|
acyclovir 400 mg Tab [VDMC]
|
Facility
|
IP
|
$1.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10363815
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| 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 |
$0.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.93
|
| Rate for Payer: Medical Associates Commercial |
$0.93
|
| Rate for Payer: Midlands Choice Commercial |
$0.87
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
|
|
acyclovir 400 mg Tab [VDMC]
|
Facility
|
OP
|
$1.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10363815
|
|
Hospital Revenue Code
|
259
|
| 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 |
$0.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.93
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.62
|
| Rate for Payer: Medical Associates Commercial |
$0.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.62
|
| Rate for Payer: Midlands Choice Commercial |
$0.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.63
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.63
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.73
|
|
|
acyclovir 50 mg/mL IV Sol 20 ml SDV [VDMC]
|
Facility
|
IP
|
$36.47
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
10363886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.53 |
| Max. Negotiated Rate |
$32.82 |
| Rate for Payer: Aetna of IA Commercial |
$32.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.82
|
| Rate for Payer: Cash Price |
$29.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.35
|
| Rate for Payer: Medical Associates Commercial |
$27.35
|
| Rate for Payer: Midlands Choice Commercial |
$25.53
|
| Rate for Payer: United Healthcare Commercial |
$32.82
|
|
|
acyclovir 50 mg/mL IV Sol 20 ml SDV [VDMC]
|
Facility
|
OP
|
$36.47
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
10363886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.23 |
| Max. Negotiated Rate |
$32.82 |
| Rate for Payer: Aetna of IA Commercial |
$32.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.82
|
| Rate for Payer: Aetna of IA Medicare |
$20.79
|
| Rate for Payer: Amerigroup Medicaid |
$18.41
|
| Rate for Payer: Amerigroup Medicare |
$18.42
|
| Rate for Payer: Cash Price |
$29.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.35
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.24
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.23
|
| Rate for Payer: Medical Associates Commercial |
$27.35
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.24
|
| Rate for Payer: Midlands Choice Commercial |
$25.53
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.51
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$18.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$27.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.35
|
| Rate for Payer: United Healthcare Commercial |
$32.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.52
|
|
|
acyclovir Top 5% Oint 15 gm [VDMC]
|
Facility
|
IP
|
$99.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10363957
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$69.38 |
| Max. Negotiated Rate |
$89.21 |
| Rate for Payer: Aetna of IA Commercial |
$89.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.21
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.34
|
| Rate for Payer: Medical Associates Commercial |
$74.34
|
| Rate for Payer: Midlands Choice Commercial |
$69.38
|
| Rate for Payer: United Healthcare Commercial |
$89.21
|
|
|
acyclovir Top 5% Oint 15 gm [VDMC]
|
Facility
|
OP
|
$99.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10363957
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$49.54 |
| Max. Negotiated Rate |
$89.21 |
| Rate for Payer: Aetna of IA Commercial |
$89.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.21
|
| Rate for Payer: Aetna of IA Medicare |
$56.50
|
| Rate for Payer: Amerigroup Medicaid |
$50.03
|
| Rate for Payer: Amerigroup Medicare |
$50.06
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.34
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.54
|
| Rate for Payer: Medical Associates Commercial |
$74.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.56
|
| Rate for Payer: Midlands Choice Commercial |
$69.38
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.30
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$50.27
|
| Rate for Payer: Oscar Health of IA Commercial |
$74.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.34
|
| Rate for Payer: United Healthcare Commercial |
$89.21
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.48
|
|
|
ADAPTOR UNION SCREW
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.81 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Aetna of IA Commercial |
$860.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$860.40
|
| Rate for Payer: Aetna of IA Medicare |
$544.92
|
| Rate for Payer: Amerigroup Medicaid |
$482.49
|
| Rate for Payer: Amerigroup Medicare |
$482.78
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$717.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$478.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$477.81
|
| Rate for Payer: Medical Associates Commercial |
$717.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$478.00
|
| Rate for Payer: Midlands Choice Commercial |
$669.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$485.17
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$484.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$717.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$717.00
|
| Rate for Payer: United Healthcare Commercial |
$860.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$564.04
|
|
|
ADAPTOR UNION SCREW
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.20 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Aetna of IA Commercial |
$860.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$860.40
