|
solifenacin 5 mg Tab
|
Facility
IP
|
$1.53
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700263
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna of IA Commercial |
$1.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.38
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.15
|
| Rate for Payer: Medical Associates Commercial |
$1.15
|
| Rate for Payer: Midlands Choice Commercial |
$1.07
|
| Rate for Payer: United Healthcare Commercial |
$1.38
|
|
|
solifenacin 5 mg Tab
|
Facility
OP
|
$1.53
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700263
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna of IA Commercial |
$1.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.38
|
| Rate for Payer: Aetna of IA Medicare |
$0.87
|
| Rate for Payer: Amerigroup Medicaid |
$0.77
|
| Rate for Payer: Amerigroup Medicare |
$0.77
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.15
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.77
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.76
|
| Rate for Payer: Medical Associates Commercial |
$1.15
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.77
|
| Rate for Payer: Midlands Choice Commercial |
$1.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.15
|
| Rate for Payer: United Healthcare Commercial |
$1.38
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.90
|
|
|
Soluble Transferrin Receptor DMCL
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
8820558
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.47 |
| 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 |
$102.92
|
| Rate for Payer: Wellmark IA PPO |
$113.21
|
|
|
Soluble Transferrin Receptor DMCL
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
8820558
|
|
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
|
|
|
SONICANCHOR KIT 2.5X10MM/ FOREC FIBRE #0
|
Facility
OP
|
$693.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8470642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.36 |
| Max. Negotiated Rate |
$623.70 |
| Rate for Payer: Aetna of IA Commercial |
$623.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$623.70
|
| Rate for Payer: Aetna of IA Medicare |
$395.01
|
| Rate for Payer: Amerigroup Medicaid |
$349.76
|
| Rate for Payer: Amerigroup Medicare |
$349.96
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$519.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$346.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$346.36
|
| Rate for Payer: Medical Associates Commercial |
$519.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$346.50
|
| Rate for Payer: Midlands Choice Commercial |
$485.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$351.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$519.75
|
| Rate for Payer: United Healthcare Commercial |
$623.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$408.87
|
|
|
SONICANCHOR KIT 2.5X10MM/ FOREC FIBRE #0
|
Facility
IP
|
$693.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8470642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$485.10 |
| Max. Negotiated Rate |
$623.70 |
| Rate for Payer: Aetna of IA Commercial |
$623.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$623.70
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$519.75
|
| Rate for Payer: Medical Associates Commercial |
$519.75
|
| Rate for Payer: Midlands Choice Commercial |
$485.10
|
| Rate for Payer: United Healthcare Commercial |
$623.70
|
|
|
SORBAFIX ABSORBABLE FIXATION SYSTEM
|
Facility
OP
|
$711.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8773701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.36 |
| Max. Negotiated Rate |
$639.90 |
| Rate for Payer: Aetna of IA Commercial |
$639.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$639.90
|
| Rate for Payer: Aetna of IA Medicare |
$405.27
|
| Rate for Payer: Amerigroup Medicaid |
$358.84
|
| Rate for Payer: Amerigroup Medicare |
$359.06
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$533.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$355.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$355.36
|
| Rate for Payer: Medical Associates Commercial |
$533.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$355.50
|
| Rate for Payer: Midlands Choice Commercial |
$497.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$360.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$533.25
|
| Rate for Payer: United Healthcare Commercial |
$639.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$419.49
|
|
|
SORBAFIX ABSORBABLE FIXATION SYSTEM
|
Facility
IP
|
$711.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8773701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.70 |
| Max. Negotiated Rate |
$639.90 |
| Rate for Payer: Aetna of IA Commercial |
$639.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$639.90
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$533.25
|
| Rate for Payer: Medical Associates Commercial |
$533.25
|
| Rate for Payer: Midlands Choice Commercial |
$497.70
|
| Rate for Payer: United Healthcare Commercial |
$639.90
|
|
|
sotalol 120 mg Tab
|
Facility
OP
|
$1.29
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702440
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of IA Commercial |
$1.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.16
|
| Rate for Payer: Aetna of IA Medicare |
$0.74
|
| Rate for Payer: Amerigroup Medicaid |
$0.65
|
| Rate for Payer: Amerigroup Medicare |
$0.65
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.64
|
| Rate for Payer: Medical Associates Commercial |
$0.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.65
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.97
|
| Rate for Payer: United Healthcare Commercial |
$1.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.76
|
|
|
