|
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
|
|
|
Aftercare, Musculoskeletal System and Connective Tissue With CC
|
Facility
IP
|
$14,784.29
|
|
|
Service Code
|
MS-DRG 560
|
| Hospital Charge Code |
367
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$14,784.29 |
| Rate for Payer: Amerigroup Medicaid |
$14,712.87
|
| 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 |
$14,570.03
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14,784.29
|
|
|
Aftercare, Musculoskeletal System and Connective Tissue With MCC
|
Facility
IP
|
$14,784.29
|
|
|
Service Code
|
MS-DRG 559
|
| Hospital Charge Code |
366
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$14,784.29 |
| Rate for Payer: Amerigroup Medicaid |
$14,712.87
|
| 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 |
$14,570.03
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14,784.29
|
|
|
Aftercare, Musculoskeletal System and Connective Tissue Without CC/MCC
|
Facility
IP
|
$6,432.02
|
|
|
Service Code
|
MS-DRG 561
|
| Hospital Charge Code |
368
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,432.02 |
| Rate for Payer: Amerigroup Medicaid |
$6,400.95
|
| 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 |
$6,338.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,432.02
|
|
|
Aftercare With CC/MCC
|
Facility
IP
|
$21,719.26
|
|
|
Service Code
|
MS-DRG 949
|
| Hospital Charge Code |
655
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$21,719.26 |
| Rate for Payer: Amerigroup Medicaid |
$21,614.33
|
| 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 |
$21,404.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21,719.26
|
|
|
Aftercare Without CC/MCC
|
Facility
IP
|
$6,259.77
|
|
|
Service Code
|
MS-DRG 950
|
| Hospital Charge Code |
656
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,259.77 |
| Rate for Payer: Amerigroup Medicaid |
$6,229.53
|
| 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 |
$6,169.05
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,259.77
|
|
|
AICD Generator Procedures
|
Facility
IP
|
$44,252.48
|
|
|
Service Code
|
MS-DRG 245
|
| Hospital Charge Code |
107
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$44,252.48 |
| Rate for Payer: Amerigroup Medicaid |
$44,038.70
|
| 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 |
$43,611.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44,252.48
|
|
|
AICD Lead Procedures
|
Facility
IP
|
$29,772.32
|
|
|
Service Code
|
MS-DRG 265
|
| Hospital Charge Code |
127
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$29,772.32 |
| Rate for Payer: Amerigroup Medicaid |
$29,628.50
|
| 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 |
$29,340.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29,772.32
|
|
|
AIRWAY SUCTION-NASOTRACHEAL ONLY
|
Facility
IP
|
$176.00
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
5338782
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna of IA Commercial |
$158.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$158.40
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.00
|
| Rate for Payer: Medical Associates Commercial |
$132.00
|
| Rate for Payer: Midlands Choice Commercial |
$123.20
|
| Rate for Payer: United Healthcare Commercial |
$158.40
|
|
|
AIRWAY SUCTION-NASOTRACHEAL ONLY
|
Facility
OP
|
$176.00
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
5338782
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$41.54 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna of IA Commercial |
$158.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$158.40
|
| Rate for Payer: Aetna of IA Medicare |
$100.32
|
| Rate for Payer: Amerigroup Medicaid |
$88.83
|
| Rate for Payer: Amerigroup Medicare |
$88.88
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$88.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$87.96
|
| Rate for Payer: Medical Associates Commercial |
$132.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.00
|
| Rate for Payer: Midlands Choice Commercial |
$123.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$89.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$158.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.84
|
| Rate for Payer: Wellmark IA HMO |
$41.54
|
| Rate for Payer: Wellmark IA PPO |
$45.69
|
|
|
ALBUMIN
|
Facility
IP
|
$47.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
1620877
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna of IA Commercial |
$42.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$42.30
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.25
|
| Rate for Payer: Medical Associates Commercial |
$35.25
|
| Rate for Payer: Midlands Choice Commercial |
$32.90
|
| Rate for Payer: United Healthcare Commercial |
$42.30
|
|
|
ALBUMIN
|
Facility
IP
|
$47.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
8093923
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna of IA Commercial |
$42.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$42.30
