|
naproxen 500 mg Tab [VDMC]
|
Facility
|
OP
|
$1.34
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10408333
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Aetna of IA Commercial |
$1.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.21
|
| Rate for Payer: Aetna of IA Medicare |
$0.76
|
| Rate for Payer: Amerigroup Medicaid |
$0.77
|
| Rate for Payer: Amerigroup Medicare |
$0.61
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.01
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.77
|
| Rate for Payer: Medical Associates Commercial |
$1.01
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.60
|
| Rate for Payer: Midlands Choice Commercial |
$0.94
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.69
|
| Rate for Payer: United Healthcare Commercial |
$1.21
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.79
|
|
|
naproxen 500 mg Tab [VDMC]
|
Facility
|
IP
|
$1.34
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10408333
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Aetna of IA Commercial |
$1.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.21
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.01
|
| Rate for Payer: Medical Associates Commercial |
$1.01
|
| Rate for Payer: Midlands Choice Commercial |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$1.21
|
|
|
NASAL CAUTERY/PACKING
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
7982782
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$86.64 |
| Max. Negotiated Rate |
$347.80 |
| Rate for Payer: Amerigroup Medicaid |
$87.49
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$86.64
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$87.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$236.25
|
| Rate for Payer: United Healthcare Commercial |
$215.09
|
| Rate for Payer: Wellmark IA HMO WHPI |
$295.60
|
| Rate for Payer: Wellmark IA PPO |
$347.80
|
|
|
N BLOCK INJ FACIAL
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
4866813
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Aetna of IA Commercial |
$513.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$513.00
|
| Rate for Payer: Aetna of IA Medicare |
$324.90
|
| Rate for Payer: Amerigroup Medicaid |
$328.78
|
| Rate for Payer: Amerigroup Medicare |
$259.06
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$427.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$256.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$325.58
|
| Rate for Payer: Medical Associates Commercial |
$427.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$256.50
|
| Rate for Payer: Midlands Choice Commercial |
$399.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$330.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$294.98
|
| Rate for Payer: United Healthcare Commercial |
$513.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$336.30
|
|
|
N BLOCK INJ FACIAL
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
4866813
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Aetna of IA Commercial |
$513.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$513.00
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$427.50
|
| Rate for Payer: Medical Associates Commercial |
$427.50
|
| Rate for Payer: Midlands Choice Commercial |
$399.00
|
| Rate for Payer: United Healthcare Commercial |
$513.00
|
|
|
N BLOCK INJ FACIAL
|
Professional
|
Both
|
$444.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
7982765
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Medical Associates Commercial |
$333.00
|
| Rate for Payer: Midlands Choice Commercial |
$310.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$333.00
|
| Rate for Payer: Wellmark IA HMO WHPI |
$259.00
|
| Rate for Payer: Wellmark IA PPO |
$317.00
|
|
|
N BLOCK OTHER PERIPHERAL
|
Facility
|
OP
|
$635.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
4866820
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$285.75 |
| Max. Negotiated Rate |
$839.58 |
| Rate for Payer: Aetna of IA Commercial |
$571.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$571.50
|
| Rate for Payer: Aetna of IA Medicare |
$361.95
|
| Rate for Payer: Amerigroup Medicaid |
$366.27
|
| Rate for Payer: Amerigroup Medicare |
$288.61
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$476.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$285.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$362.71
|
| Rate for Payer: Medical Associates Commercial |
$476.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$285.75
|
| Rate for Payer: Midlands Choice Commercial |
$444.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$368.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$328.61
|
| Rate for Payer: United Healthcare Commercial |
$571.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$374.65
|
| Rate for Payer: Wellmark IA HMO WHPI |
$762.18
|
| Rate for Payer: Wellmark IA PPO |
$839.58
|
|
|
N BLOCK OTHER PERIPHERAL
|
Facility
|
IP
|
$635.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
4866820
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$444.50 |
| Max. Negotiated Rate |
$571.50 |
| Rate for Payer: Aetna of IA Commercial |
$571.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$571.50
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$476.25
|
| Rate for Payer: Medical Associates Commercial |
$476.25
|
| Rate for Payer: Midlands Choice Commercial |
