|
PAP THIN PREP
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT G0123
|
| Hospital Charge Code |
8089044
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Aetna of IA Medicare |
$62.70
|
| Rate for Payer: Amerigroup Medicaid |
$55.52
|
| Rate for Payer: Amerigroup Medicare |
$55.55
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.98
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.00
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.82
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$55.79
|
| Rate for Payer: Oscar Health of IA Commercial |
$82.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.90
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
PAP THIN PREP
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT G0123
|
| Hospital Charge Code |
8089044
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
|
|
Paracentesis Procedure
|
Facility
|
OP
|
$688.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
8060784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.86 |
| Max. Negotiated Rate |
$1,351.72 |
| Rate for Payer: Aetna of IA Commercial |
$619.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$619.20
|
| Rate for Payer: Aetna of IA Medicare |
$392.16
|
| Rate for Payer: Amerigroup Medicaid |
$347.23
|
| Rate for Payer: Amerigroup Medicare |
$347.44
|
| Rate for Payer: Cash Price |
$550.40
|
| Rate for Payer: Cash Price |
$550.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$516.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$344.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$343.86
|
| Rate for Payer: Medical Associates Commercial |
$516.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$344.00
|
| Rate for Payer: Midlands Choice Commercial |
$481.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$349.16
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$348.95
|
| Rate for Payer: Oscar Health of IA Commercial |
$516.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$516.00
|
| Rate for Payer: United Healthcare Commercial |
$619.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$405.92
|
| Rate for Payer: Wellmark IA HMO |
$1,228.84
|
| Rate for Payer: Wellmark IA PPO |
$1,351.72
|
|
|
Paracentesis Procedure
|
Facility
|
IP
|
$688.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
8060784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$619.20 |
| Rate for Payer: Aetna of IA Commercial |
$619.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$619.20
|
| Rate for Payer: Cash Price |
$550.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$516.00
|
| Rate for Payer: Medical Associates Commercial |
$516.00
|
| Rate for Payer: Midlands Choice Commercial |
$481.60
|
| Rate for Payer: United Healthcare Commercial |
$619.20
|
|
|
PARAFFIN BATH
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 97018 GO
|
| Hospital Charge Code |
1373447
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
|
|
PARAFFIN BATH
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 97018 GO
|
| Hospital Charge Code |
1373447
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Aetna of IA Medicare |
$41.61
|
| Rate for Payer: Amerigroup Medicaid |
$36.84
|
| Rate for Payer: Amerigroup Medicare |
$36.86
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.49
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.50
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.05
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$37.03
|
| Rate for Payer: Oscar Health of IA Commercial |
$54.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.75
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.07
|
|
|
PARAFFIN BATH APPLICATION
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 97018 GP
|
| Hospital Charge Code |
1373914
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
|
|
PARAFFIN BATH APPLICATION
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 97018 GP
|
| Hospital Charge Code |
1373914
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Aetna of IA Medicare |
$41.61
|
| Rate for Payer: Amerigroup Medicaid |
$36.84
|
| Rate for Payer: Amerigroup Medicare |
$36.86
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.49
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.50
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.05
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$37.03
|
| Rate for Payer: Oscar Health of IA Commercial |
$54.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.75
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.07
|
|
|
Parathyroid Hormone Intact DMCL
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
8037747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$85.56 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna of IA Commercial |
$252.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$252.90
|
| Rate for Payer: Aetna of IA Medicare |
$160.17
|
| Rate for Payer: Amerigroup Medicaid |
$141.82
|
| Rate for Payer: Amerigroup Medicare |
$141.90
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$210.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$140.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$140.44
|
| Rate for Payer: Medical Associates Commercial |
$210.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$140.50
|
| Rate for Payer: Midlands Choice Commercial |
$196.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$142.61
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$142.52
|
| Rate for Payer: Oscar Health of IA Commercial |
$210.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$210.75
|
| Rate for Payer: United Healthcare Commercial |
$252.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$165.79
|
| Rate for Payer: Wellmark IA HMO |
$85.56
|
| Rate for Payer: Wellmark IA PPO |
$94.12
|
|
|
Parathyroid Hormone Intact DMCL
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
8037747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$196.70 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna of IA Commercial |
$252.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$252.90
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$210.75
|
| Rate for Payer: Medical Associates Commercial |
$210.75
|
| Rate for Payer: Midlands Choice Commercial |
$196.70
|
| Rate for Payer: United Healthcare Commercial |
$252.90
|
|
|
paricalcitol 5 mcg/mL Sol SDV Inj Sol [VDMC]
|
Facility
|
OP
|
$30.10
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
23689427
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$27.09 |
| Rate for Payer: Aetna of IA Commercial |
$27.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.09
|
| Rate for Payer: Aetna of IA Medicare |
$17.16
|
| Rate for Payer: Amerigroup Medicaid |
$15.19
|
| Rate for Payer: Amerigroup Medicare |
$15.20
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.58
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.04
|
| Rate for Payer: Medical Associates Commercial |
$22.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.05
|
| Rate for Payer: Midlands Choice Commercial |
$21.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.28
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$15.27
|
| Rate for Payer: Oscar Health of IA Commercial |
$22.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.58
|
| Rate for Payer: United Healthcare Commercial |
$27.09
|
| Rate for Payer: United Healthcare Managed Medicare |
$17.76
|
|
|
paricalcitol 5 mcg/mL Sol SDV Inj Sol [VDMC]
|
Facility
|
IP
|
$30.10
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
23689427
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.07 |
| Max. Negotiated Rate |
$27.09 |
| Rate for Payer: Aetna of IA Commercial |