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.25
|
| Rate for Payer: Medical Associates Commercial |
$35.25
|
| Rate for Payer: Midlands Choice Commercial |
$32.90
|
| Rate for Payer: United Healthcare Commercial |
$42.30
|
|
|
ALBUMIN
|
Facility
OP
|
$47.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
1620877
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna of IA Commercial |
$42.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$42.30
|
| Rate for Payer: Aetna of IA Medicare |
$26.79
|
| Rate for Payer: Amerigroup Medicaid |
$23.72
|
| Rate for Payer: Amerigroup Medicare |
$23.74
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.49
|
| Rate for Payer: Medical Associates Commercial |
$35.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.50
|
| Rate for Payer: Midlands Choice Commercial |
$32.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$35.25
|
| Rate for Payer: United Healthcare Commercial |
$42.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$27.73
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
ALBUMIN
|
Facility
OP
|
$47.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
8093923
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna of IA Commercial |
$42.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$42.30
|
| Rate for Payer: Aetna of IA Medicare |
$26.79
|
| Rate for Payer: Amerigroup Medicaid |
$23.72
|
| Rate for Payer: Amerigroup Medicare |
$23.74
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.49
|
| Rate for Payer: Medical Associates Commercial |
$35.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.50
|
| Rate for Payer: Midlands Choice Commercial |
$32.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$35.25
|
| Rate for Payer: United Healthcare Commercial |
$42.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$27.73
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
albumin human 25% IV Sol 50 mL SDV
|
Facility
OP
|
$190.00
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
43700036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.96 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$171.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$171.00
|
| Rate for Payer: Aetna of IA Medicare |
$108.30
|
| Rate for Payer: Amerigroup Medicaid |
$95.89
|
| Rate for Payer: Amerigroup Medicare |
$95.95
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$142.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$95.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$94.96
|
| Rate for Payer: Medical Associates Commercial |
$142.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$95.00
|
| Rate for Payer: Midlands Choice Commercial |
$133.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$96.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$142.50
|
| Rate for Payer: United Healthcare Commercial |
$171.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$112.10
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
albumin human 25% IV Sol 50 mL SDV
|
Facility
IP
|
$190.00
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
43700036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of IA Commercial |
$171.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$171.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$142.50
|
| Rate for Payer: Medical Associates Commercial |
$142.50
|
| Rate for Payer: Midlands Choice Commercial |
$133.00
|
| Rate for Payer: United Healthcare Commercial |
$171.00
|
|
|
albumin human 5% IV Sol 250 mL SDV
|
Facility
IP
|
$207.00
|
|
|
Service Code
|
CPT P9045
|
| Hospital Charge Code |
43799929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$186.30 |
| Rate for Payer: Aetna of IA Commercial |
$186.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$186.30
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$155.25
|
| Rate for Payer: Medical Associates Commercial |
$155.25
|
| Rate for Payer: Midlands Choice Commercial |
$144.90
|
| Rate for Payer: United Healthcare Commercial |
$186.30
|
|
|
albumin human 5% IV Sol 250 mL SDV
|
Facility
OP
|
$207.00
|
|
|
Service Code
|
CPT P9045
|
| Hospital Charge Code |
43799929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$186.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$186.30
|
| Rate for Payer: Aetna of IA Medicare |
$117.99
|
| Rate for Payer: Amerigroup Medicaid |
$104.47
|
| Rate for Payer: Amerigroup Medicare |
$104.54
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$155.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$103.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$103.46
|
| Rate for Payer: Medical Associates Commercial |
$155.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$103.50
|
| Rate for Payer: Midlands Choice Commercial |
$144.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$105.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$155.25
|
| Rate for Payer: United Healthcare Commercial |
$186.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$122.13