$444.50
|
| Rate for Payer: United Healthcare Commercial |
$571.50
|
|
|
N BLOCK OTHER PERIPHERAL
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
7982764
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$82.28 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Amerigroup Medicaid |
$83.09
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$82.28
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$82.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$151.50
|
| Rate for Payer: United Healthcare Commercial |
$115.70
|
| Rate for Payer: Wellmark IA HMO WHPI |
$141.60
|
| Rate for Payer: Wellmark IA PPO |
$166.60
|
|
|
NBS BIOTINIDASE
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 82261
|
| Hospital Charge Code |
8098975
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.68 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of IA Commercial |
$124.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$124.20
|
| Rate for Payer: Aetna of IA Medicare |
$78.66
|
| Rate for Payer: Amerigroup Medicaid |
$79.60
|
| Rate for Payer: Amerigroup Medicare |
$62.72
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$62.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$78.83
|
| Rate for Payer: Medical Associates Commercial |
$103.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.10
|
| Rate for Payer: Midlands Choice Commercial |
$96.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.42
|
| Rate for Payer: United Healthcare Commercial |
$124.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$81.42
|
| Rate for Payer: Wellmark IA HMO WHPI |
$61.68
|
| Rate for Payer: Wellmark IA PPO |
$67.95
|
|
|
NBS BIOTINIDASE
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 82261
|
| Hospital Charge Code |
8098975
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of IA Commercial |
$124.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$124.20
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.50
|
| Rate for Payer: Medical Associates Commercial |
$103.50
|
| Rate for Payer: Midlands Choice Commercial |
$96.60
|
| Rate for Payer: United Healthcare Commercial |
$124.20
|
|
|
NBS FETAL ADN-HGB
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
8098976
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
NBS FETAL ADN-HGB
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
8098976
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.68 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$80.18
|
| Rate for Payer: Amerigroup Medicare |
$63.18
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$62.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.40
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.55
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.93
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO WHPI |
$61.68
|
| Rate for Payer: Wellmark IA PPO |
$67.95
|
|
|
NBS PKU
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 84030
|
| Hospital Charge Code |
8099019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$35.18
|
| Rate for Payer: Amerigroup Medicare |
$27.72
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.84
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.45
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.57
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
NBS PKU
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 84030
|
| Hospital Charge Code |
8099019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
NBS PROGESTERONE
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
8098974
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of IA Commercial |
$153.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$153.00
|
| Rate for Payer: Aetna of IA Medicare |
$96.90
|
| Rate for Payer: Amerigroup Medicaid |
$98.06
|
| Rate for Payer: Amerigroup Medicare |
$77.26
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$127.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$76.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$97.10
|
| Rate for Payer: Medical Associates Commercial |
$127.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$76.50
|
| Rate for Payer: Midlands Choice Commercial |
$119.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$98.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$87.98
|
| Rate for Payer: United Healthcare Commercial |
$153.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$100.30
|
| Rate for Payer: Wellmark IA HMO WHPI |
$49.63
|
| Rate for Payer: Wellmark IA PPO |
$54.67
|
|
|
NBS PROGESTERONE
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
8098974
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of IA Commercial |
$153.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$153.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$127.50
|
| Rate for Payer: Medical Associates Commercial |
$127.50
|
| Rate for Payer: Midlands Choice Commercial |
$119.00
|
| Rate for Payer: United Healthcare Commercial |
$153.00
|
|
|
NBS T4 ELUTION
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 84437
|
| Hospital Charge Code |
8098977
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna of IA Commercial |
$55.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$55.80
|
| Rate for Payer: Aetna of IA Medicare |
$35.34
|
| Rate for Payer: Amerigroup Medicaid |
$35.76
|
| Rate for Payer: Amerigroup Medicare |
$28.18
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.41
