotiated Rate |
$414.90 |
| Rate for Payer: Aetna of IA Commercial |
$414.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$414.90
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$345.75
|
| Rate for Payer: Medical Associates Commercial |
$345.75
|
| Rate for Payer: Midlands Choice Commercial |
$322.70
|
| Rate for Payer: United Healthcare Commercial |
$414.90
|
|
|
NON-STRES TEST (COB)
|
Facility
OP
|
$461.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
4126788
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$230.41 |
| Max. Negotiated Rate |
$533.32 |
| Rate for Payer: Aetna of IA Commercial |
$414.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$414.90
|
| Rate for Payer: Aetna of IA Medicare |
$262.77
|
| Rate for Payer: Amerigroup Medicaid |
$232.67
|
| Rate for Payer: Amerigroup Medicare |
$232.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$345.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$230.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$230.41
|
| Rate for Payer: Medical Associates Commercial |
$345.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$230.50
|
| Rate for Payer: Midlands Choice Commercial |
$322.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$233.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$345.75
|
| Rate for Payer: United Healthcare Commercial |
$414.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$271.99
|
| Rate for Payer: Wellmark IA HMO |
$484.84
|
| Rate for Payer: Wellmark IA PPO |
$533.32
|
|
|
NON-STRES TEST (COB)
|
Facility
OP
|
$461.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
4096783
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$230.41 |
| Max. Negotiated Rate |
$533.32 |
| Rate for Payer: Aetna of IA Commercial |
$414.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$414.90
|
| Rate for Payer: Aetna of IA Medicare |
$262.77
|
| Rate for Payer: Amerigroup Medicaid |
$232.67
|
| Rate for Payer: Amerigroup Medicare |
$232.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$345.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$230.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$230.41
|
| Rate for Payer: Medical Associates Commercial |
$345.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$230.50
|
| Rate for Payer: Midlands Choice Commercial |
$322.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$233.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$345.75
|
| Rate for Payer: United Healthcare Commercial |
$414.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$271.99
|
| Rate for Payer: Wellmark IA HMO |
$484.84
|
| Rate for Payer: Wellmark IA PPO |
$533.32
|
|
|
NON-STRES TEST (COB)
|
Facility
IP
|
$461.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
4126788
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$322.70 |
| Max. Negotiated Rate |
$414.90 |
| Rate for Payer: Aetna of IA Commercial |
$414.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$414.90
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$345.75
|
| Rate for Payer: Medical Associates Commercial |
$345.75
|
| Rate for Payer: Midlands Choice Commercial |
$322.70
|
| Rate for Payer: United Healthcare Commercial |
$414.90
|
|
|
Nontraumatic Stupor and Coma With MCC
|
Facility
IP
|
$20,595.26
|
|
|
Service Code
|
MS-DRG 080
|
| Hospital Charge Code |
760
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$20,595.26 |
| Rate for Payer: Amerigroup Medicaid |
$20,495.76
|
| 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 |
$20,296.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20,595.26
|
|
|
Nontraumatic Stupor and Coma Without MCC
|
Facility
IP
|
$5,393.64
|
|
|
Service Code
|
MS-DRG 081
|
| Hospital Charge Code |
761
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,393.64 |
| Rate for Payer: Amerigroup Medicaid |
$5,367.59
|
| 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 |
$5,315.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,393.64
|
|
|
NOREPINEPHRINE 4 MG/250 ML-D5W
|
Facility
IP
|
$123.58
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43700556
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.51 |
| Max. Negotiated Rate |
$111.22 |
| Rate for Payer: Aetna of IA Commercial |
$111.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$111.22
|
| Rate for Payer: Cash Price |
$98.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.68
|
| Rate for Payer: Medical Associates Commercial |
$92.68
|
| Rate for Payer: Midlands Choice Commercial |
$86.51
|
| Rate for Payer: United Healthcare Commercial |
$111.22
|
|
|
NOREPINEPHRINE 4 MG/250 ML-D5W
|
Facility
OP
|
$123.58
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43700556
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.77 |
| Max. Negotiated Rate |
$111.22 |
| Rate for Payer: Aetna of IA Commercial |
$111.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$111.22
|
| Rate for Payer: Aetna of IA Medicare |
$70.44
|
| Rate for Payer: Amerigroup Medicaid |
$62.37
|
| Rate for Payer: Amerigroup Medicare |
$62.41
|
