|
ADM IVP EA ADL SEQ SAME MED SC
|
Facility
OP
|
$46.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
8012942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.99 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna of IA Commercial |
$41.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.40
|
| Rate for Payer: Aetna of IA Medicare |
$26.22
|
| Rate for Payer: Amerigroup Medicaid |
$23.22
|
| Rate for Payer: Amerigroup Medicare |
$23.23
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.99
|
| Rate for Payer: Medical Associates Commercial |
$34.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.00
|
| Rate for Payer: Midlands Choice Commercial |
$32.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.50
|
| Rate for Payer: United Healthcare Commercial |
$41.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$27.14
|
|
|
ADM IVP EA ADL SEQ SAME MED SC
|
Facility
IP
|
$46.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
8012942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna of IA Commercial |
$41.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.50
|
| Rate for Payer: Medical Associates Commercial |
$34.50
|
| Rate for Payer: Midlands Choice Commercial |
$32.20
|
| Rate for Payer: United Healthcare Commercial |
$41.40
|
|
|
ADM IVP TX
|
Facility
OP
|
$108.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
6922828
|
|
Hospital Revenue Code
|
260
|
| 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: Partners Health Alliance Commercial |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$97.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.72
|
|
|
ADM IVP TX
|
Facility
IP
|
$108.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
4866832
|
|
Hospital Revenue Code
|
260
|
| 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
|
|
|
ADM IVP TX
|
Facility
IP
|
$108.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
6922828
|
|
Hospital Revenue Code
|
260
|
| 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
|
|
|
ADM IVP TX
|
Facility
OP
|
$108.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
4866832
|
|
Hospital Revenue Code
|
260
|
| 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: Partners Health Alliance Commercial |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$97.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.72
|
|
|
ADM IVP TX EA ADD'L MED
|
Facility
OP
|
$64.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
4866830
|
|
Hospital Revenue Code
|
260
|
| 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: Partners Health Alliance Commercial |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
|
|
ADM IVP TX EA ADD'L MED
|
Facility
OP
|
$64.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
6922829
|
|
Hospital Revenue Code
|
260
|
| 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: Partners Health Alliance Commercial |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
|
|
ADM IVP TX EA ADD'L MED
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
4866830
|
|
Hospital Revenue Code
|
260
|
| 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 IVP TX EA ADD'L MED
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
6922829
|
|
Hospital Revenue Code
|
260
|
| 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 IVP TX, SCHEDULED
|
Facility
OP
|
$108.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
8012940
|
|
Hospital Revenue Code
|
761
|
| 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: Partners Health Alliance Commercial |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$97.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.72
|
|
|
ADM IVP TX, SCHEDULED
|
Facility
IP
|
$108.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
8012940
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
ADM IVP TX, SCHEDULED EA ADD'L
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
8012941
|
|
Hospital Revenue Code
|
761
|
| 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 IVP TX, SCHEDULED EA ADD'L
|
Facility
OP
|
$64.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
8012941
|
|
Hospital Revenue Code
|
761
|
| 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: Partners Health Alliance Commercial |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
|
|
ADM IVP TX SCHED W/ OTHER PROC
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
8012939
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of IA Commercial |
$51.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.30
|
| Rate for Payer: Aetna of IA Medicare |
$32.49
|
| Rate for Payer: Amerigroup Medicaid |
$28.77
|
| Rate for Payer: Amerigroup Medicare |
$28.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.49
|
| Rate for Payer: Medical Associates Commercial |
$42.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.50
|
| Rate for Payer: Midlands Choice Commercial |
$39.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.75
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.63
|
|
|
ADM IVP TX SCHED W/ OTHER PROC
|
Facility
IP
|
$57.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
8012939
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of IA Commercial |
$51.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.30
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.75
|
| Rate for Payer: Medical Associates Commercial |
$42.75
|
| Rate for Payer: Midlands Choice Commercial |
$39.90
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
|
|
ADM VACC 1ST
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
4866871
