|
ramipril 1.25 mg Cap [VDMC]
|
Facility
|
OP
|
$1.30
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10418397
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Aetna of IA Commercial |
$1.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.17
|
| Rate for Payer: Aetna of IA Medicare |
$0.74
|
| Rate for Payer: Amerigroup Medicaid |
$0.75
|
| Rate for Payer: Amerigroup Medicare |
$0.59
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.98
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.59
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.74
|
| Rate for Payer: Medical Associates Commercial |
$0.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.59
|
| Rate for Payer: Midlands Choice Commercial |
$0.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.67
|
| Rate for Payer: United Healthcare Commercial |
$1.17
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.77
|
|
|
ramipril 5 mg Cap [VDMC]
|
Facility
|
OP
|
$1.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10418535
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of IA Commercial |
$1.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.00
|
| Rate for Payer: Aetna of IA Medicare |
$0.63
|
| Rate for Payer: Amerigroup Medicaid |
$0.64
|
| Rate for Payer: Amerigroup Medicare |
$0.50
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.83
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.63
|
| Rate for Payer: Medical Associates Commercial |
$0.83
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.50
|
| Rate for Payer: Midlands Choice Commercial |
$0.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.57
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.65
|
|
|
ramipril 5 mg Cap [VDMC]
|
Facility
|
IP
|
$1.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10418535
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of IA Commercial |
$1.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.00
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.83
|
| Rate for Payer: Medical Associates Commercial |
$0.83
|
| Rate for Payer: Midlands Choice Commercial |
$0.78
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
|
|
RANGE OF MOTION (NOT HAND)
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 95851 GP
|
| Hospital Charge Code |
6344972
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna of IA Commercial |
$45.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.50
|
| Rate for Payer: Medical Associates Commercial |
$37.50
|
| Rate for Payer: Midlands Choice Commercial |
$35.00
|
| Rate for Payer: United Healthcare Commercial |
$45.00
|
|
|
RANGE OF MOTION (NOT HAND)
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 95851 GP
|
| Hospital Charge Code |
6344972
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna of IA Commercial |
$45.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.00
|
| Rate for Payer: Aetna of IA Medicare |
$28.50
|
| Rate for Payer: Amerigroup Medicaid |
$28.84
|
| Rate for Payer: Amerigroup Medicare |
$22.73
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.56
|
| Rate for Payer: Medical Associates Commercial |
$37.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.50
|
| Rate for Payer: Midlands Choice Commercial |
$35.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$25.88
|
| Rate for Payer: United Healthcare Commercial |
$45.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$29.50
|
|
|
ranolazine 500 mg oral ER (12hr) Tab [VDMC]
|
Facility
|
OP
|
$2.81
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10418675
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Aetna of IA Commercial |
$2.53
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.53
|
| Rate for Payer: Aetna of IA Medicare |
$1.60
|
| Rate for Payer: Amerigroup Medicaid |
$1.62
|
| Rate for Payer: Amerigroup Medicare |
$1.28
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.11
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.26
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.60
|
| Rate for Payer: Medical Associates Commercial |
$2.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.26
|
| Rate for Payer: Midlands Choice Commercial |
$1.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.45
|
| Rate for Payer: United Healthcare Commercial |
$2.53
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.66
|
|
|
ranolazine 500 mg oral ER (12hr) Tab [VDMC]
|
Facility
|
IP
|
$2.81
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10418675
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Aetna of IA Commercial |
$2.53
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.53
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.11
|
| Rate for Payer: Medical Associates Commercial |
$2.11
|
| Rate for Payer: Midlands Choice Commercial |
$1.97
|
| Rate for Payer: United Healthcare Commercial |
$2.53
|
|
|
Rapid Plasma Reagin DMCL
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
8037793
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
|
|
Rapid Plasma Reagin DMCL
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
8037793
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Aetna of IA Medicare |
$33.06
|
| Rate for Payer: Amerigroup Medicaid |
$33.45
|
| Rate for Payer: Amerigroup Medicare |
$26.36
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.13
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.10
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.02
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.22
|
|
|
rasagiline 1 mg oral tablet [VDMC]
|
Facility
|
OP
|
$11.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10418744
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Aetna of IA Commercial |
$10.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.44
|
| Rate for Payer: Aetna of IA Medicare |
$6.61
|
| Rate for Payer: Amerigroup Medicaid |
$6.69
|
| Rate for Payer: Amerigroup Medicare |
$5.27
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.70
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.63
|
| Rate for Payer: Medical Associates Commercial |
$8.70
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.22
|
| Rate for Payer: Midlands Choice Commercial |
$8.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$6.01
|
| Rate for Payer: United Healthcare Commercial |
$10.44
|
| Rate for Payer: United Healthcare Managed Medicare |
$6.85
|
|
|
rasagiline 1 mg oral tablet [VDMC]
|
Facility
|
IP
|
$11.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10418744
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Aetna of IA Commercial |
$10.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.44
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.70
|
| Rate for Payer: Medical Associates Commercial |
$8.70
|
| Rate for Payer: Midlands Choice Commercial |
$8.12
|
| Rate for Payer: United Healthcare Commercial |
$10.44
|
|
|
RBC AUTOMATED CELL COUNT
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 85041
|
| Hospital Charge Code |
4006787
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Aetna of IA Medicare |
$19.38
|
| Rate for Payer: Amerigroup Medicaid |
$19.61
|
| Rate for Payer: Amerigroup Medicare |
$15.45
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.42
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.30
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$17.59
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.06
|
|
|
RBC AUTOMATED CELL COUNT
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 85041
|
| Hospital Charge Code |
4006787
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
|
|
RBC Folate DMCL
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
8037794
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna of IA Commercial |
$148.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$148.50
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$123.75
|
| Rate for Payer: Medical Associates Commercial |
$123.75
|
| Rate for Payer: Midlands Choice Commercial |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$148.50