| Rate for Payer: Cash Price |
$98.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.68
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$61.79
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.77
|
| Rate for Payer: Medical Associates Commercial |
$92.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$61.79
|
| Rate for Payer: Midlands Choice Commercial |
$86.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$92.68
|
| Rate for Payer: United Healthcare Commercial |
$111.22
|
| Rate for Payer: United Healthcare Managed Medicare |
$72.91
|
|
|
Normal Newborn
|
Facility
IP
|
$2,844.46
|
|
|
Service Code
|
MS-DRG 795
|
| Hospital Charge Code |
537
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$2,844.46 |
| Rate for Payer: Amerigroup Medicaid |
$2,830.72
|
| 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 |
$2,803.24
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,844.46
|
|
|
nortriptyline
|
Facility
IP
|
$1.25
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna of IA Commercial |
$1.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.12
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.94
|
| Rate for Payer: Medical Associates Commercial |
$0.94
|
| Rate for Payer: Midlands Choice Commercial |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
|
|
nortriptyline
|
Facility
OP
|
$1.25
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna of IA Commercial |
$1.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.12
|
| Rate for Payer: Aetna of IA Medicare |
$0.71
|
| Rate for Payer: Amerigroup Medicaid |
$0.63
|
| Rate for Payer: Amerigroup Medicare |
$0.63
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.94
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.63
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.62
|
| Rate for Payer: Medical Associates Commercial |
$0.94
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.63
|
| Rate for Payer: Midlands Choice Commercial |
$0.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.74
|
|
|
nortriptyline 10 mg Cap
|
Facility
OP
|
$1.40
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna of IA Commercial |
$1.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.26
|
| Rate for Payer: Aetna of IA Medicare |
$0.80
|
| Rate for Payer: Amerigroup Medicaid |
$0.71
|
| Rate for Payer: Amerigroup Medicare |
$0.71
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.05
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.70
|
| Rate for Payer: Medical Associates Commercial |
$1.05
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.70
|
| Rate for Payer: Midlands Choice Commercial |
$0.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$1.26
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.83
|
|
|
nortriptyline 10 mg Cap
|
Facility
IP
|
$1.40
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna of IA Commercial |
$1.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.26
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.05
|
| Rate for Payer: Medical Associates Commercial |
$1.05
|
| Rate for Payer: Midlands Choice Commercial |
$0.98
|
| Rate for Payer: United Healthcare Commercial |
$1.26
|
|
|
NOVAFIXPATCH 4x4cm
|
Facility
OP
|
$3,960.00
|
|
|
Service Code
|
CPT Q4208
|
| Hospital Charge Code |
8822525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,881.08 |
| Max. Negotiated Rate |
$3,564.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,564.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,564.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,257.20
|
| Rate for Payer: Amerigroup Medicaid |
$1,998.61
|
| Rate for Payer: Amerigroup Medicare |
$1,999.80
|
| Rate for Payer: Cash Price |
$3,168.00
|
| Rate for Payer: Cash Price |
$3,168.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,970.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,980.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,979.21
|
| Rate for Payer: Medical Associates Commercial |
$2,970.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,980.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,772.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,009.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,970.00
|
| Rate for Payer: United Healthcare Commercial |
$3,564.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,336.40
|
| Rate for Payer: Wellmark IA HMO |
$1,881.08
|
| Rate for Payer: Wellmark IA PPO |
$2,069.19
|
|
|
NOVAFIXPATCH 4x4cm
|
Facility
IP
|
$3,960.00
|
|
|
Service Code
|
CPT Q4208
|
| Hospital Charge Code |
8822525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.00 |
| Max. Negotiated Rate |
$3,564.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,564.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,564.00
|
| Rate for Payer: Cash Price |
$3,168.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,970.00
|
| Rate for Payer: Medical Associates Commercial |
$2,970.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,772.00
|
| Rate for Payer: United Healthcare Commercial |
$3,564.00
|
|