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of IA Commercial |
$27.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.50
|
| Rate for Payer: Medical Associates Commercial |
$22.50
|
| Rate for Payer: Midlands Choice Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$27.00
|
|
|
ADM VACC 1ST
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
4866871
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Aetna of IA Commercial |
$27.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.00
|
| Rate for Payer: Aetna of IA Medicare |
$17.10
|
| Rate for Payer: Amerigroup Medicaid |
$15.14
|
| Rate for Payer: Amerigroup Medicare |
$15.15
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.99
|
| Rate for Payer: Medical Associates Commercial |
$22.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.00
|
| Rate for Payer: Midlands Choice Commercial |
$21.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.50
|
| Rate for Payer: United Healthcare Commercial |
$27.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$17.70
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
|
ADM VACC EA ADDL VACCINE
|
Facility
IP
|
$41.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
4866874
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
|
|
ADM VACC EA ADDL VACCINE
|
Facility
OP
|
$41.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
4866874
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.49 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Aetna of IA Medicare |
$23.37
|
| Rate for Payer: Amerigroup Medicaid |
$20.69
|
| Rate for Payer: Amerigroup Medicare |
$20.70
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.49
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.50
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.75
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.19
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
|
ado-trastuzumab emtansine 100 mg SDV
|
Facility
IP
|
$13,235.76
|
|
|
Service Code
|
CPT J9354
|
| Hospital Charge Code |
43700513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,265.03 |
| Max. Negotiated Rate |
$11,912.18 |
| Rate for Payer: Aetna of IA Commercial |
$11,912.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,912.18
|
| Rate for Payer: Cash Price |
$10,588.61
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,926.82
|
| Rate for Payer: Medical Associates Commercial |
$9,926.82
|
| Rate for Payer: Midlands Choice Commercial |
$9,265.03
|
| Rate for Payer: United Healthcare Commercial |
$11,912.18
|
|
|
ado-trastuzumab emtansine 100 mg SDV
|
Facility
OP
|
$13,235.76
|
|
|
Service Code
|
CPT J9354
|
| Hospital Charge Code |
43700513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,615.23 |
| Max. Negotiated Rate |
$11,912.18 |
| Rate for Payer: Aetna of IA Commercial |
$11,912.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,912.18
|
| Rate for Payer: Aetna of IA Medicare |
$7,544.38
|
| Rate for Payer: Amerigroup Medicaid |
$6,680.09
|
| Rate for Payer: Amerigroup Medicare |
$6,684.06
|
| Rate for Payer: Cash Price |
$10,588.61
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,926.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6,617.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,615.23
|
| Rate for Payer: Medical Associates Commercial |
$9,926.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$6,617.88
|
| Rate for Payer: Midlands Choice Commercial |
$9,265.03
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,717.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$9,926.82
|
| Rate for Payer: United Healthcare Commercial |
$11,912.18
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,809.10
|
|
|
Adrenal and Pituitary Procedures With CC/MCC
|
Facility
IP
|
$25,281.23
|
|
|
Service Code
|
MS-DRG 614
|
| Hospital Charge Code |
406
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$25,281.23 |
| Rate for Payer: Amerigroup Medicaid |
$25,159.10
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$24,914.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25,281.23
|
|
|
Adrenal and Pituitary Procedures Without CC/MCC
|
Facility
IP
|
$15,184.88
|
|
|
Service Code
|
MS-DRG 615
|
| Hospital Charge Code |
407
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$15,184.88 |
| Rate for Payer: Amerigroup Medicaid |
$15,111.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14,964.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15,184.88
|
|
|
ADRENOCORTICOTROPHIC HORMONE
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
8037486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$85.56 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Aetna of IA Commercial |
$236.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$236.70
|
| Rate for Payer: Aetna of IA Medicare |
$149.91
|
| Rate for Payer: Amerigroup Medicaid |
$132.74
|
| Rate for Payer: Amerigroup Medicare |
$132.82
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$197.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$131.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$131.45
|
| Rate for Payer: Medical Associates Commercial |
$197.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$131.50
|
| Rate for Payer: Midlands Choice Commercial |
$184.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$133.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$197.25
|
| Rate for Payer: United Healthcare Commercial |
$236.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$155.17
|
| Rate for Payer: Wellmark IA HMO |
$85.56
|
| Rate for Payer: Wellmark IA PPO |
$94.12
|
|
