|
Protein Urine Random DMCL
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
8037738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
Protein Urine Random DMCL
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
8037738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$35.18
|
| Rate for Payer: Amerigroup Medicare |
$27.72
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.84
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.45
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.57
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
Protein Urine Timed DMCL
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
8037739
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$35.18
|
| Rate for Payer: Amerigroup Medicare |
$27.72
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.84
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.45
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.57
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
Protein Urine Timed DMCL
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
8037739
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
prucalopride 2 mg Tab [VDMC]
|
Facility
|
OP
|
$66.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
26827722
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$59.47 |
| Rate for Payer: Aetna of IA Commercial |
$59.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.47
|
| Rate for Payer: Aetna of IA Medicare |
$37.67
|
| Rate for Payer: Amerigroup Medicaid |
$38.12
|
| Rate for Payer: Amerigroup Medicare |
$30.03
|
| Rate for Payer: Cash Price |
$52.87
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.56
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.74
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.75
|
| Rate for Payer: Medical Associates Commercial |
$49.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.74
|
| Rate for Payer: Midlands Choice Commercial |
$46.26
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.20
|
| Rate for Payer: United Healthcare Commercial |
$59.47
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.99
|
|
|
prucalopride 2 mg Tab [VDMC]
|
Facility
|
IP
|
$66.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
26827722
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$46.26 |
| Max. Negotiated Rate |
$59.47 |
| Rate for Payer: Aetna of IA Commercial |
$59.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.47
|
| Rate for Payer: Cash Price |
$52.87
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.56
|
| Rate for Payer: Medical Associates Commercial |
$49.56
|
| Rate for Payer: Midlands Choice Commercial |
$46.26
|
| Rate for Payer: United Healthcare Commercial |
$59.47
|
|
|
PSA DIAG
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
8037784
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.68 |
| 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 |
$86.52
|
| Rate for Payer: Amerigroup Medicare |
$68.18
|
| 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 |
$67.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$85.68
|
| Rate for Payer: Medical Associates Commercial |
$112.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$105.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$86.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.62
|
| Rate for Payer: United Healthcare Commercial |
$135.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$88.50
|
| Rate for Payer: Wellmark IA HMO WHPI |
$61.68
|
| Rate for Payer: Wellmark IA PPO |
$67.95
|
|
|
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
|
$148.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
1634882
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.68 |
| 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 |
$85.37
|
| Rate for Payer: Amerigroup Medicare |
$67.27
|
| 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 |
$66.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$84.54
|
| Rate for Payer: Medical Associates Commercial |
$111.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$66.60
|
| Rate for Payer: Midlands Choice Commercial |
$103.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$85.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$76.59
|
| Rate for Payer: United Healthcare Commercial |
$133.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.32
|
| Rate for Payer: Wellmark IA HMO WHPI |
$61.68
|
| Rate for Payer: Wellmark IA PPO |
$67.95
|
|
|
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
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
8038996
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.68 |
| 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 |
$86.52
|
| Rate for Payer: Amerigroup Medicare |
$68.18
|
| 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 |
$67.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$85.68
|
| Rate for Payer: Medical Associates Commercial |
$112.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$105.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$86.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.62
|
| Rate for Payer: United Healthcare Commercial |
$135.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$88.50
|
| Rate for Payer: Wellmark IA HMO WHPI |
$61.68
|
| Rate for Payer: Wellmark IA PPO |
$67.95
|
|
|
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
|
|
|
pseudoephedrine 30 mg Tab [VDMC]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417559
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| 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 |
$0.63
|
| Rate for Payer: Amerigroup Medicare |
$0.49
|
| 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 |
$0.49
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.62
|
| Rate for Payer: Medical Associates Commercial |
$0.81
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.49
|
| Rate for Payer: Midlands Choice Commercial |
$0.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.56
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.64
|
|
|
pseudoephedrine 30 mg Tab [VDMC]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417559
|
|
Hospital Revenue Code
|
259
|
| 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 |
$0.81
|
| Rate for Payer: Medical Associates Commercial |
$0.81
|
| Rate for Payer: Midlands Choice Commercial |
$0.76
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
|
|
PSYCHOSES
|
Facility
|
IP
|
$8,018.08
|
|
|
Service Code
|
MSDRG 885
|
| Min. Negotiated Rate |
$7,901.87 |
| Max. Negotiated Rate |
$8,018.08 |
| Rate for Payer: Amerigroup Medicaid |
$7,979.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,901.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,018.08
|
|
|
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 |
$2.00 |
| 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 |
$2.56
|
| Rate for Payer: Amerigroup Medicare |
$2.02
|
| 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 |
$2.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.54
|
| Rate for Payer: Medical Associates Commercial |
$3.33
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.00
|
| Rate for Payer: Midlands Choice Commercial |
$3.11
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.30
|
| 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 |
$99.00 |
| 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: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$126.90
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| 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 |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.66
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.85
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
| Rate for Payer: Wellmark IA HMO WHPI |
$100.68
|
| Rate for Payer: Wellmark IA PPO |
$110.90
|
|
|
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 |
$81.45 |
| Max. Negotiated Rate |
$244.45 |
| 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 |
$104.40
|
| Rate for Payer: Amerigroup Medicare |
$82.26
|
| Rate for Payer: Cash Price |
$144.80
|
| 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 |
$81.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$103.39
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.45
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.67
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.79
|
| Rate for Payer: Wellmark IA HMO WHPI |
$221.92
|
| Rate for Payer: Wellmark IA PPO |
$244.45
|
|
|
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 |
$81.45 |
| Max. Negotiated Rate |
$244.45 |
| 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 |
$104.40
|
| Rate for Payer: Amerigroup Medicare |
$82.26
|
| Rate for Payer: Cash Price |
$144.80
|
| 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 |
$81.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$103.39
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.45
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.67
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.79
|
| Rate for Payer: Wellmark IA HMO WHPI |
$221.92
|
| Rate for Payer: Wellmark IA PPO |
$244.45
|
|
|
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 |
$81.45 |
| Max. Negotiated Rate |
$244.45 |
| 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 |
$104.40
|
| Rate for Payer: Amerigroup Medicare |
$82.26
|
| Rate for Payer: Cash Price |
$144.80
|
| 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 |
$81.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$103.39
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.45
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.67
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.79
|
| Rate for Payer: Wellmark IA HMO WHPI |
$221.92
|
| Rate for Payer: Wellmark IA PPO |
$244.45
|
|
|
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
|
|
