|
pseudoephedrine 30 mg Tab [VDMC]
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417559
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Aetna of IA Commercial |
$0.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.97
|
| 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 |
$0.81
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.54
|
| Rate for Payer: Medical Associates Commercial |
$0.81
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.54
|
| Rate for Payer: Midlands Choice Commercial |
$0.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.55
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.55
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$0.97
|
| 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 |
$6,907.21 |
| Max. Negotiated Rate |
$7,008.78 |
| Rate for Payer: Amerigroup Medicaid |
$6,974.92
|
| 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 [VDMC]
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
21047240
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$2.25
|
| Rate for Payer: Oscar Health of IA Commercial |
$3.33
|
| 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
|
|
|
psyllium-orange 12 g UD packet Pow [VDMC]
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
21047240
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
|
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 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: Molina Healthcare Managed Medicare |
$111.58
|
| Rate for Payer: Oscar Health of IA Commercial |
$165.00
|
| 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 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: Molina Healthcare Managed Medicare |
$91.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$135.75
|
| 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: Molina Healthcare Managed Medicare |
$91.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$135.75
|
| 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
|
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: Molina Healthcare Managed Medicare |
$91.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$135.75
|
| 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 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 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: Molina Healthcare Managed Medicare |
$76.59
|
| Rate for Payer: Oscar Health of IA Commercial |
$113.25
|
| 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
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
1635510
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.49 |
| 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: Aetna of IA Medicare |
$24.51
|
| Rate for Payer: Amerigroup Medicaid |
$21.70
|
| Rate for Payer: Amerigroup Medicare |
$21.72
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$21.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.49
|
| Rate for Payer: Medical Associates Commercial |
$32.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$21.50
|
| Rate for Payer: Midlands Choice Commercial |
$30.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21.82
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$21.81
|
| Rate for Payer: Oscar Health of IA Commercial |
$32.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$32.25
|
| Rate for Payer: United Healthcare Commercial |
$38.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.37
|
| Rate for Payer: Wellmark IA HMO |
$24.18
|
| Rate for Payer: Wellmark IA PPO |
$26.60
|
|
|
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
|
|
|
PTNM NEUROELTRD STIM POST TIBIAL
|
Facility
|
OP
|
$659.00
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
8588846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.37 |
| Max. Negotiated Rate |
$703.14 |
| Rate for Payer: Aetna of IA Commercial |
$593.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$593.10
|
| Rate for Payer: Aetna of IA Medicare |
$375.63
|
| Rate for Payer: Amerigroup Medicaid |
$332.60
|
| Rate for Payer: Amerigroup Medicare |
$332.80
|
| Rate for Payer: Cash Price |
$527.20
|
| Rate for Payer: Cash Price |
$527.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$494.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$329.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$329.37
|
| Rate for Payer: Medical Associates Commercial |
$494.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$329.50
|
| Rate for Payer: Midlands Choice Commercial |
$461.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$334.44
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$334.24
|
| Rate for Payer: Oscar Health of IA Commercial |
$494.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$494.25
|
| Rate for Payer: United Healthcare Commercial |
$593.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$388.81
|
| Rate for Payer: Wellmark IA HMO |
$639.22
|
| Rate for Payer: Wellmark IA PPO |
$703.14
|
|
|
PTNM NEUROELTRD STIM POST TIBIAL
|
Facility
|
IP
|
$659.00
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
8588846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$461.30 |
| Max. Negotiated Rate |
$593.10 |
| Rate for Payer: Aetna of IA Commercial |
$593.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$593.10
|
| Rate for Payer: Cash Price |
$527.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$494.25
|
| Rate for Payer: Medical Associates Commercial |
$494.25
|
| Rate for Payer: Midlands Choice Commercial |
$461.30
|
| Rate for Payer: United Healthcare Commercial |
$593.10
|
|
|
PT RE-EVAL EST PLAN CARE
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 97164 GP
|
| Hospital Charge Code |
8397249
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Aetna of IA Commercial |
$123.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$123.30
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$102.75
|
| Rate for Payer: Medical Associates Commercial |
$102.75
|
| Rate for Payer: Midlands Choice Commercial |
$95.90
|
| Rate for Payer: United Healthcare Commercial |
$123.30
|
|
|
PT RE-EVAL EST PLAN CARE
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 97164 GP
|
| Hospital Charge Code |
8397249
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$68.47 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Aetna of IA Commercial |
$123.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$123.30
|
| Rate for Payer: Aetna of IA Medicare |
$78.09
|
| Rate for Payer: Amerigroup Medicaid |
$69.14
|
| Rate for Payer: Amerigroup Medicare |
$69.18
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$102.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$68.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$68.47
|
| Rate for Payer: Medical Associates Commercial |
$102.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$68.50
|
| Rate for Payer: Midlands Choice Commercial |
$95.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$69.53
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$69.49
|
| Rate for Payer: Oscar Health of IA Commercial |
$102.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.75
|
| Rate for Payer: United Healthcare Commercial |
$123.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$80.83
|
|
|
PT RE-EVALUATION
|
Facility
|
IP
|
$92.00
|
|
| Hospital Charge Code |
5520784
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna of IA Commercial |
$82.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$82.80
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$69.00
|
| Rate for Payer: Medical Associates Commercial |
$69.00
|
| Rate for Payer: Midlands Choice Commercial |
$64.40
|
| Rate for Payer: United Healthcare Commercial |
$82.80
|
|
|
PT RE-EVALUATION
|
Facility
|
OP
|
$92.00
|
|
| Hospital Charge Code |
5520784
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$45.98 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna of IA Commercial |
$82.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$82.80
|
| Rate for Payer: Aetna of IA Medicare |
$52.44
|
| Rate for Payer: Amerigroup Medicaid |
$46.43
|
| Rate for Payer: Amerigroup Medicare |
$46.46
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$69.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$46.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$45.98
|
| Rate for Payer: Medical Associates Commercial |
$69.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$46.00
|
| Rate for Payer: Midlands Choice Commercial |
$64.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$46.69
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$46.66
|
| Rate for Payer: Oscar Health of IA Commercial |
$69.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$69.00
|
| Rate for Payer: United Healthcare Commercial |
$82.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$54.28
|
|
|
PTT
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
633794
|
|
Hospital Revenue Code
|
305
|
| 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
|
|
|
PTT
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
633794
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.18 |
| 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: 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: Molina Healthcare Managed Medicare |
$32.46
|
| Rate for Payer: Oscar Health of IA Commercial |
$48.00
|
| 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
|
| Rate for Payer: Wellmark IA HMO |
$24.18
|
| Rate for Payer: Wellmark IA PPO |
$26.60
|
|
|
PTT SUBSTITUTION, PLASMA FRACTIONS
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
8093944
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.18 |
| 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: 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: Molina Healthcare Managed Medicare |
$32.46
|
| Rate for Payer: Oscar Health of IA Commercial |
$48.00
|
| 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
|
| Rate for Payer: Wellmark IA HMO |
$24.18
|
| Rate for Payer: Wellmark IA PPO |
$26.60
|
|
