|
orphenadrine citrate 60 mg/2ml soln [VDMC]
|
Facility
|
IP
|
$32.42
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
10429845
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.70 |
| Max. Negotiated Rate |
$29.18 |
| Rate for Payer: Aetna of IA Commercial |
$29.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.18
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.32
|
| Rate for Payer: Medical Associates Commercial |
$24.32
|
| Rate for Payer: Midlands Choice Commercial |
$22.70
|
| Rate for Payer: United Healthcare Commercial |
$29.18
|
|
|
orphenadrine citrate 60 mg/2ml soln [VDMC]
|
Facility
|
OP
|
$32.42
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
10429845
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$29.18 |
| Rate for Payer: Aetna of IA Commercial |
$29.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.18
|
| Rate for Payer: Aetna of IA Medicare |
$18.48
|
| Rate for Payer: Amerigroup Medicaid |
$18.70
|
| Rate for Payer: Amerigroup Medicare |
$14.74
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.59
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.52
|
| Rate for Payer: Medical Associates Commercial |
$24.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.59
|
| Rate for Payer: Midlands Choice Commercial |
$22.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.78
|
| Rate for Payer: United Healthcare Commercial |
$29.18
|
| Rate for Payer: United Healthcare Managed Medicare |
$19.13
|
|
|
ORTHO DYNBRAC PER 15 MIN
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 97760 GO
|
| Hospital Charge Code |
1373573
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Aetna of IA Commercial |
$117.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.90
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$98.25
|
| Rate for Payer: Medical Associates Commercial |
$98.25
|
| Rate for Payer: Midlands Choice Commercial |
$91.70
|
| Rate for Payer: United Healthcare Commercial |
$117.90
|
|
|
ORTHO DYNBRAC PER 15 MIN
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 97760 GO
|
| Hospital Charge Code |
1373573
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$58.95 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Aetna of IA Commercial |
$117.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.90
|
| Rate for Payer: Aetna of IA Medicare |
$74.67
|
| Rate for Payer: Amerigroup Medicaid |
$75.56
|
| Rate for Payer: Amerigroup Medicare |
$59.54
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$98.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$58.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.83
|
| Rate for Payer: Medical Associates Commercial |
$98.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.95
|
| Rate for Payer: Midlands Choice Commercial |
$91.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$67.79
|
| Rate for Payer: United Healthcare Commercial |
$117.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$77.29
|
|
|
ORTHOTICS TRAINING MGMT/BRACE 15 MIN
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 97760 GP
|
| Hospital Charge Code |
1374120
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Aetna of IA Commercial |
$117.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.90
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$98.25
|
| Rate for Payer: Medical Associates Commercial |
$98.25
|
| Rate for Payer: Midlands Choice Commercial |
$91.70
|
| Rate for Payer: United Healthcare Commercial |
$117.90
|
|
|
ORTHOTICS TRAINING MGMT/BRACE 15 MIN
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 97760 GP
|
| Hospital Charge Code |
1374120
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.95 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Aetna of IA Commercial |
$117.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.90
|
| Rate for Payer: Aetna of IA Medicare |
$74.67
|
| Rate for Payer: Amerigroup Medicaid |
$75.56
|
| Rate for Payer: Amerigroup Medicare |
$59.54
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$98.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$58.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.83
|
| Rate for Payer: Medical Associates Commercial |
$98.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.95
|
| Rate for Payer: Midlands Choice Commercial |
$91.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$67.79
|
| Rate for Payer: United Healthcare Commercial |
$117.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$77.29
|
|
|
oseltamivir 30 mg Cap [VDMC]
|
Facility
|
IP
|
$3.90
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
14563568
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna of IA Commercial |
$3.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.51
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.92
|
| Rate for Payer: Medical Associates Commercial |
$2.92
|
| Rate for Payer: Midlands Choice Commercial |
$2.73
|
| Rate for Payer: United Healthcare Commercial |
$3.51
|
|
|
oseltamivir 30 mg Cap [VDMC]
|
Facility
|
OP
|
$3.90
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
14563568
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna of IA Commercial |
$3.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.51
|
| Rate for Payer: Aetna of IA Medicare |
$2.22
|
| Rate for Payer: Amerigroup Medicaid |
$2.25
|
| Rate for Payer: Amerigroup Medicare |
$1.77
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.92
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.23
|
| Rate for Payer: Medical Associates Commercial |
$2.92
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.75
|
| Rate for Payer: Midlands Choice Commercial |
$2.73
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.02
|
| Rate for Payer: United Healthcare Commercial |
$3.51
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.30
|
|
|
oseltamivir 6 mg/mL Pow 60ml [VDMC]
|
Facility
|
IP
|
$116.84
