|
ALLOGRAFT 30X40MM 722-TS
|
Facility
IP
|
$3,960.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8942325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.00 |
| Max. Negotiated Rate |
$3,564.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,564.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,564.00
|
| Rate for Payer: Cash Price |
$3,168.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,970.00
|
| Rate for Payer: Medical Associates Commercial |
$2,970.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,772.00
|
| Rate for Payer: United Healthcare Commercial |
$3,564.00
|
|
|
allopurinol 100 mg Tab
|
Facility
IP
|
$1.13
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of IA Commercial |
$1.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.02
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.85
|
| Rate for Payer: Medical Associates Commercial |
$0.85
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
|
|
allopurinol 100 mg Tab
|
Facility
OP
|
$1.13
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of IA Commercial |
$1.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.02
|
| Rate for Payer: Aetna of IA Medicare |
$0.64
|
| Rate for Payer: Amerigroup Medicaid |
$0.57
|
| Rate for Payer: Amerigroup Medicare |
$0.57
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.85
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.56
|
| Rate for Payer: Medical Associates Commercial |
$0.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.57
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.67
|
|
|
allopurinol 300 mg Tab
|
Facility
OP
|
$1.31
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Aetna of IA Commercial |
$1.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.18
|
| Rate for Payer: Aetna of IA Medicare |
$0.75
|
| Rate for Payer: Amerigroup Medicaid |
$0.66
|
| Rate for Payer: Amerigroup Medicare |
$0.66
|
| Rate for Payer: Cash Price |
$1.05
|
| 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 |
$0.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.65
|
| Rate for Payer: Medical Associates Commercial |
$0.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.66
|
| Rate for Payer: Midlands Choice Commercial |
$0.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.98
|
| Rate for Payer: United Healthcare Commercial |
$1.18
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.77
|
|
|
allopurinol 300 mg Tab
|
Facility
IP
|
$1.31
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Aetna of IA Commercial |
$1.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.18
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.98
|
| Rate for Payer: Medical Associates Commercial |
$0.98
|
| Rate for Payer: Midlands Choice Commercial |
$0.92
|
| Rate for Payer: United Healthcare Commercial |
$1.18
|
|
|
ALPHA 1-ANTITRYPSIN
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
8037489
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
ALPHA 1-ANTITRYPSIN
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
8037489
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
alpha 1-proteinase inhibitor human 1000mg/20ml SDV
|
Facility
IP
|
$1,267.36
|
|
|
Service Code
|
CPT J0256
|
| Hospital Charge Code |
43700535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$887.15 |
| Max. Negotiated Rate |
$1,140.62 |
| Rate for Payer: Aetna of IA Commercial |
$1,140.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,140.62
|
| Rate for Payer: Cash Price |
$1,013.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$950.52
|
| Rate for Payer: Medical Associates Commercial |
$950.52
|
| Rate for Payer: Midlands Choice Commercial |
$887.15
|
| Rate for Payer: United Healthcare Commercial |
$1,140.62
|
|
|
alpha 1-proteinase inhibitor human 1000mg/20ml SDV
|
Facility
OP
|
$1,267.36
|
|
|
Service Code
|
CPT J0256
|
| Hospital Charge Code |
43700535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$633.43 |
| Max. Negotiated Rate |
$1,140.62 |
| Rate for Payer: Aetna of IA Commercial |
$1,140.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,140.62
|
| Rate for Payer: Aetna of IA Medicare |
$722.40
|
| Rate for Payer: Amerigroup Medicaid |
$639.64
|
| Rate for Payer: Amerigroup Medicare |
$640.02
|
| Rate for Payer: Cash Price |
$1,013.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$950.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$633.68
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$633.43
|
| Rate for Payer: Medical Associates Commercial |
$950.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$633.68
|
| Rate for Payer: Midlands Choice Commercial |
$887.15
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$643.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$950.52
|
| Rate for Payer: United Healthcare Commercial |
$1,140.62
|
| Rate for Payer: United Healthcare Managed Medicare |
$747.74
|
|
|
ALPHA FETOPROTEIN
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
8086832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
ALPHA FETOPROTEIN
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
8086832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
Alpha Fetoprotein Tumor Marker DMCL
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
8037491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
Alpha Fetoprotein Tumor Marker DMCL
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
8037491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
ALPRAZolam 0.25 mg Tab
|
Facility
IP
|
$3.08
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702332
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna of IA Commercial |
$2.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.77
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.31
|
| Rate for Payer: Medical Associates Commercial |
$2.31
|
| Rate for Payer: Midlands Choice Commercial |
$2.16
|
| Rate for Payer: United Healthcare Commercial |
$2.77
|
|
|
ALPRAZolam 0.25 mg Tab
|
Facility
OP
|
$3.08
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702332
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna of IA Commercial |
$2.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.77
|
| Rate for Payer: Aetna of IA Medicare |
$1.76
|
| Rate for Payer: Amerigroup Medicaid |
$1.55
|
| Rate for Payer: Amerigroup Medicare |
$1.56
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.31
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.54
|
| Rate for Payer: Medical Associates Commercial |
$2.31
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.54
|
| Rate for Payer: Midlands Choice Commercial |
$2.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.31
|
| Rate for Payer: United Healthcare Commercial |
$2.77
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.82
|
|
|
ALPRAZolam 0.5 mg Tab
|
Facility
OP
|
$3.10
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702334
