|
NEUROLOGICAL EYE DISORDERS
|
Facility
|
IP
|
$9,648.50
|
|
|
Service Code
|
MSDRG 123
|
| Min. Negotiated Rate |
$9,508.66 |
| Max. Negotiated Rate |
$9,648.50 |
| Rate for Payer: Amerigroup Medicaid |
$9,601.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9,508.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,648.50
|
|
|
NEUROMUSCULAR ED PER 15 MIN
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 97112 GO
|
| Hospital Charge Code |
750905
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$165.57 |
| 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 |
$65.76
|
| Rate for Payer: Amerigroup Medicare |
$51.81
|
| 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 |
$51.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.12
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.30
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$59.00
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO WHPI |
$150.31
|
| Rate for Payer: Wellmark IA PPO |
$165.57
|
|
|
NEUROMUSCULAR ED PER 15 MIN
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 97112 GO
|
| Hospital Charge Code |
750905
|
|
Hospital Revenue Code
|
430
|
| 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
|
|
|
NEUROMUSCULAR RE-ED 15 MIN
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 97112 GP
|
| Hospital Charge Code |
1373913
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$165.57 |
| 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 |
$65.76
|
| Rate for Payer: Amerigroup Medicare |
$51.81
|
| 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 |
$51.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.12
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.30
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$59.00
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO WHPI |
$150.31
|
| Rate for Payer: Wellmark IA PPO |
$165.57
|
|
|
NEUROMUSCULAR RE-ED 15 MIN
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 97112 GP
|
| Hospital Charge Code |
1373913
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
NEUROMUSCULAR RE-ED 15 MIN
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97112 GN
|
| Hospital Charge Code |
7697845
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$165.57 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Aetna of IA Medicare |
$103.17
|
| Rate for Payer: Amerigroup Medicaid |
$104.40
|
| Rate for Payer: Amerigroup Medicare |
$82.26
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$103.39
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.45
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.67
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.79
|
| Rate for Payer: Wellmark IA HMO WHPI |
$150.31
|
| Rate for Payer: Wellmark IA PPO |
$165.57
|
|
|
NEUROMUSCULAR RE-ED 15 MIN
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97112 GN
|
| Hospital Charge Code |
7697845
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.75
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL
|
Facility
|
OP
|
$3,803.47
|
|
|
Service Code
|
CPT 64721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,452.83 |
| Max. Negotiated Rate |
$3,803.47 |
| Rate for Payer: Wellmark IA HMO WHPI |
$3,452.83
|
| Rate for Payer: Wellmark IA PPO |
$3,803.47
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL
|
Facility
|
OP
|
$3,803.47
|
|
|
Service Code
|
CPT 64721
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,452.83 |
| Max. Negotiated Rate |
$3,803.47 |
| Rate for Payer: Wellmark IA HMO WHPI |
$3,452.83
|
| Rate for Payer: Wellmark IA PPO |
$3,803.47
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW
|
Facility
|
OP
|
$3,803.47
|
|
|
Service Code
|
CPT 64718
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,452.83 |
| Max. Negotiated Rate |
$3,803.47 |
| Rate for Payer: Wellmark IA HMO WHPI |
$3,452.83
|
| Rate for Payer: Wellmark IA PPO |
$3,803.47
|
|
|
NEUROSES EXCEPT DEPRESSIVE
|
Facility
|
IP
|
$5,671.55
|
|
|
Service Code
|
MSDRG 882
|
| Min. Negotiated Rate |
$5,589.35 |
| Max. Negotiated Rate |
$5,671.55 |
| Rate for Payer: Amerigroup Medicaid |
$5,644.14
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5,589.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,671.55
|
|
|
NEWBORN HEARING SCREEN
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
7290782
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$218.37 |
| Max. Negotiated Rate |
$954.00 |
| Rate for Payer: Aetna of IA Commercial |
$954.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$954.00
|
| Rate for Payer: Aetna of IA Medicare |
$604.20
|
| Rate for Payer: Amerigroup Medicaid |
$611.41
|
| Rate for Payer: Amerigroup Medicare |
$481.77
|
| Rate for Payer: Cash Price |
$848.00
|
| Rate for Payer: Cash Price |
$848.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$795.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$477.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$605.47