sotalol 120 mg Tab
|
Facility
IP
|
$1.29
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702440
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of IA Commercial |
$1.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.16
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.97
|
| Rate for Payer: Medical Associates Commercial |
$0.97
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.16
|
|
|
sotalol 80 mg Tab
|
Facility
OP
|
$1.20
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43722001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna of IA Commercial |
$1.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.08
|
| Rate for Payer: Aetna of IA Medicare |
$0.68
|
| Rate for Payer: Amerigroup Medicaid |
$0.61
|
| Rate for Payer: Amerigroup Medicare |
$0.61
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.90
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.60
|
| Rate for Payer: Medical Associates Commercial |
$0.90
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.60
|
| Rate for Payer: Midlands Choice Commercial |
$0.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.71
|
|
|
sotalol 80 mg Tab
|
Facility
IP
|
$1.20
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43722001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna of IA Commercial |
$1.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.08
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.90
|
| Rate for Payer: Medical Associates Commercial |
$0.90
|
| Rate for Payer: Midlands Choice Commercial |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.08
|
|
|
SPADE TWO-STEP HAMMER TOE IMPLANT 34.5MMX3.0MMX14MM
|
Facility
OP
|
$2,223.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8868035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,111.06 |
| Max. Negotiated Rate |
$2,000.70 |
| Rate for Payer: Aetna of IA Commercial |
$2,000.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,000.70
|
| Rate for Payer: Aetna of IA Medicare |
$1,267.11
|
| Rate for Payer: Amerigroup Medicaid |
$1,121.95
|
| Rate for Payer: Amerigroup Medicare |
$1,122.62
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,667.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,111.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,111.06
|
| Rate for Payer: Medical Associates Commercial |
$1,667.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,111.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,556.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,128.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,667.25
|
| Rate for Payer: United Healthcare Commercial |
$2,000.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,311.57
|
|
|
SPADE TWO-STEP HAMMER TOE IMPLANT 34.5MMX3.0MMX14MM
|
Facility
IP
|
$2,223.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8868035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.10 |
| Max. Negotiated Rate |
$2,000.70 |
| Rate for Payer: Aetna of IA Commercial |
$2,000.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,000.70
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,667.25
|
| Rate for Payer: Medical Associates Commercial |
$1,667.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,556.10
|
| Rate for Payer: United Healthcare Commercial |
$2,000.70
|
|
|
SPADE TWO-STEP HAMMER TOE IMPLANT 3.4MMX3.0MMX18MM
|
Facility
IP
|
$2,223.00
|
|
| Hospital Charge Code |
8810198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.10 |
| Max. Negotiated Rate |
$2,000.70 |
| Rate for Payer: Aetna of IA Commercial |
$2,000.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,000.70
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,667.25
|
| Rate for Payer: Medical Associates Commercial |
$1,667.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,556.10
|
| Rate for Payer: United Healthcare Commercial |
$2,000.70
|
|
|
SPADE TWO-STEP HAMMER TOE IMPLANT 3.4MMX3.0MMX18MM
|
Facility
OP
|
$2,223.00
|
|
| Hospital Charge Code |
8810198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,111.06 |
| Max. Negotiated Rate |
$2,000.70 |
| Rate for Payer: Aetna of IA Commercial |
$2,000.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,000.70
|
| Rate for Payer: Aetna of IA Medicare |
$1,267.11
|
| Rate for Payer: Amerigroup Medicaid |
$1,121.95
|
| Rate for Payer: Amerigroup Medicare |
$1,122.62
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,667.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,111.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,111.06
|
| Rate for Payer: Medical Associates Commercial |
$1,667.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,111.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,556.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,128.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,667.25
|
| Rate for Payer: United Healthcare Commercial |
$2,000.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,311.57
|
|
|
SPADE TWO-STEP HAMMER TOE IMPLANT - 3.4MMX3.0MMX6MM
|
Facility
OP
|
$1,800.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8788811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$899.64 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,620.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,620.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,026.00
|
| Rate for Payer: Amerigroup Medicaid |
$908.46
|
| Rate for Payer: Amerigroup Medicare |
$909.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,350.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$900.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$899.64
|
| Rate for Payer: Medical Associates Commercial |
$1,350.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$900.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,260.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$913.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,350.00