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Aetna of IA Commercial |
$2.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.79
|
| Rate for Payer: Aetna of IA Medicare |
$1.77
|
| Rate for Payer: Amerigroup Medicaid |
$1.56
|
| Rate for Payer: Amerigroup Medicare |
$1.57
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.55
|
| Rate for Payer: Medical Associates Commercial |
$2.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.55
|
| Rate for Payer: Midlands Choice Commercial |
$2.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.32
|
| Rate for Payer: United Healthcare Commercial |
$2.79
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.83
|
|
|
ALPRAZolam 0.5 mg Tab
|
Facility
IP
|
$3.10
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702334
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Aetna of IA Commercial |
$2.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.79
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.32
|
| Rate for Payer: Medical Associates Commercial |
$2.32
|
| Rate for Payer: Midlands Choice Commercial |
$2.17
|
| Rate for Payer: United Healthcare Commercial |
$2.79
|
|
|
ALPRAZolam 1 mg oral Dis Tab
|
Facility
OP
|
$9.82
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: Partners Health Alliance Commercial |
$7.36
|
| Rate for Payer: Aetna of IA Commercial |
$8.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8.84
|
| Rate for Payer: Aetna of IA Medicare |
$5.60
|
| Rate for Payer: Amerigroup Medicaid |
$4.96
|
| Rate for Payer: Amerigroup Medicare |
$4.96
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4.91
|
| Rate for Payer: Medical Associates Commercial |
$7.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$4.91
|
| Rate for Payer: Midlands Choice Commercial |
$6.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4.98
|
| Rate for Payer: United Healthcare Commercial |
$8.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$5.79
|
|
|
ALPRAZolam 1 mg oral Dis Tab
|
Facility
IP
|
$9.82
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: Aetna of IA Commercial |
$8.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8.84
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.36
|
| Rate for Payer: Medical Associates Commercial |
$7.36
|
| Rate for Payer: Midlands Choice Commercial |
$6.87
|
| Rate for Payer: United Healthcare Commercial |
$8.84
|
|
|
ALPRAZolam 1 mg Tab
|
Facility
IP
|
$3.10
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43733836
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Aetna of IA Commercial |
$2.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.79
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.32
|
| Rate for Payer: Medical Associates Commercial |
$2.32
|
| Rate for Payer: Midlands Choice Commercial |
$2.17
|
| Rate for Payer: United Healthcare Commercial |
$2.79
|
|
|
ALPRAZolam 1 mg Tab
|
Facility
OP
|
$3.10
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43733836
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Aetna of IA Commercial |
$2.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.79
|
| Rate for Payer: Aetna of IA Medicare |
$1.77
|
| Rate for Payer: Amerigroup Medicaid |
$1.56
|
| Rate for Payer: Amerigroup Medicare |
$1.57
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.55
|
| Rate for Payer: Medical Associates Commercial |
$2.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.55
|
| Rate for Payer: Midlands Choice Commercial |
$2.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.32
|
| Rate for Payer: United Healthcare Commercial |
$2.79
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.83
|
|
|
ALS1 EMERGENCY
|
Facility
OP
|
$889.00
|
|
|
Service Code
|
CPT A0427 QN
|
| Hospital Charge Code |
5230783
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$444.32 |
| Max. Negotiated Rate |
$800.10 |
| Rate for Payer: Aetna of IA Commercial |
$800.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$800.10
|
| Rate for Payer: Aetna of IA Medicare |
$506.73
|
| Rate for Payer: Amerigroup Medicaid |
$448.68
|
| Rate for Payer: Amerigroup Medicare |
$448.94
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$666.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$444.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$444.32
|
| Rate for Payer: Medical Associates Commercial |
$666.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$444.50
|
| Rate for Payer: Midlands Choice Commercial |
$622.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$451.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$666.75
|
| Rate for Payer: United Healthcare Commercial |
$800.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$755.65
|
|
|
ALS1 EMERGENCY
|
Facility
IP
|
$889.00
|
|
|
Service Code
|
CPT A0427 QN
|
| Hospital Charge Code |
5230783
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$622.30 |
| Max. Negotiated Rate |
$800.10 |
| Rate for Payer: Aetna of IA Commercial |
$800.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$800.10
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$666.75
|
| Rate for Payer: Medical Associates Commercial |
$666.75
|
| Rate for Payer: Midlands Choice Commercial |
$622.30
|
| Rate for Payer: United Healthcare Commercial |
$800.10
|
|
|
ALS1 NON EMERGENCY
|
Facility
OP
|
$464.00
|
|
|
Service Code
|
CPT A0426 QN
|
| Hospital Charge Code |
5230782
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$231.91 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna of IA Commercial |
$417.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$417.60
|
| Rate for Payer: Aetna of IA Medicare |
$264.48
|
| Rate for Payer: Amerigroup Medicaid |
$234.18
|
| Rate for Payer: Amerigroup Medicare |
$234.32
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$348.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$232.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$231.91
|
| Rate for Payer: Medical Associates Commercial |
$348.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$232.00
|
| Rate for Payer: Midlands Choice Commercial |
$324.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$235.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$348.00
|
| Rate for Payer: United Healthcare Commercial |
$417.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$394.40
|
|
|
ALS1 NON EMERGENCY
|
Facility
IP
|
$464.00
|
|
|
Service Code
|
CPT A0426 QN
|
| Hospital Charge Code |
5230782
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$324.80 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna of IA Commercial |
$417.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$417.60
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$348.00
|
| Rate for Payer: Medical Associates Commercial |
$348.00
|
| Rate for Payer: Midlands Choice Commercial |
$324.80
|
| Rate for Payer: United Healthcare Commercial |
$417.60
|
|