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
albuterol 0.083% 2.5mg neb Sol 3 mL SDV
|
Facility
IP
|
$4.73
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna of IA Commercial |
$4.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.26
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.55
|
| Rate for Payer: Medical Associates Commercial |
$3.55
|
| Rate for Payer: Midlands Choice Commercial |
$3.31
|
| Rate for Payer: United Healthcare Commercial |
$4.26
|
|
|
albuterol 0.083% 2.5mg neb Sol 3 mL SDV
|
Facility
OP
|
$4.73
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna of IA Commercial |
$4.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.26
|
| Rate for Payer: Aetna of IA Medicare |
$2.70
|
| Rate for Payer: Amerigroup Medicaid |
$2.39
|
| Rate for Payer: Amerigroup Medicare |
$2.39
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.55
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.36
|
| Rate for Payer: Medical Associates Commercial |
$3.55
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.36
|
| Rate for Payer: Midlands Choice Commercial |
$3.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.55
|
| Rate for Payer: United Healthcare Commercial |
$4.26
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.79
|
|
|
albuterol 0.5% 5mg/ml 20ml Inh Sol
|
Facility
IP
|
$180.64
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43709091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$162.58 |
| Rate for Payer: Aetna of IA Commercial |
$162.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.58
|
| Rate for Payer: Cash Price |
$144.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.48
|
| Rate for Payer: Medical Associates Commercial |
$135.48
|
| Rate for Payer: Midlands Choice Commercial |
$126.45
|
| Rate for Payer: United Healthcare Commercial |
$162.58
|
|
|
albuterol 0.5% 5mg/ml 20ml Inh Sol
|
Facility
OP
|
$180.64
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43709091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.28 |
| Max. Negotiated Rate |
$162.58 |
| Rate for Payer: Aetna of IA Commercial |
$162.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.58
|
| Rate for Payer: Aetna of IA Medicare |
$102.96
|
| Rate for Payer: Amerigroup Medicaid |
$91.17
|
| Rate for Payer: Amerigroup Medicare |
$91.22
|
| Rate for Payer: Cash Price |
$144.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.48
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.28
|
| Rate for Payer: Medical Associates Commercial |
$135.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.32
|
| Rate for Payer: Midlands Choice Commercial |
$126.45
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.48
|
| Rate for Payer: United Healthcare Commercial |
$162.58
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.58
|
|
|
albuterol 1.25mg Inh Sol 3 mL
|
Facility
OP
|
$6.03
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43731007
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$5.43 |
| Rate for Payer: Aetna of IA Commercial |
$5.43
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.43
|
| Rate for Payer: Aetna of IA Medicare |
$3.44
|
| Rate for Payer: Amerigroup Medicaid |
$3.04
|
| Rate for Payer: Amerigroup Medicare |
$3.05
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.01
|
| Rate for Payer: Medical Associates Commercial |
$4.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.02
|
| Rate for Payer: Midlands Choice Commercial |
$4.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$4.52
|
| Rate for Payer: United Healthcare Commercial |
$5.43
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.56
|
|
|
albuterol 1.25mg Inh Sol 3 mL
|
Facility
IP
|
$6.03
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43731007
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$5.43 |
| Rate for Payer: Aetna of IA Commercial |
$5.43
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.43
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.52
|
| Rate for Payer: Medical Associates Commercial |
$4.52
|
| Rate for Payer: Midlands Choice Commercial |
$4.22
|
| Rate for Payer: United Healthcare Commercial |
$5.43
|
|
|
albuterol CFC free 90 mcg/inh Inh Aer w/Adapt
|
Facility
OP
|
$72.85
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.41 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna of IA Commercial |
$65.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.56
|
| Rate for Payer: Aetna of IA Medicare |
$41.52
|
| Rate for Payer: Amerigroup Medicaid |
$36.77
|
| Rate for Payer: Amerigroup Medicare |
$36.79
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.41
|
| Rate for Payer: Medical Associates Commercial |
$54.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.42
|
| Rate for Payer: Midlands Choice Commercial |
$51.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.64
|
| Rate for Payer: United Healthcare Commercial |
$65.56
|
| Rate for Payer: United Healthcare Managed Medicare |
$42.98
|
|