|
| Rate for Payer: Medical Associates Commercial |
$795.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$477.00
|
| Rate for Payer: Midlands Choice Commercial |
$742.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$614.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$548.55
|
| Rate for Payer: United Healthcare Commercial |
$954.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$625.40
|
| Rate for Payer: Wellmark IA HMO WHPI |
$218.37
|
| Rate for Payer: Wellmark IA PPO |
$240.55
|
|
|
NEWBORN HEARING SCREEN
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
7290782
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$742.00 |
| Max. Negotiated Rate |
$954.00 |
| Rate for Payer: Aetna of IA Commercial |
$954.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$954.00
|
| Rate for Payer: Cash Price |
$848.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$795.00
|
| Rate for Payer: Medical Associates Commercial |
$795.00
|
| Rate for Payer: Midlands Choice Commercial |
$742.00
|
| Rate for Payer: United Healthcare Commercial |
$954.00
|
|
|
NEW PATIENT COMPREHENSIVE
|
Professional
|
Both
|
$679.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
8101313
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$149.83 |
| Max. Negotiated Rate |
$509.25 |
| Rate for Payer: Amerigroup Medicaid |
$151.30
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$149.83
|
| Rate for Payer: Medical Associates Commercial |
$509.25
|
| Rate for Payer: Midlands Choice Commercial |
$475.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$150.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$509.25
|
| Rate for Payer: United Healthcare Commercial |
$226.84
|
| Rate for Payer: Wellmark IA HMO WHPI |
$315.10
|
| Rate for Payer: Wellmark IA PPO |
$315.10
|
|
|
NEW PATIENT DETAILED
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
8101312
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$120.18 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Amerigroup Medicaid |
$121.35
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$120.18
|
| Rate for Payer: Medical Associates Commercial |
$405.00
|
| Rate for Payer: Midlands Choice Commercial |
$378.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$120.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$405.00
|
| Rate for Payer: United Healthcare Commercial |
$179.26
|
| Rate for Payer: Wellmark IA HMO WHPI |
$239.00
|
| Rate for Payer: Wellmark IA PPO |
$239.00
|
|
|
NEW PATIENT EXPANDED
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
8101311
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$267.00 |
| Rate for Payer: Amerigroup Medicaid |
$83.81
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$83.00
|
| Rate for Payer: Medical Associates Commercial |
$267.00
|
| Rate for Payer: Midlands Choice Commercial |
$249.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$83.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$267.00
|
| Rate for Payer: United Healthcare Commercial |
$116.93
|
| Rate for Payer: Wellmark IA HMO WHPI |
$159.50
|
| Rate for Payer: Wellmark IA PPO |
$159.50
|
|
|
NEW PATIENT FOCUSED
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
8101310
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$58.98 |
| Max. Negotiated Rate |
$188.25 |
| Rate for Payer: Amerigroup Medicaid |
$59.55
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$58.98
|
| Rate for Payer: Medical Associates Commercial |
$188.25
|
| Rate for Payer: Midlands Choice Commercial |
$175.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$59.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$188.25
|
| Rate for Payer: United Healthcare Commercial |
$82.34
|
| Rate for Payer: Wellmark IA HMO WHPI |
$103.30
|
| Rate for Payer: Wellmark IA PPO |
$103.30
|
|
|
Niacin 100 mg Tab [VDMC]
|
Facility
|
OP
|
$1.05
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
16782013
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna of IA Commercial |
$0.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.94
|
| Rate for Payer: Aetna of IA Medicare |
$0.60
|
| Rate for Payer: Amerigroup Medicaid |
$0.60
|
| Rate for Payer: Amerigroup Medicare |
$0.48
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.79
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.47
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.60
|
| Rate for Payer: Medical Associates Commercial |
$0.79
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.47
|
| Rate for Payer: Midlands Choice Commercial |
$0.73
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.54
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.62
|
|
|
Niacin 100 mg Tab [VDMC]
|
Facility
|
IP
|
$1.05
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
16782013