|
| Rate for Payer: Medical Associates Commercial |
$46.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.90
|
| Rate for Payer: Midlands Choice Commercial |
$43.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$32.08
|
| Rate for Payer: United Healthcare Commercial |
$55.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$36.58
|
| Rate for Payer: Wellmark IA HMO WHPI |
$49.63
|
| Rate for Payer: Wellmark IA PPO |
$54.67
|
|
|
NBS T4 ELUTION
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 84437
|
| Hospital Charge Code |
8098977
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna of IA Commercial |
$55.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$55.80
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.50
|
| Rate for Payer: Medical Associates Commercial |
$46.50
|
| Rate for Payer: Midlands Choice Commercial |
$43.40
|
| Rate for Payer: United Healthcare Commercial |
$55.80
|
|
|
nebivolol 5 mg Tab [VDMC]
|
Facility
|
IP
|
$3.91
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11224858
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna of IA Commercial |
$3.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.52
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.94
|
| Rate for Payer: Medical Associates Commercial |
$2.94
|
| Rate for Payer: Midlands Choice Commercial |
$2.74
|
| Rate for Payer: United Healthcare Commercial |
$3.52
|
|
|
nebivolol 5 mg Tab [VDMC]
|
Facility
|
OP
|
$3.91
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11224858
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna of IA Commercial |
$3.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.52
|
| Rate for Payer: Aetna of IA Medicare |
$2.23
|
| Rate for Payer: Amerigroup Medicaid |
$2.26
|
| Rate for Payer: Amerigroup Medicare |
$1.78
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.94
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.24
|
| Rate for Payer: Medical Associates Commercial |
$2.94
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.76
|
| Rate for Payer: Midlands Choice Commercial |
$2.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.03
|
| Rate for Payer: United Healthcare Commercial |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.31
|
|
|
NEB TRT/MDI - SPUTUM INDUCTION
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
5758782
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna of IA Commercial |
$201.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$201.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$168.00
|
| Rate for Payer: Medical Associates Commercial |
$168.00
|
| Rate for Payer: Midlands Choice Commercial |
$156.80
|
| Rate for Payer: United Healthcare Commercial |
$201.60
|
|
|
NEB TRT/MDI - SPUTUM INDUCTION
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4770831
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$203.84 |
| Rate for Payer: Aetna of IA Commercial |
$201.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$201.60
|
| Rate for Payer: Aetna of IA Medicare |
$127.68
|
| Rate for Payer: Amerigroup Medicaid |
$129.20
|
| Rate for Payer: Amerigroup Medicare |
$101.81
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$168.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$100.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$127.95
|
| Rate for Payer: Medical Associates Commercial |
$168.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$100.80
|
| Rate for Payer: Midlands Choice Commercial |
$156.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$129.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$115.92
|
| Rate for Payer: United Healthcare Commercial |
$201.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$132.16
|
| Rate for Payer: Wellmark IA HMO WHPI |
$185.05
|
| Rate for Payer: Wellmark IA PPO |
$203.84
|
|
|
NEB TRT/MDI - SPUTUM INDUCTION
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4770831
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna of IA Commercial |
$201.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$201.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$168.00
|
| Rate for Payer: Medical Associates Commercial |
$168.00
|
| Rate for Payer: Midlands Choice Commercial |
$156.80
|
| Rate for Payer: United Healthcare Commercial |
$201.60
|
|
|
NEB TRT/MDI - SPUTUM INDUCTION
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
5758782
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$203.84 |
| Rate for Payer: Aetna of IA Commercial |
$201.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$201.60
|
| Rate for Payer: Aetna of IA Medicare |
$127.68
|
| Rate for Payer: Amerigroup Medicaid |
$129.20
|
| Rate for Payer: Amerigroup Medicare |
$101.81
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$168.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$100.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$127.95
|
| Rate for Payer: Medical Associates Commercial |
$168.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$100.80
|
| Rate for Payer: Midlands Choice Commercial |
$156.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$129.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$115.92
|
| Rate for Payer: United Healthcare Commercial |
$201.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$132.16
|
| Rate for Payer: Wellmark IA HMO WHPI |
$185.05
|
| Rate for Payer: Wellmark IA PPO |
$203.84
|
|
