|
prucalopride 2 mg Tab
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43799940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna of IA Commercial |
$56.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$56.70
|
| Rate for Payer: Aetna of IA Medicare |
$35.91
|
| Rate for Payer: Amerigroup Medicaid |
$31.80
|
| Rate for Payer: Amerigroup Medicare |
$31.82
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.49
|
| Rate for Payer: Medical Associates Commercial |
$47.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.50
|
| Rate for Payer: Midlands Choice Commercial |
$44.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$31.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$47.25
|
| Rate for Payer: United Healthcare Commercial |
$56.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.17
|
|
|
PSA DIAG
|
Facility
OP
|
$148.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
1634882
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna of IA Commercial |
$133.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$133.20
|
| Rate for Payer: Aetna of IA Medicare |
$84.36
|
| Rate for Payer: Amerigroup Medicaid |
$74.70
|
| Rate for Payer: Amerigroup Medicare |
$74.74
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$74.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.97
|
| Rate for Payer: Medical Associates Commercial |
$111.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$74.00
|
| Rate for Payer: Midlands Choice Commercial |
$103.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.00
|
| Rate for Payer: United Healthcare Commercial |
$133.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.32
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
PSA DIAG
|
Facility
IP
|
$148.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
1634882
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna of IA Commercial |
$133.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$133.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.00
|
| Rate for Payer: Medical Associates Commercial |
$111.00
|
| Rate for Payer: Midlands Choice Commercial |
$103.60
|
| Rate for Payer: United Healthcare Commercial |
$133.20
|
|
|
PSA DIAG
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
8037784
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of IA Commercial |
$135.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.00
|
| Rate for Payer: Aetna of IA Medicare |
$85.50
|
| Rate for Payer: Amerigroup Medicaid |
$75.70
|
| Rate for Payer: Amerigroup Medicare |
$75.75
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$112.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$75.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.97
|
| Rate for Payer: Medical Associates Commercial |
$112.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$105.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$76.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$112.50
|
| Rate for Payer: United Healthcare Commercial |
$135.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$88.50
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
PSA DIAG
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
8037784
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of IA Commercial |
$135.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$112.50
|
| Rate for Payer: Medical Associates Commercial |
$112.50
|
| Rate for Payer: Midlands Choice Commercial |
$105.00
|
| Rate for Payer: United Healthcare Commercial |
$135.00
|
|
|
PSA FREE
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
8038996
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of IA Commercial |
$135.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$112.50
|
| Rate for Payer: Medical Associates Commercial |
$112.50
|
| Rate for Payer: Midlands Choice Commercial |
$105.00
|
| Rate for Payer: United Healthcare Commercial |
$135.00
|
|
|
PSA FREE
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
8038996
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of IA Commercial |
$135.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.00
|
| Rate for Payer: Aetna of IA Medicare |
$85.50
|
| Rate for Payer: Amerigroup Medicaid |
$75.70
|
| Rate for Payer: Amerigroup Medicare |
$75.75
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$112.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$75.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.97
|
| Rate for Payer: Medical Associates Commercial |
$112.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$105.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$76.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$112.50
|
| Rate for Payer: United Healthcare Commercial |
$135.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$88.50
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
pseudoephedrine 120 mg ER Tab
|
Facility
IP
|
$2.32
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43799270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Aetna of IA Commercial |
$2.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.09
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.74
|
| Rate for Payer: Medical Associates Commercial |
$1.74
|
| Rate for Payer: Midlands Choice Commercial |
$1.62
|
| Rate for Payer: United Healthcare Commercial |
$2.09
|
|
|
pseudoephedrine 120 mg ER Tab
|
Facility
OP
|
$2.32
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43799270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Aetna of IA Commercial |
$2.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.09
|
| Rate for Payer: Aetna of IA Medicare |
$1.32
|
| Rate for Payer: Amerigroup Medicaid |
$1.17
|
| Rate for Payer: Amerigroup Medicare |
$1.17
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.74
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.16
|
| Rate for Payer: Medical Associates Commercial |
$1.74
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.16
|
| Rate for Payer: Midlands Choice Commercial |
$1.62
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.74
|
| Rate for Payer: United Healthcare Commercial |
$2.09
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.37
|
|
|
pseudoephedrine 30 mg Tab
|
Facility
IP
|
$1.09
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna of IA Commercial |
$0.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.98
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.82
|
| Rate for Payer: Medical Associates Commercial |
$0.82
|
| Rate for Payer: Midlands Choice Commercial |
$0.76
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
|
|
pseudoephedrine 30 mg Tab
|
Facility
OP
|
$1.09
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna of IA Commercial |
$0.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.98