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna of IA Commercial |
$0.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.94
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.79
|
| Rate for Payer: Medical Associates Commercial |
$0.79
|
| Rate for Payer: Midlands Choice Commercial |
$0.73
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
|
|
niCARdipine 2.5 mg/mL 10ml Inj Sol [VDMC]
|
Facility
|
OP
|
$52.45
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
10408469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$47.21 |
| Rate for Payer: Aetna of IA Commercial |
$47.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$47.21
|
| Rate for Payer: Aetna of IA Medicare |
$29.90
|
| Rate for Payer: Amerigroup Medicaid |
$30.25
|
| Rate for Payer: Amerigroup Medicare |
$23.84
|
| Rate for Payer: Cash Price |
$41.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.34
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.96
|
| Rate for Payer: Medical Associates Commercial |
$39.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.60
|
| Rate for Payer: Midlands Choice Commercial |
$36.72
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.14
|
| Rate for Payer: United Healthcare Commercial |
$47.21
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.95
|
|
|
niCARdipine 2.5 mg/mL 10ml Inj Sol [VDMC]
|
Facility
|
IP
|
$52.45
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
10408469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$47.21 |
| Rate for Payer: Aetna of IA Commercial |
$47.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$47.21
|
| Rate for Payer: Cash Price |
$41.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.34
|
| Rate for Payer: Medical Associates Commercial |
$39.34
|
| Rate for Payer: Midlands Choice Commercial |
$36.72
|
| Rate for Payer: United Healthcare Commercial |
$47.21
|
|
|
nicotine 14 mg/24 hr Transderm ER Film [VDMC]
|
Facility
|
IP
|
$17.23
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10408540
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$15.51 |
| Rate for Payer: Aetna of IA Commercial |
$15.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$15.51
|
| Rate for Payer: Cash Price |
$13.79
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.93
|
| Rate for Payer: Medical Associates Commercial |
$12.93
|
| Rate for Payer: Midlands Choice Commercial |
$12.06
|
| Rate for Payer: United Healthcare Commercial |
$15.51
|
|
|
nicotine 14 mg/24 hr Transderm ER Film [VDMC]
|
Facility
|
OP
|
$17.23
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10408540
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$15.51 |
| Rate for Payer: Aetna of IA Commercial |
$15.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$15.51
|
| Rate for Payer: Aetna of IA Medicare |
$9.82
|
| Rate for Payer: Amerigroup Medicaid |
$9.94
|
| Rate for Payer: Amerigroup Medicare |
$7.83
|
| Rate for Payer: Cash Price |
$13.79
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.93
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9.84
|
| Rate for Payer: Medical Associates Commercial |
$12.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.76
|
| Rate for Payer: Midlands Choice Commercial |
$12.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$8.92
|
| Rate for Payer: United Healthcare Commercial |
$15.51
|
| Rate for Payer: United Healthcare Managed Medicare |
$10.17
|
|
|
nicotine 21 mg/24 hr Transderm ER Film [VDMC]
|
Facility
|
IP
|
$12.77
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10431766
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$11.49 |
| Rate for Payer: Aetna of IA Commercial |
$11.49
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.49
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.58
|
| Rate for Payer: Medical Associates Commercial |
$9.58
|
| Rate for Payer: Midlands Choice Commercial |
$8.94
|
| Rate for Payer: United Healthcare Commercial |
$11.49
|
|
|
nicotine 21 mg/24 hr Transderm ER Film [VDMC]
|
Facility
|
OP
|
$12.77
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10431766
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$11.49 |
| Rate for Payer: Aetna of IA Commercial |
$11.49
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.49
|
| Rate for Payer: Aetna of IA Medicare |
$7.28
|
| Rate for Payer: Amerigroup Medicaid |
$7.36
|
| Rate for Payer: Amerigroup Medicare |
$5.80
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.58
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.29
|
| Rate for Payer: Medical Associates Commercial |
$9.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.75
|
| Rate for Payer: Midlands Choice Commercial |
$8.94
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$6.61
|
| Rate for Payer: United Healthcare Commercial |
$11.49
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.53
|
|
