|
ACRYSOLF IQ LENS 21.5
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
8893483
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$393.75 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Aetna of IA Commercial |
$787.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$787.50
|
| Rate for Payer: Aetna of IA Medicare |
$498.75
|
| Rate for Payer: Amerigroup Medicaid |
$504.70
|
| Rate for Payer: Amerigroup Medicare |
$397.69
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$656.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$393.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$499.80
|
| Rate for Payer: Medical Associates Commercial |
$656.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$393.75
|
| Rate for Payer: Midlands Choice Commercial |
$612.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$507.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$452.81
|
| Rate for Payer: United Healthcare Commercial |
$787.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$516.25
|
|
|
activated charcoal (ped) 25 g Oral Susp 120 mL [VDMC]
|
Facility
|
OP
|
$84.72
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10377167
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.12 |
| Max. Negotiated Rate |
$76.25 |
| Rate for Payer: Aetna of IA Commercial |
$76.25
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.25
|
| Rate for Payer: Aetna of IA Medicare |
$48.29
|
| Rate for Payer: Amerigroup Medicaid |
$48.87
|
| Rate for Payer: Amerigroup Medicare |
$38.51
|
| Rate for Payer: Cash Price |
$67.78
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.54
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.12
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$48.39
|
| Rate for Payer: Medical Associates Commercial |
$63.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.12
|
| Rate for Payer: Midlands Choice Commercial |
$59.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.84
|
| Rate for Payer: United Healthcare Commercial |
$76.25
|
| Rate for Payer: United Healthcare Managed Medicare |
$49.98
|
|
|
activated charcoal (ped) 25 g Oral Susp 120 mL [VDMC]
|
Facility
|
IP
|
$84.72
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10377167
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$59.30 |
| Max. Negotiated Rate |
$76.25 |
| Rate for Payer: Aetna of IA Commercial |
$76.25
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.25
|
| Rate for Payer: Cash Price |
$67.78
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.54
|
| Rate for Payer: Medical Associates Commercial |
$63.54
|
| Rate for Payer: Midlands Choice Commercial |
$59.30
|
| Rate for Payer: United Healthcare Commercial |
$76.25
|
|
|
activated charcoal-sorbitol 50 g Oral Susp 240 mL [VDMC]
|
Facility
|
IP
|
$86.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10377232
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$77.65 |
| Rate for Payer: Aetna of IA Commercial |
$77.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.65
|
| Rate for Payer: Cash Price |
$69.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.71
|
| Rate for Payer: Medical Associates Commercial |
$64.71
|
| Rate for Payer: Midlands Choice Commercial |
$60.40
|
| Rate for Payer: United Healthcare Commercial |
$77.65
|
|
|
activated charcoal-sorbitol 50 g Oral Susp 240 mL [VDMC]
|
Facility
|
OP
|
$86.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10377232
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.83 |
| Max. Negotiated Rate |
$77.65 |
| Rate for Payer: Aetna of IA Commercial |
$77.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.65
|
| Rate for Payer: Aetna of IA Medicare |
$49.18
|
| Rate for Payer: Amerigroup Medicaid |
$49.77
|
| Rate for Payer: Amerigroup Medicare |
$39.21
|
| Rate for Payer: Cash Price |
$69.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.71
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.83
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.28
|
| Rate for Payer: Medical Associates Commercial |
$64.71
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.83
|
| Rate for Payer: Midlands Choice Commercial |
$60.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.65
|
| Rate for Payer: United Healthcare Commercial |
$77.65
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.91
|
|
|
ACUTE HEPATITIS PROFILE
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
8037485
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$136.35 |
| Max. Negotiated Rate |
$272.70 |
| Rate for Payer: Aetna of IA Commercial |
$272.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$272.70
|
| Rate for Payer: Aetna of IA Medicare |
$172.71
|
| Rate for Payer: Amerigroup Medicaid |
$174.77
|
| Rate for Payer: Amerigroup Medicare |
$137.71
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$227.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$136.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$173.07
|
| Rate for Payer: Medical Associates Commercial |
$227.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$136.35
|
| Rate for Payer: Midlands Choice Commercial |
$212.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$175.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$156.80
|
| Rate for Payer: United Healthcare Commercial |
$272.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$178.77
|
|
|
ACUTE HEPATITIS PROFILE
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
8037485
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$212.10 |
| Max. Negotiated Rate |
$272.70 |
| Rate for Payer: Aetna of IA Commercial |
$272.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$272.70
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$227.25