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$717.00
|
| Rate for Payer: Medical Associates Commercial |
$717.00
|
| Rate for Payer: Midlands Choice Commercial |
$669.20
|
| Rate for Payer: United Healthcare Commercial |
$860.40
|
|
|
adenosine 3 mg/mL 2 ml syringe SDS [VDMC]
|
Facility
|
OP
|
$78.50
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
10364026
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.23 |
| Max. Negotiated Rate |
$70.65 |
| Rate for Payer: Aetna of IA Commercial |
$70.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$70.65
|
| Rate for Payer: Aetna of IA Medicare |
$44.74
|
| Rate for Payer: Amerigroup Medicaid |
$39.62
|
| Rate for Payer: Amerigroup Medicare |
$39.64
|
| Rate for Payer: Cash Price |
$62.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.88
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$39.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$39.23
|
| Rate for Payer: Medical Associates Commercial |
$58.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$39.25
|
| Rate for Payer: Midlands Choice Commercial |
$54.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.84
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$39.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$58.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$58.88
|
| Rate for Payer: United Healthcare Commercial |
$70.65
|
| Rate for Payer: United Healthcare Managed Medicare |
$46.32
|
|
|
adenosine 3 mg/mL 2 ml syringe SDS [VDMC]
|
Facility
|
IP
|
$78.50
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
10364026
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$54.95 |
| Max. Negotiated Rate |
$70.65 |
| Rate for Payer: Aetna of IA Commercial |
$70.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$70.65
|
| Rate for Payer: Cash Price |
$62.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.88
|
| Rate for Payer: Medical Associates Commercial |
$58.88
|
| Rate for Payer: Midlands Choice Commercial |
$54.95
|
| Rate for Payer: United Healthcare Commercial |
$70.65
|
|
|
ADL TRAINING EA 15 MIN
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 97535 GO
|
| Hospital Charge Code |
1373569
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of IA Commercial |
$97.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.20
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.00
|
| Rate for Payer: Medical Associates Commercial |
$81.00
|
| Rate for Payer: Midlands Choice Commercial |
$75.60
|
| Rate for Payer: United Healthcare Commercial |
$97.20
|
|
|
ADL TRAINING EA 15 MIN
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 97535 GO
|
| Hospital Charge Code |
1373569
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$53.98 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of IA Commercial |
$97.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.20
|
| Rate for Payer: Aetna of IA Medicare |
$61.56
|
| Rate for Payer: Amerigroup Medicaid |
$54.51
|
| Rate for Payer: Amerigroup Medicare |
$54.54
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$54.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$53.98
|
| Rate for Payer: Medical Associates Commercial |
$81.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$54.00
|
| Rate for Payer: Midlands Choice Commercial |
$75.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$54.81
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$54.78
|
| Rate for Payer: Oscar Health of IA Commercial |
$81.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$97.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.72
|
|
|
ADM IM
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
6922826
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$32.99 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna of IA Commercial |
$59.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.40
|
| Rate for Payer: Aetna of IA Medicare |
$37.62
|
| Rate for Payer: Amerigroup Medicaid |
$33.31
|
| Rate for Payer: Amerigroup Medicare |
$33.33
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.99
|
| Rate for Payer: Medical Associates Commercial |
$49.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.00
|
| Rate for Payer: Midlands Choice Commercial |
$46.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.50
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$33.48
|
| Rate for Payer: Oscar Health of IA Commercial |
$49.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$59.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.94
|
|
|
ADM IM
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
4866834
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
|
|
ADM IM
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
6922826
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna of IA Commercial |
$59.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.50
|
| Rate for Payer: Medical Associates Commercial |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$59.40
|
|
|
ADM IM
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
4866834
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$31.99 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Aetna of IA Medicare |
$36.48
|
| Rate for Payer: Amerigroup Medicaid |
$32.30
|
| Rate for Payer: Amerigroup Medicare |
$32.32
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.99
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$32.46
|
| Rate for Payer: Oscar Health of IA Commercial |
$48.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
|
|
ADM IM SCHEDULED
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
8012938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna of IA Commercial |
$59.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.50
|
| Rate for Payer: Medical Associates Commercial |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$59.40