|
| Rate for Payer: United Healthcare Commercial |
$1,620.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,062.00
|
|
|
SPADE TWO-STEP HAMMER TOE IMPLANT - 3.4MMX3.0MMX6MM
|
Facility
IP
|
$1,800.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8788811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,260.00 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,620.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,350.00
|
| Rate for Payer: Medical Associates Commercial |
$1,350.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,260.00
|
| Rate for Payer: United Healthcare Commercial |
$1,620.00
|
|
|
SPECIALTY CARE TRANSPORT
|
Facility
IP
|
$1,334.00
|
|
|
Service Code
|
CPT A0434 QN
|
| Hospital Charge Code |
7932763
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$933.80 |
| Max. Negotiated Rate |
$1,200.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,200.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,200.60
|
| Rate for Payer: Cash Price |
$1,067.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,000.50
|
| Rate for Payer: Medical Associates Commercial |
$1,000.50
|
| Rate for Payer: Midlands Choice Commercial |
$933.80
|
| Rate for Payer: United Healthcare Commercial |
$1,200.60
|
|
|
SPECIALTY CARE TRANSPORT
|
Facility
OP
|
$1,334.00
|
|
|
Service Code
|
CPT A0434 QN
|
| Hospital Charge Code |
7932763
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$666.73 |
| Max. Negotiated Rate |
$1,200.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,200.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,200.60
|
| Rate for Payer: Aetna of IA Medicare |
$760.38
|
| Rate for Payer: Amerigroup Medicaid |
$673.27
|
| Rate for Payer: Amerigroup Medicare |
$673.67
|
| Rate for Payer: Cash Price |
$1,067.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,000.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$667.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$666.73
|
| Rate for Payer: Medical Associates Commercial |
$1,000.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$667.00
|
| Rate for Payer: Midlands Choice Commercial |
$933.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$677.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,000.50
|
| Rate for Payer: United Healthcare Commercial |
$1,200.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,133.90
|
|
|
Speech Language Pathology Video Swallow
|
Facility
OP
|
$389.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
985772
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.56 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Aetna of IA Commercial |
$350.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$350.10
|
| Rate for Payer: Aetna of IA Medicare |
$221.73
|
| Rate for Payer: Amerigroup Medicaid |
$196.33
|
| Rate for Payer: Amerigroup Medicare |
$196.44
|
| Rate for Payer: Cash Price |
$311.20
|
| Rate for Payer: Cash Price |
$311.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$291.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$194.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$194.42
|
| Rate for Payer: Medical Associates Commercial |
$291.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$194.50
|
| Rate for Payer: Midlands Choice Commercial |
$272.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$197.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$291.75
|
| Rate for Payer: United Healthcare Commercial |
$350.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$229.51
|
| Rate for Payer: Wellmark IA HMO |
$178.56
|
| Rate for Payer: Wellmark IA PPO |
$196.42
|
|
|
Speech Language Pathology Video Swallow
|
Facility
IP
|
$389.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
985772
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.30 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Aetna of IA Commercial |
$350.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$350.10
|
| Rate for Payer: Cash Price |
$311.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$291.75
|
| Rate for Payer: Medical Associates Commercial |
$291.75
|
| Rate for Payer: Midlands Choice Commercial |
$272.30
|
| Rate for Payer: United Healthcare Commercial |
$350.10
|
|
|
SPEECH/OTHR COMMUNCATE INDIVIDUAL TX
|
Facility
IP
|
$163.00
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
5526782
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$114.10 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna of IA Commercial |
$146.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.70
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$122.25
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: United Healthcare Commercial |
$146.70
|
|
|
SPEECH/OTHR COMMUNCATE INDIVIDUAL TX
|
Facility
OP
|
$163.00
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
5526782
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$81.47 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna of IA Commercial |
$146.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.70
|
| Rate for Payer: Aetna of IA Medicare |
$92.91
|
| Rate for Payer: Amerigroup Medicaid |
$82.27
|
| Rate for Payer: Amerigroup Medicare |
$82.32
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$122.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$81.47
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.50
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$82.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$122.25
|
| Rate for Payer: United Healthcare Commercial |
$146.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$96.17
|
|
|
SPHINCTEROTOMY ER CHARGE
|
Professional
|
$530.00
|
|
| Hospital Charge Code |
8069012
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$371.00
|
|