|
| Rate for Payer: Medical Associates Commercial |
$227.25
|
| Rate for Payer: Midlands Choice Commercial |
$212.10
|
| Rate for Payer: United Healthcare Commercial |
$272.70
|
|
|
acyclovir 400 mg Tab [VDMC]
|
Facility
|
IP
|
$1.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10363815
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna of IA Commercial |
$1.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.12
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.93
|
| Rate for Payer: Medical Associates Commercial |
$0.93
|
| Rate for Payer: Midlands Choice Commercial |
$0.87
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
|
|
acyclovir 400 mg Tab [VDMC]
|
Facility
|
OP
|
$1.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10363815
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna of IA Commercial |
$1.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.12
|
| Rate for Payer: Aetna of IA Medicare |
$0.71
|
| Rate for Payer: Amerigroup Medicaid |
$0.72
|
| Rate for Payer: Amerigroup Medicare |
$0.56
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.93
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.71
|
| Rate for Payer: Medical Associates Commercial |
$0.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.56
|
| Rate for Payer: Midlands Choice Commercial |
$0.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.64
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.73
|
|
|
acyclovir 50 mg/mL IV Sol 20 ml SDV [VDMC]
|
Facility
|
OP
|
$36.47
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
10363886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$32.82 |
| Rate for Payer: Aetna of IA Commercial |
$32.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.82
|
| Rate for Payer: Aetna of IA Medicare |
$20.79
|
| Rate for Payer: Amerigroup Medicaid |
$21.04
|
| Rate for Payer: Amerigroup Medicare |
$16.58
|
| Rate for Payer: Cash Price |
$29.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.35
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.83
|
| Rate for Payer: Medical Associates Commercial |
$27.35
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.41
|
| Rate for Payer: Midlands Choice Commercial |
$25.53
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.87
|
| Rate for Payer: United Healthcare Commercial |
$32.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.52
|
|
|
acyclovir 50 mg/mL IV Sol 20 ml SDV [VDMC]
|
Facility
|
IP
|
$36.47
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
10363886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.53 |
| Max. Negotiated Rate |
$32.82 |
| Rate for Payer: Aetna of IA Commercial |
$32.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.82
|
| Rate for Payer: Cash Price |
$29.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.35
|
| Rate for Payer: Medical Associates Commercial |
$27.35
|
| Rate for Payer: Midlands Choice Commercial |
$25.53
|
| Rate for Payer: United Healthcare Commercial |
$32.82
|
|
|
ADAPTOR UNION SCREW
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.20 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Aetna of IA Commercial |
$860.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$860.40
|
| Rate for Payer: Aetna of IA Medicare |
$544.92
|
| Rate for Payer: Amerigroup Medicaid |
$551.42
|
| Rate for Payer: Amerigroup Medicare |
$434.50
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$717.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$430.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$546.07
|
| Rate for Payer: Medical Associates Commercial |
$717.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$430.20
|
| Rate for Payer: Midlands Choice Commercial |
$669.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$554.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$494.73
|
| Rate for Payer: United Healthcare Commercial |
$860.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$564.04
|
|
|
ADAPTOR UNION SCREW
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.20 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Aetna of IA Commercial |
$860.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$860.40
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$717.00
|
| Rate for Payer: Medical Associates Commercial |
$717.00
|
| Rate for Payer: Midlands Choice Commercial |
$669.20
|
| Rate for Payer: United Healthcare Commercial |
$860.40
|
|
|
ADD ON CODE FOR INTERACTIVE COMPLEXITY (ED)
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
CPT 90785 AJ|HO
|
| Hospital Charge Code |
4919421
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$24.02 |
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Medical Associates Commercial |
$16.50
|
| Rate for Payer: Midlands Choice Commercial |
$15.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.50
|
| Rate for Payer: United Healthcare Commercial |
$24.02
|
|
|
adenosine 3 mg/mL 2 ml syringe SDS [VDMC]
|
Facility
|
IP
|
$78.50
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
10364026
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$54.95 |
| Max. Negotiated Rate |
$70.65 |
| Rate for Payer: Aetna of IA Commercial |
$70.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$70.65
|
| Rate for Payer: Cash Price |
$62.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.88
|
| Rate for Payer: Medical Associates Commercial |
$58.88
|
| Rate for Payer: Midlands Choice Commercial |
$54.95
|
| Rate for Payer: United Healthcare Commercial |
$70.65
|
|
|
adenosine 3 mg/mL 2 ml syringe SDS [VDMC]
|
Facility
|
OP
|
$78.50
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
10364026
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.33 |
| Max. Negotiated Rate |
$70.65 |