|
| Rate for Payer: Aetna of IA Medicare |
$0.62
|
| Rate for Payer: Amerigroup Medicaid |
$0.55
|
| Rate for Payer: Amerigroup Medicare |
$0.55
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.54
|
| Rate for Payer: Medical Associates Commercial |
$0.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.55
|
| Rate for Payer: Midlands Choice Commercial |
$0.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.64
|
|
|
Psychoses
|
Facility
IP
|
$7,008.78
|
|
|
Service Code
|
MS-DRG 885
|
| Hospital Charge Code |
615
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,008.78 |
| Rate for Payer: Amerigroup Medicaid |
$6,974.92
|
| 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 |
$6,907.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,008.78
|
|
|
psyllium-orange 12 g UD packet Pow
|
Facility
IP
|
$4.44
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna of IA Commercial |
$4.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.00
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.33
|
| Rate for Payer: Medical Associates Commercial |
$3.33
|
| Rate for Payer: Midlands Choice Commercial |
$3.11
|
| Rate for Payer: United Healthcare Commercial |
$4.00
|
|
|
psyllium-orange 12 g UD packet Pow
|
Facility
OP
|
$4.44
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna of IA Commercial |
$4.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.00
|
| Rate for Payer: Aetna of IA Medicare |
$2.53
|
| Rate for Payer: Amerigroup Medicaid |
$2.24
|
| Rate for Payer: Amerigroup Medicare |
$2.24
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.33
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.22
|
| Rate for Payer: Medical Associates Commercial |
$3.33
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.22
|
| Rate for Payer: Midlands Choice Commercial |
$3.11
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.33
|
| Rate for Payer: United Healthcare Commercial |
$4.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.62
|
|
|
PT 20210 Gene Mutation DMCL
|
Facility
OP
|
$220.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
8037791
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.96 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$111.03
|
| Rate for Payer: Amerigroup Medicare |
$111.10
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$110.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$109.96
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$110.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$111.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
| Rate for Payer: Wellmark IA HMO |
$143.22
|
| Rate for Payer: Wellmark IA PPO |
$157.54
|
|
|
PT 20210 Gene Mutation DMCL
|
Facility
IP
|
$220.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
8037791
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
|
|
PT EVAL HIGH COMPLEX 45 MIN
|
Facility
OP
|
$181.00
|
|
|
Service Code
|
CPT 97163 GP
|
| Hospital Charge Code |
8397241
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$90.46 |
| 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: Aetna of IA Medicare |
$103.17
|
| Rate for Payer: Amerigroup Medicaid |
$91.35
|
| Rate for Payer: Amerigroup Medicare |
$91.40
|
| 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 |
$90.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.46
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.50
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.75
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.79
|
|
|
PT EVAL HIGH COMPLEX 45 MIN
|
Facility
IP
|
$181.00
|
|
|
Service Code
|
CPT 97163 GP
|
| Hospital Charge Code |
8397241
|
|
Hospital Revenue Code
|
424
|
| 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
|
|
|
PT EVAL LOW COMPLEX 20 MIN
|
Facility
OP
|
$181.00
|
|
|
Service Code
|
CPT 97161 GP
|
| Hospital Charge Code |
8397225
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$90.46 |
| 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: Aetna of IA Medicare |
$103.17
|
| Rate for Payer: Amerigroup Medicaid |
$91.35
|
| Rate for Payer: Amerigroup Medicare |
$91.40
|
| 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 |
$90.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.46
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.50
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.75
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.79
|
|
|
PT EVAL LOW COMPLEX 20 MIN
|
Facility
IP
|
$181.00
|
|
|
Service Code
|
CPT 97161 GP
|
| Hospital Charge Code |
8397225
|
|
Hospital Revenue Code
|
424
|
| 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
|
|
|
PT EVAL MOD COMPLEX 30 MIN
|
Facility
IP
|
$181.00
|
|
|
Service Code
|
CPT 97162 GP
|
| Hospital Charge Code |
8397234
|
|
Hospital Revenue Code
|
424
|
| 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
|
|
|
PT EVAL MOD COMPLEX 30 MIN
|
Facility
OP
|
$181.00
|
|
|
Service Code
|
CPT 97162 GP
|
| Hospital Charge Code |
8397234
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$90.46 |
| 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: Aetna of IA Medicare |
$103.17
|
| Rate for Payer: Amerigroup Medicaid |
$91.35
|
| Rate for Payer: Amerigroup Medicare |
$91.40
|
| 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 |
$90.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.46
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.50
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.75
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.79
|
|
|
PT EVALUATION
|
Facility
IP
|
$151.00
|
|
| Hospital Charge Code |
5516782
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
|
|
PT EVALUATION
|
Facility
OP
|
$151.00
|
|
| Hospital Charge Code |
5516782
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$75.47 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Aetna of IA Medicare |
$86.07
|
| Rate for Payer: Amerigroup Medicaid |
$76.21
|
| Rate for Payer: Amerigroup Medicare |
$76.26
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$75.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$75.47
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.50
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$76.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.25
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$89.09
|
|
|
PT/INR
|
Facility
IP
|
$43.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
1635510
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna of IA Commercial |
$38.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.70
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.25
|
| Rate for Payer: Medical Associates Commercial |
$32.25
|
| Rate for Payer: Midlands Choice Commercial |
$30.10
|
| Rate for Payer: United Healthcare Commercial |
$38.70
|
|