|
|
|
ADM IM SCHEDULED
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
8012938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.99 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna of IA Commercial |
$59.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.40
|
| Rate for Payer: Aetna of IA Medicare |
$37.62
|
| Rate for Payer: Amerigroup Medicaid |
$33.31
|
| Rate for Payer: Amerigroup Medicare |
$33.33
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.99
|
| Rate for Payer: Medical Associates Commercial |
$49.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.00
|
| Rate for Payer: Midlands Choice Commercial |
$46.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.50
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$33.48
|
| Rate for Payer: Oscar Health of IA Commercial |
$49.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$59.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.94
|
|
|
ADM IM SCHEDULED ADDITIONAL
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 96372 59
|
| Hospital Charge Code |
8012945
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna of IA Commercial |
$59.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.50
|
| Rate for Payer: Medical Associates Commercial |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$59.40
|
|
|
ADM IM SCHEDULED ADDITIONAL
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 96372 59
|
| Hospital Charge Code |
8012945
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.99 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna of IA Commercial |
$59.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.40
|
| Rate for Payer: Aetna of IA Medicare |
$37.62
|
| Rate for Payer: Amerigroup Medicaid |
$33.31
|
| Rate for Payer: Amerigroup Medicare |
$33.33
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.99
|
| Rate for Payer: Medical Associates Commercial |
$49.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.00
|
| Rate for Payer: Midlands Choice Commercial |
$46.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.50
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$33.48
|
| Rate for Payer: Oscar Health of IA Commercial |
$49.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$59.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.94
|
|
|
ADMIN FLU VACCINE
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
8012757
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna of IA Commercial |
$40.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.50
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.75
|
| Rate for Payer: Medical Associates Commercial |
$33.75
|
| Rate for Payer: Midlands Choice Commercial |
$31.50
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
|
|
ADMIN FLU VACCINE
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
8012757
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.49 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna of IA Commercial |
$40.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.50
|
| Rate for Payer: Aetna of IA Medicare |
$25.65
|
| Rate for Payer: Amerigroup Medicaid |
$22.71
|
| Rate for Payer: Amerigroup Medicare |
$22.72
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.49
|
| Rate for Payer: Medical Associates Commercial |
$33.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.50
|
| Rate for Payer: Midlands Choice Commercial |
$31.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.84
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$22.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$33.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.75
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.55
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
|
ADMINISTER IM CHARGE
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
8068907
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$30.06 |
| Rate for Payer: Aetna of IA Medicare |
$13.19
|
| Rate for Payer: Amerigroup Medicaid |
$13.64
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.83
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.45
|
| Rate for Payer: Medical Associates Commercial |
$23.74
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.19
|
| Rate for Payer: Midlands Choice Commercial |
$30.06
|
| Rate for Payer: Oscar Health of IA Commercial |
$23.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.78
|
|
|
ADMIN PNEUMOVAC VACCINE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
8012758
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna of IA Commercial |
$13.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.50
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.25
|
| Rate for Payer: Medical Associates Commercial |
$11.25
|
| Rate for Payer: Midlands Choice Commercial |
$10.50
|
| Rate for Payer: United Healthcare Commercial |
$13.50
|
|
|
ADMIN PNEUMOVAC VACCINE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
8012758
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Aetna of IA Commercial |
$13.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.50
|
| Rate for Payer: Aetna of IA Medicare |
$8.55
|
| Rate for Payer: Amerigroup Medicaid |
$7.57
|
| Rate for Payer: Amerigroup Medicare |
$7.58
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.50
|
| Rate for Payer: Medical Associates Commercial |
$11.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.50
|
| Rate for Payer: Midlands Choice Commercial |
$10.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.61
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$7.61
|
| Rate for Payer: Oscar Health of IA Commercial |
$11.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.25
|
| Rate for Payer: United Healthcare Commercial |
$13.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.85
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