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10410690
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$105.16 |
| Rate for Payer: Aetna of IA Commercial |
$105.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.16
|
| Rate for Payer: Cash Price |
$93.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.63
|
| Rate for Payer: Medical Associates Commercial |
$87.63
|
| Rate for Payer: Midlands Choice Commercial |
$81.79
|
| Rate for Payer: United Healthcare Commercial |
$105.16
|
|
|
oseltamivir 6 mg/mL Pow 60ml [VDMC]
|
Facility
|
OP
|
$116.84
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10410690
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$52.58 |
| Max. Negotiated Rate |
$105.16 |
| Rate for Payer: Aetna of IA Commercial |
$105.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.16
|
| Rate for Payer: Aetna of IA Medicare |
$66.60
|
| Rate for Payer: Amerigroup Medicaid |
$67.39
|
| Rate for Payer: Amerigroup Medicare |
$53.10
|
| Rate for Payer: Cash Price |
$93.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.63
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$66.74
|
| Rate for Payer: Medical Associates Commercial |
$87.63
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.58
|
| Rate for Payer: Midlands Choice Commercial |
$81.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$67.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$60.47
|
| Rate for Payer: United Healthcare Commercial |
$105.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$68.94
|
|
|
oseltamivir 75 mg Cap [VDMC]
|
Facility
|
IP
|
$3.89
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10410755
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna of IA Commercial |
$3.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.50
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.92
|
| Rate for Payer: Medical Associates Commercial |
$2.92
|
| Rate for Payer: Midlands Choice Commercial |
$2.72
|
| Rate for Payer: United Healthcare Commercial |
$3.50
|
|
|
oseltamivir 75 mg Cap [VDMC]
|
Facility
|
OP
|
$3.89
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10410755
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna of IA Commercial |
$3.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.50
|
| Rate for Payer: Aetna of IA Medicare |
$2.22
|
| Rate for Payer: Amerigroup Medicaid |
$2.24
|
| Rate for Payer: Amerigroup Medicare |
$1.77
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.92
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.22
|
| Rate for Payer: Medical Associates Commercial |
$2.92
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.75
|
| Rate for Payer: Midlands Choice Commercial |
$2.72
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.01
|
| Rate for Payer: United Healthcare Commercial |
$3.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.29
|
|
|
Osmolality DMCL
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
8037745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.35 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna of IA Commercial |
$56.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$56.70
|
| Rate for Payer: Aetna of IA Medicare |
$35.91
|
| Rate for Payer: Amerigroup Medicaid |
$36.34
|
| Rate for Payer: Amerigroup Medicare |
$28.63
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.99
|
| Rate for Payer: Medical Associates Commercial |
$47.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.35
|
| Rate for Payer: Midlands Choice Commercial |
$44.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$32.60
|
| Rate for Payer: United Healthcare Commercial |
$56.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.17
|
|
|
Osmolality DMCL
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
8037745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna of IA Commercial |
$56.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$56.70
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.25
|
| Rate for Payer: Medical Associates Commercial |
$47.25
|
| Rate for Payer: Midlands Choice Commercial |
$44.10
|
| Rate for Payer: United Healthcare Commercial |
$56.70
|
|
|
Osmolality Urine DMCL
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
8037735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna of IA Commercial |
$58.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.50
|
| Rate for Payer: Aetna of IA Medicare |
$37.05
|
| Rate for Payer: Amerigroup Medicaid |
$37.49
|
| Rate for Payer: Amerigroup Medicare |
$29.54
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.13
|
| Rate for Payer: Medical Associates Commercial |
$48.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.25
|
| Rate for Payer: Midlands Choice Commercial |
$45.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.64
|
| Rate for Payer: United Healthcare Commercial |
$58.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.35
|
|
|
Osmolality Urine DMCL
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
8037735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna of IA Commercial |
$58.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.50
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.75
|
| Rate for Payer: Medical Associates Commercial |
$48.75
|
| Rate for Payer: Midlands Choice Commercial |
$45.50
|
| Rate for Payer: United Healthcare Commercial |
$58.50
|
|
|
OSSIO FIBER SUTURE ANCHOR SYSTEM
|
Facility
|
IP
|
$3,051.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8972320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,135.70 |
| Max. Negotiated Rate |
$2,745.90 |
| Rate for Payer: Aetna of IA Commercial |
$2,745.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,745.90
|
| Rate for Payer: Cash Price |
$2,440.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,288.25
|
| Rate for Payer: Medical Associates Commercial |
$2,288.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,135.70
|
