|
paliperidone palmitate 1560 mg/5 mL Sus [VDMC]
|
Facility
|
IP
|
$37,769.90
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
26738572
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26,438.93 |
| Max. Negotiated Rate |
$33,992.91 |
| Rate for Payer: Aetna of IA Commercial |
$33,992.91
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33,992.91
|
| Rate for Payer: Cash Price |
$30,215.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28,327.42
|
| Rate for Payer: Medical Associates Commercial |
$28,327.42
|
| Rate for Payer: Midlands Choice Commercial |
$26,438.93
|
| Rate for Payer: United Healthcare Commercial |
$33,992.91
|
|
|
paliperidone palmitate 1560 mg/5 mL Sus [VDMC]
|
Facility
|
OP
|
$37,769.90
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
26738572
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16,996.46 |
| Max. Negotiated Rate |
$33,992.91 |
| Rate for Payer: Aetna of IA Commercial |
$33,992.91
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33,992.91
|
| Rate for Payer: Aetna of IA Medicare |
$21,528.84
|
| Rate for Payer: Amerigroup Medicaid |
$21,785.68
|
| Rate for Payer: Amerigroup Medicare |
$17,166.42
|
| Rate for Payer: Cash Price |
$30,215.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28,327.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16,996.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21,574.17
|
| Rate for Payer: Medical Associates Commercial |
$28,327.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$16,996.46
|
| Rate for Payer: Midlands Choice Commercial |
$26,438.93
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21,891.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$19,545.92
|
| Rate for Payer: United Healthcare Commercial |
$33,992.91
|
| Rate for Payer: United Healthcare Managed Medicare |
$22,284.24
|
|
|
paliperidone palmitate 156 mg/mL Sus [VDMC]
|
Facility
|
IP
|
$4,486.54
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
27990289
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3,140.58 |
| Max. Negotiated Rate |
$4,037.89 |
| Rate for Payer: Aetna of IA Commercial |
$4,037.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,037.89
|
| Rate for Payer: Cash Price |
$3,589.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,364.90
|
| Rate for Payer: Medical Associates Commercial |
$3,364.90
|
| Rate for Payer: Midlands Choice Commercial |
$3,140.58
|
| Rate for Payer: United Healthcare Commercial |
$4,037.89
|
|
|
paliperidone palmitate 156 mg/mL Sus [VDMC]
|
Facility
|
OP
|
$4,486.54
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
27990289
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2,018.94 |
| Max. Negotiated Rate |
$4,037.89 |
| Rate for Payer: Aetna of IA Commercial |
$4,037.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,037.89
|
| Rate for Payer: Aetna of IA Medicare |
$2,557.33
|
| Rate for Payer: Amerigroup Medicaid |
$2,587.84
|
| Rate for Payer: Amerigroup Medicare |
$2,039.13
|
| Rate for Payer: Cash Price |
$3,589.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,364.90
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,018.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,562.71
|
| Rate for Payer: Medical Associates Commercial |
$3,364.90
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,018.94
|
| Rate for Payer: Midlands Choice Commercial |
$3,140.58
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,600.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,321.78
|
| Rate for Payer: United Healthcare Commercial |
$4,037.89
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,647.06
|
|
|
palonosetron 0.25 mg/5 mL SDV [VDMC]
|
Facility
|
OP
|
$65.84
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
13339269
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.63 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$59.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.26
|
| Rate for Payer: Aetna of IA Medicare |
$37.53
|
| Rate for Payer: Amerigroup Medicaid |
$37.98
|
| Rate for Payer: Amerigroup Medicare |
$29.92
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.63
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.61
|
| Rate for Payer: Medical Associates Commercial |
$49.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.63
|
| Rate for Payer: Midlands Choice Commercial |
$46.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.07
|
| Rate for Payer: United Healthcare Commercial |
$59.26
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.85
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
palonosetron 0.25 mg/5 mL SDV [VDMC]
|
Facility
|
IP
|
$65.84
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
13339269
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$46.09 |
| Max. Negotiated Rate |
$59.26 |
| Rate for Payer: Aetna of IA Commercial |
$59.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.26
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.38
|
| Rate for Payer: Medical Associates Commercial |
$49.38
|
| Rate for Payer: Midlands Choice Commercial |
$46.09
|
| Rate for Payer: United Healthcare Commercial |
$59.26
|
|
|
pamidronate 3 mg/mL 10 ml SDV [VDMC]
|
Facility
|
OP
|
$54.24
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