|
|
|
RBC Folate DMCL
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
8037794
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.25 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna of IA Commercial |
$148.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$148.50
|
| Rate for Payer: Aetna of IA Medicare |
$94.05
|
| Rate for Payer: Amerigroup Medicaid |
$95.17
|
| Rate for Payer: Amerigroup Medicare |
$74.99
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$123.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$74.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$94.25
|
| Rate for Payer: Medical Associates Commercial |
$123.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$74.25
|
| Rate for Payer: Midlands Choice Commercial |
$115.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$95.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.39
|
| Rate for Payer: United Healthcare Commercial |
$148.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$97.35
|
|
|
REAMER, LOW PROFILE
|
Facility
|
IP
|
$351.00
|
|
| Hospital Charge Code |
8047061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.70 |
| Max. Negotiated Rate |
$315.90 |
| Rate for Payer: Aetna of IA Commercial |
$315.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.90
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$263.25
|
| Rate for Payer: Medical Associates Commercial |
$263.25
|
| Rate for Payer: Midlands Choice Commercial |
$245.70
|
| Rate for Payer: United Healthcare Commercial |
$315.90
|
|
|
REAMER, LOW PROFILE
|
Facility
|
OP
|
$351.00
|
|
| Hospital Charge Code |
8047061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.95 |
| Max. Negotiated Rate |
$315.90 |
| Rate for Payer: Aetna of IA Commercial |
$315.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.90
|
| Rate for Payer: Aetna of IA Medicare |
$200.07
|
| Rate for Payer: Amerigroup Medicaid |
$202.46
|
| Rate for Payer: Amerigroup Medicare |
$159.53
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$263.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$157.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$200.49
|
| Rate for Payer: Medical Associates Commercial |
$263.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.95
|
| Rate for Payer: Midlands Choice Commercial |
$245.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$203.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$181.64
|
| Rate for Payer: United Healthcare Commercial |
$315.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$207.09
|
|
|
REAMER SHAFT 8.0X448MM
|
Facility
|
OP
|
$355.00
|
|
| Hospital Charge Code |
8025851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.75 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Aetna of IA Commercial |
$319.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$319.50
|
| Rate for Payer: Aetna of IA Medicare |
$202.35
|
| Rate for Payer: Amerigroup Medicaid |
$204.76
|
| Rate for Payer: Amerigroup Medicare |
$161.35
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$266.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$159.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.78
|
| Rate for Payer: Medical Associates Commercial |
$266.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$159.75
|
| Rate for Payer: Midlands Choice Commercial |
$248.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$205.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$183.71
|
| Rate for Payer: United Healthcare Commercial |
$319.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$209.45
|
|
|
REAMER SHAFT 8.0X448MM
|
Facility
|
IP
|
$355.00
|
|
| Hospital Charge Code |
8025851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Aetna of IA Commercial |
$319.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$319.50
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$266.25
|
| Rate for Payer: Medical Associates Commercial |
$266.25
|
| Rate for Payer: Midlands Choice Commercial |
$248.50
|
| Rate for Payer: United Healthcare Commercial |
$319.50
|
|
|
RECHARGER FOR INTELLIS ADAPTIVESTIM
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
8558056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.00 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,430.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,430.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,539.00
|
| Rate for Payer: Amerigroup Medicaid |
$1,557.36
|
| Rate for Payer: Amerigroup Medicare |
$1,227.15
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,025.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,215.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,542.24
|
| Rate for Payer: Medical Associates Commercial |
$2,025.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,215.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,890.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,564.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,397.25
|
| Rate for Payer: United Healthcare Commercial |
$2,430.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,593.00
|
|
|
RECHARGER FOR INTELLIS ADAPTIVESTIM
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
8558056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,890.00 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,430.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,430.00
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,025.00
|
| Rate for Payer: Medical Associates Commercial |
$2,025.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,890.00
|
| Rate for Payer: United Healthcare Commercial |
$2,430.00
|
|
|
RECOVERY PHASE 1: Per Interval (1 Minute)
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
8025193
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of IA Commercial |
$14.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.40
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.00
|
| Rate for Payer: Medical Associates Commercial |
$12.00
|
| Rate for Payer: Midlands Choice Commercial |
$11.20
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
|
|
RECOVERY PHASE 1: Per Interval (1 Minute)
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
8025193
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of IA Commercial |
$14.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.40
|
| Rate for Payer: Aetna of IA Medicare |
$9.12
|
| Rate for Payer: Amerigroup Medicaid |
$9.23
|
| Rate for Payer: Amerigroup Medicare |
$7.27
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9.14
|
| Rate for Payer: Medical Associates Commercial |
$12.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.20
|
| Rate for Payer: Midlands Choice Commercial |
$11.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$8.28
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$9.44
|
|
|
RECOVERY PHASE 2
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
8025190
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of IA Commercial |
$1.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.80
|
| Rate for Payer: Aetna of IA Medicare |
$1.14
|
| Rate for Payer: Amerigroup Medicaid |
$1.15
|
| Rate for Payer: Amerigroup Medicare |
$0.91
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.14
|
| Rate for Payer: Medical Associates Commercial |
$1.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.90
|
| Rate for Payer: Midlands Choice Commercial |
$1.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.03
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.18
|
|
|
RECOVERY PHASE 2
|
Facility
|
IP
|
$2.00
|
|
| Hospital Charge Code |
8025190
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of IA Commercial |
$1.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.80
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.50
|
| Rate for Payer: Medical Associates Commercial |
$1.50
|
| Rate for Payer: Midlands Choice Commercial |
$1.40
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
|