| Rate for Payer: Aetna of IA Commercial |
$70.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$70.65
|
| Rate for Payer: Aetna of IA Medicare |
$44.74
|
| Rate for Payer: Amerigroup Medicaid |
$45.28
|
| Rate for Payer: Amerigroup Medicare |
$35.68
|
| Rate for Payer: Cash Price |
$62.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.88
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.33
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$44.84
|
| Rate for Payer: Medical Associates Commercial |
$58.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.33
|
| Rate for Payer: Midlands Choice Commercial |
$54.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$45.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$40.62
|
| Rate for Payer: United Healthcare Commercial |
$70.65
|
| Rate for Payer: United Healthcare Managed Medicare |
$46.31
|
|
|
ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$2,531.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
8799105
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,147.18 |
| Max. Negotiated Rate |
$1,898.25 |
| Rate for Payer: Cash Price |
$2,024.80
|
| Rate for Payer: Cash Price |
$2,024.80
|
| Rate for Payer: Medical Associates Commercial |
$1,898.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,771.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,898.25
|
| Rate for Payer: United Healthcare Commercial |
$1,147.18
|
|
|
ADL TRAINING EA 15 MIN
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 97535 GO
|
| Hospital Charge Code |
1373569
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of IA Commercial |
$97.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.20
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.00
|
| Rate for Payer: Medical Associates Commercial |
$81.00
|
| Rate for Payer: Midlands Choice Commercial |
$75.60
|
| Rate for Payer: United Healthcare Commercial |
$97.20
|
|
|
ADL TRAINING EA 15 MIN
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 97535 GO
|
| Hospital Charge Code |
1373569
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of IA Commercial |
$97.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.20
|
| Rate for Payer: Aetna of IA Medicare |
$61.56
|
| Rate for Payer: Amerigroup Medicaid |
$62.29
|
| Rate for Payer: Amerigroup Medicare |
$49.09
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$48.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.69
|
| Rate for Payer: Medical Associates Commercial |
$81.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$48.60
|
| Rate for Payer: Midlands Choice Commercial |
$75.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.89
|
| Rate for Payer: United Healthcare Commercial |
$97.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.72
|
|
|
ADM IM
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
6922826
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna of IA Commercial |
$59.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.40
|
| Rate for Payer: Aetna of IA Medicare |
$37.62
|
| Rate for Payer: Amerigroup Medicaid |
$38.07
|
| Rate for Payer: Amerigroup Medicare |
$30.00
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.70
|
| Rate for Payer: Medical Associates Commercial |
$49.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.70
|
| Rate for Payer: Midlands Choice Commercial |
$46.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.16
|
| Rate for Payer: United Healthcare Commercial |
$59.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.94
|
|
|
ADM IM
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
6922826
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna of IA Commercial |
$59.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.50
|
| Rate for Payer: Medical Associates Commercial |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$59.40
|
|
|
ADM IM
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
4866834
|
|
Hospital Revenue Code
|
760
|
| 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
|
|
|
ADM IM
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
4866834
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$28.80 |
| 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: Aetna of IA Medicare |
$36.48
|
| Rate for Payer: Amerigroup Medicaid |
$36.92
|
| Rate for Payer: Amerigroup Medicare |
$29.09
|
| 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 |
$28.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.56
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.80
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.12
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
|
|
ADM IM SCHEDULED
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
8012938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna of IA Commercial |
$59.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.50
|
| Rate for Payer: Medical Associates Commercial |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$59.40
|
|
|
ADM IM SCHEDULED
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
8012938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna of IA Commercial |
$59.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.40
|
| Rate for Payer: Aetna of IA Medicare |
$37.62
|
| Rate for Payer: Amerigroup Medicaid |
$38.07
|
| Rate for Payer: Amerigroup Medicare |
$30.00
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.70
|
| Rate for Payer: Medical Associates Commercial |
$49.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.70
|
| Rate for Payer: Midlands Choice Commercial |
$46.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.16
|
| Rate for Payer: United Healthcare Commercial |
$59.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.94
|
|