10411386
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$48.82 |
| Rate for Payer: Aetna of IA Commercial |
$48.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$48.82
|
| Rate for Payer: Aetna of IA Medicare |
$30.92
|
| Rate for Payer: Amerigroup Medicaid |
$31.29
|
| Rate for Payer: Amerigroup Medicare |
$24.65
|
| Rate for Payer: Cash Price |
$43.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$40.68
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$24.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.98
|
| Rate for Payer: Medical Associates Commercial |
$40.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$24.41
|
| Rate for Payer: Midlands Choice Commercial |
$37.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$31.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.07
|
| Rate for Payer: United Healthcare Commercial |
$48.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$32.00
|
|
|
pamidronate 3 mg/mL 10 ml SDV [VDMC]
|
Facility
|
IP
|
$54.24
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
10411386
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.97 |
| Max. Negotiated Rate |
$48.82 |
| Rate for Payer: Aetna of IA Commercial |
$48.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$48.82
|
| Rate for Payer: Cash Price |
$43.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$40.68
|
| Rate for Payer: Medical Associates Commercial |
$40.68
|
| Rate for Payer: Midlands Choice Commercial |
$37.97
|
| Rate for Payer: United Healthcare Commercial |
$48.82
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$27,963.64
|
|
|
Service Code
|
MSDRG 406
|
| Min. Negotiated Rate |
$27,558.36 |
| Max. Negotiated Rate |
$27,963.64 |
| Rate for Payer: Amerigroup Medicaid |
$27,828.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27,558.36
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27,963.64
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$46,077.23
|
|
|
Service Code
|
MSDRG 405
|
| Min. Negotiated Rate |
$45,409.42 |
| Max. Negotiated Rate |
$46,077.23 |
| Rate for Payer: Amerigroup Medicaid |
$45,854.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$45,409.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$46,077.23
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$19,759.77
|
|
|
Service Code
|
MSDRG 407
|
| Min. Negotiated Rate |
$19,473.39 |
| Max. Negotiated Rate |
$19,759.77 |
| Rate for Payer: Amerigroup Medicaid |
$19,664.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19,473.39
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19,759.77
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$40,744.60
|
|
|
Service Code
|
MSDRG 010
|
| Min. Negotiated Rate |
$40,154.08 |
| Max. Negotiated Rate |
$40,744.60 |
| Rate for Payer: Amerigroup Medicaid |
$40,547.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40,154.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$40,744.60
|
|
|
pantoprazole 20 mg Oral DR Tab [VDMC]
|
Facility
|
OP
|
$1.63
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10411658
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of IA Commercial |
$1.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.47
|
| Rate for Payer: Aetna of IA Medicare |
$0.93
|
| Rate for Payer: Amerigroup Medicaid |
$0.94
|
| Rate for Payer: Amerigroup Medicare |
$0.74
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.93
|
| Rate for Payer: Medical Associates Commercial |
$1.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.73
|
| Rate for Payer: Midlands Choice Commercial |
$1.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.47
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.96
|
|
|
pantoprazole 20 mg Oral DR Tab [VDMC]
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10411658
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of IA Commercial |
$1.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.47
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.22
|
| Rate for Payer: Medical Associates Commercial |
$1.22
|
| Rate for Payer: Midlands Choice Commercial |
$1.14
|
| Rate for Payer: United Healthcare Commercial |
$1.47
|
|
|
pantoprazole 40 mg IV Inj [VDMC]
|
Facility
|
OP
|
$38.67
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
10411727
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$34.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.80
|
| Rate for Payer: Aetna of IA Medicare |
$22.04
|
| Rate for Payer: Amerigroup Medicaid |
$22.31
|
| Rate for Payer: Amerigroup Medicare |
$17.58
|
| Rate for Payer: Cash Price |
$30.94
|
| Rate for Payer: Cash Price |
$30.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$29.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.09
|
| Rate for Payer: Medical Associates Commercial |
$29.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.40
|
| Rate for Payer: Midlands Choice Commercial |
$27.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.01
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$22.82
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
pantoprazole 40 mg IV Inj [VDMC]
|
Facility
|
IP
|
$38.67
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
10411727
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$34.80 |