$27.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.09
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.58
|
| Rate for Payer: Medical Associates Commercial |
$22.58
|
| Rate for Payer: Midlands Choice Commercial |
$21.07
|
| Rate for Payer: United Healthcare Commercial |
$27.09
|
|
|
Parietal Cell Antibody DMCL
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
8037748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Parietal Cell Antibody DMCL
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
8037748
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
PARING OF CORN/CALLUS 2-4
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
7438806
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.97 |
| Max. Negotiated Rate |
$634.94 |
| Rate for Payer: Aetna of IA Commercial |
$129.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$129.60
|
| Rate for Payer: Aetna of IA Medicare |
$82.08
|
| Rate for Payer: Amerigroup Medicaid |
$72.68
|
| Rate for Payer: Amerigroup Medicare |
$72.72
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$72.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.97
|
| Rate for Payer: Medical Associates Commercial |
$108.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.00
|
| Rate for Payer: Midlands Choice Commercial |
$100.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$73.08
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$73.04
|
| Rate for Payer: Oscar Health of IA Commercial |
$108.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$108.00
|
| Rate for Payer: United Healthcare Commercial |
$129.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.96
|
| Rate for Payer: Wellmark IA HMO |
$577.22
|
| Rate for Payer: Wellmark IA PPO |
$634.94
|
|
|
PARING OF CORN/CALLUS 2-4
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
7438806
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna of IA Commercial |
$129.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$129.60
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.00
|
| Rate for Payer: Medical Associates Commercial |
$108.00
|
| Rate for Payer: Midlands Choice Commercial |
$100.80
|
| Rate for Payer: United Healthcare Commercial |
$129.60
|
|
|
PARoxetine 12.5 mg ER Tab [VDMC]
|
Facility
|
IP
|
$3.27
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10411863
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: Aetna of IA Commercial |
$2.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.94
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.45
|
| Rate for Payer: Medical Associates Commercial |
$2.45
|
| Rate for Payer: Midlands Choice Commercial |
$2.29
|
| Rate for Payer: United Healthcare Commercial |
$2.94
|
|
|
PARoxetine 12.5 mg ER Tab [VDMC]
|
Facility
|
OP
|
$3.27
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10411863
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: Aetna of IA Commercial |
$2.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.94
|
| Rate for Payer: Aetna of IA Medicare |
$1.86
|
| Rate for Payer: Amerigroup Medicaid |
$1.65
|
| Rate for Payer: Amerigroup Medicare |
$1.65
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.45
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.63
|
| Rate for Payer: Medical Associates Commercial |
$2.45
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.64
|
| Rate for Payer: Midlands Choice Commercial |
$2.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.66
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.66
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.45
|
| Rate for Payer: United Healthcare Commercial |
$2.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.93
|
|
|
PARoxetine 20 mg Tab [VDMC]
|
Facility
|
IP
|
$1.56
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10411932
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of IA Commercial |
$1.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.40
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.17
|
| Rate for Payer: Medical Associates Commercial |
$1.17
|
| Rate for Payer: Midlands Choice Commercial |
$1.09
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
|
|
PARoxetine 20 mg Tab [VDMC]
|
Facility
|
OP
|
$1.56
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10411932
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of IA Commercial |
$1.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.40
|
| Rate for Payer: Aetna of IA Medicare |
$0.89
|
| Rate for Payer: Amerigroup Medicaid |
$0.79
|
| Rate for Payer: Amerigroup Medicare |
$0.79
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.17
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.78
|
| Rate for Payer: Medical Associates Commercial |
$1.17
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.78
|
| Rate for Payer: Midlands Choice Commercial |
$1.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.79
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.79
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.17
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.92
|
|
|
PARS SUTURE IMPLANT KIT W/SUTURETAPE
|
Facility
|
IP
|
$2,691.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8783230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,883.70 |
| Max. Negotiated Rate |
$2,421.90 |
| Rate for Payer: Aetna of IA Commercial |
$2,421.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,421.90
|
| Rate for Payer: Cash Price |
$2,152.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,018.25
|
| Rate for Payer: Medical Associates Commercial |
$2,018.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,883.70
|
| Rate for Payer: United Healthcare Commercial |
$2,421.90
|
|
|
PARS SUTURE IMPLANT KIT W/SUTURETAPE
|
Facility
|
OP
|
$2,691.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8783230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,344.96 |
| Max. Negotiated Rate |
$2,421.90 |
| Rate for Payer: Aetna of IA Commercial |
$2,421.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,421.90
|
| Rate for Payer: Aetna of IA Medicare |
$1,533.87
|
| Rate for Payer: Amerigroup Medicaid |
$1,358.15
|
| Rate for Payer: Amerigroup Medicare |
$1,358.96
|
| Rate for Payer: Cash Price |
$2,152.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,018.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,345.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,344.96
|
| Rate for Payer: Medical Associates Commercial |
$2,018.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,345.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,883.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,365.68
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,364.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,018.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,018.25
|
| Rate for Payer: United Healthcare Commercial |
$2,421.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,587.69
|
|
|
Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus
|
Facility
|
OP
|
$4,658.74
|
|
|
Service Code
|
CPT 28120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,235.22 |
| Max. Negotiated Rate |
$4,658.74 |
| Rate for Payer: Wellmark IA HMO |
$4,235.22
|
| Rate for Payer: Wellmark IA PPO |
$4,658.74
|
|
|
Partial Thromboplastin Time DMCL
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
8037749
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.18 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO |
$24.18
|
| Rate for Payer: Wellmark IA PPO |
$26.60
|
|
|
Partial Thromboplastin Time DMCL
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
8037749
|
|
Hospital Revenue Code
|
305
|
| 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
|
|