| Rate for Payer: United Healthcare Commercial |
$2,745.90
|
|
|
OSSIO FIBER SUTURE ANCHOR SYSTEM
|
Facility
|
OP
|
$3,051.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8972320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,372.95 |
| Max. Negotiated Rate |
$2,745.90 |
| Rate for Payer: Aetna of IA Commercial |
$2,745.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,745.90
|
| Rate for Payer: Aetna of IA Medicare |
$1,739.07
|
| Rate for Payer: Amerigroup Medicaid |
$1,759.82
|
| Rate for Payer: Amerigroup Medicare |
$1,386.68
|
| Rate for Payer: Cash Price |
$2,440.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,288.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,372.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,742.73
|
| Rate for Payer: Medical Associates Commercial |
$2,288.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,372.95
|
| Rate for Payer: Midlands Choice Commercial |
$2,135.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,768.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,578.89
|
| Rate for Payer: United Healthcare Commercial |
$2,745.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,800.09
|
|
|
OT Cog Ther Intervent, Addl 15 Min Units
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
8774214
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of IA Commercial |
$76.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.50
|
| Rate for Payer: Aetna of IA Medicare |
$48.45
|
| Rate for Payer: Amerigroup Medicaid |
$49.03
|
| Rate for Payer: Amerigroup Medicare |
$38.63
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$48.55
|
| Rate for Payer: Medical Associates Commercial |
$63.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.25
|
| Rate for Payer: Midlands Choice Commercial |
$59.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.99
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.15
|
|
|
OT Cog Ther Intervent, Addl 15 Min Units
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
8774214
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of IA Commercial |
$76.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.50
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.75
|
| Rate for Payer: Medical Associates Commercial |
$63.75
|
| Rate for Payer: Midlands Choice Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
|
|
OT Cog Ther Intervent,First 15 Min Units
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
8774208
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of IA Commercial |
$76.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.50
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.75
|
| Rate for Payer: Medical Associates Commercial |
$63.75
|
| Rate for Payer: Midlands Choice Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
|
|
OT Cog Ther Intervent,First 15 Min Units
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
8774208
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of IA Commercial |
$76.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.50
|
| Rate for Payer: Aetna of IA Medicare |
$48.45
|
| Rate for Payer: Amerigroup Medicaid |
$49.03
|
| Rate for Payer: Amerigroup Medicare |
$38.63
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$48.55
|
| Rate for Payer: Medical Associates Commercial |
$63.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.25
|
| Rate for Payer: Midlands Choice Commercial |
$59.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.99
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.15
|
|
|
OT EVAL
|
Facility
|
OP
|
$158.00
|
|
| Hospital Charge Code |
4812784
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$71.10 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Aetna of IA Commercial |
$142.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$142.20
|
| Rate for Payer: Aetna of IA Medicare |
$90.06
|
| Rate for Payer: Amerigroup Medicaid |
$91.13
|
| Rate for Payer: Amerigroup Medicare |
$71.81
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$118.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$71.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.25
|
| Rate for Payer: Medical Associates Commercial |
$118.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.10
|
| Rate for Payer: Midlands Choice Commercial |
$110.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.77
|
| Rate for Payer: United Healthcare Commercial |
$142.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.22
|
|
|
OT EVAL
|
Facility
|
IP
|
$158.00
|
|
| Hospital Charge Code |
4812784
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Aetna of IA Commercial |
$142.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$142.20
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$118.50
|
| Rate for Payer: Medical Associates Commercial |
$118.50
|
| Rate for Payer: Midlands Choice Commercial |
$110.60
|
| Rate for Payer: United Healthcare Commercial |
$142.20
|
|
|
OT EVAL HIGH COMPLEX 60 MIN
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 97167 GO
|
| Hospital Charge Code |
8397275
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$71.10 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Aetna of IA Commercial |
$142.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$142.20
|
| Rate for Payer: Aetna of IA Medicare |
$90.06
|
| Rate for Payer: Amerigroup Medicaid |
$91.13
|
| Rate for Payer: Amerigroup Medicare |
$71.81
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$118.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$71.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.25
|
| Rate for Payer: Medical Associates Commercial |
$118.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.10
|
| Rate for Payer: Midlands Choice Commercial |
$110.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.77
|
| Rate for Payer: United Healthcare Commercial |
$142.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.22
|
|