| Rate for Payer: Aetna of IA Commercial |
$34.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.80
|
| Rate for Payer: Cash Price |
$30.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$29.00
|
| Rate for Payer: Medical Associates Commercial |
$29.00
|
| Rate for Payer: Midlands Choice Commercial |
$27.07
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
|
|
pantoprazole 40 mg Oral DR Tab [VDMC]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10411794
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna of IA Commercial |
$1.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.26
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.05
|
| Rate for Payer: Medical Associates Commercial |
$1.05
|
| Rate for Payer: Midlands Choice Commercial |
$0.98
|
| Rate for Payer: United Healthcare Commercial |
$1.26
|
|
|
pantoprazole 40 mg Oral DR Tab [VDMC]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10411794
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna of IA Commercial |
$1.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.26
|
| Rate for Payer: Aetna of IA Medicare |
$0.80
|
| Rate for Payer: Amerigroup Medicaid |
$0.81
|
| Rate for Payer: Amerigroup Medicare |
$0.63
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.05
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.63
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.80
|
| Rate for Payer: Medical Associates Commercial |
$1.05
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.63
|
| Rate for Payer: Midlands Choice Commercial |
$0.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.72
|
| Rate for Payer: United Healthcare Commercial |
$1.26
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.82
|
|
|
PAP THIN PREP
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
8089044
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Aetna of IA Medicare |
$62.70
|
| Rate for Payer: Amerigroup Medicaid |
$63.45
|
| Rate for Payer: Amerigroup Medicare |
$50.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$62.83
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$63.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.92
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$51.76
|
| Rate for Payer: Wellmark IA PPO |
$57.01
|
|
|
PAP THIN PREP
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
8089044
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
|
|
Paracentesis Procedure
|
Facility
|
OP
|
$688.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
8060784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.60 |
| Max. Negotiated Rate |
$1,659.63 |
| Rate for Payer: Aetna of IA Commercial |
$619.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$619.20
|
| Rate for Payer: Aetna of IA Medicare |
$392.16
|
| Rate for Payer: Amerigroup Medicaid |
$396.84
|
| Rate for Payer: Amerigroup Medicare |
$312.70
|
| Rate for Payer: Cash Price |
$550.40
|
| Rate for Payer: Cash Price |
$550.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$516.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$309.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$392.99
|
| Rate for Payer: Medical Associates Commercial |
$516.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$309.60
|
| Rate for Payer: Midlands Choice Commercial |
$481.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$398.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$356.04
|
| Rate for Payer: United Healthcare Commercial |
$619.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$405.92
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,506.63
|
| Rate for Payer: Wellmark IA PPO |
$1,659.63
|
|
|
Paracentesis Procedure
|
Facility
|
IP
|
$688.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
8060784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$619.20 |
| Rate for Payer: Aetna of IA Commercial |
$619.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$619.20
|
| Rate for Payer: Cash Price |
$550.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$516.00
|
| Rate for Payer: Medical Associates Commercial |
$516.00
|
| Rate for Payer: Midlands Choice Commercial |
$481.60
|
| Rate for Payer: United Healthcare Commercial |
$619.20
|
|
|
PARAFFIN BATH
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 97018 GO
|
| Hospital Charge Code |
1373447
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$81.22 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Aetna of IA Medicare |
$41.61
|
| Rate for Payer: Amerigroup Medicaid |
$42.11
|
| Rate for Payer: Amerigroup Medicare |
$33.18
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.70
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.85
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$37.78
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.07
|
| Rate for Payer: Wellmark IA HMO WHPI |
$73.74
|
| Rate for Payer: Wellmark IA PPO |
$81.22
|
|
|
PARAFFIN BATH
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 97018 GO
|
| Hospital Charge Code |
1373447
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
|
|
PARAFFIN BATH APPLICATION
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 97018 GP
|
| Hospital Charge Code |
1373914
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
|
