|
tetanus immune globulin 250 units IM SD Sol 1 EA [VDMC]
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
10424180
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$659.40 |
| Max. Negotiated Rate |
$847.80 |
| Rate for Payer: Aetna of IA Commercial |
$847.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$847.80
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$706.50
|
| Rate for Payer: Medical Associates Commercial |
$706.50
|
| Rate for Payer: Midlands Choice Commercial |
$659.40
|
| Rate for Payer: United Healthcare Commercial |
$847.80
|
|
|
tetracaine ophthalmic 0.5% 4 ml Sol [VDMC]
|
Facility
|
IP
|
$64.52
|
|
|
Service Code
|
NDC 00065-0741-12
|
| Hospital Charge Code |
12719136
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$45.16 |
| Max. Negotiated Rate |
$58.06 |
| Rate for Payer: Aetna of IA Commercial |
$58.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.06
|
| Rate for Payer: Cash Price |
$51.61
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.39
|
| Rate for Payer: Medical Associates Commercial |
$48.39
|
| Rate for Payer: Midlands Choice Commercial |
$45.16
|
| Rate for Payer: United Healthcare Commercial |
$58.06
|
|
|
tetracaine ophthalmic 0.5% 4 ml Sol [VDMC]
|
Facility
|
OP
|
$64.52
|
|
|
Service Code
|
NDC 00065-0741-12
|
| Hospital Charge Code |
12719136
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.03 |
| Max. Negotiated Rate |
$58.06 |
| Rate for Payer: Aetna of IA Commercial |
$58.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.06
|
| Rate for Payer: Aetna of IA Medicare |
$36.77
|
| Rate for Payer: Amerigroup Medicaid |
$37.21
|
| Rate for Payer: Amerigroup Medicare |
$29.32
|
| Rate for Payer: Cash Price |
$51.61
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.39
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.03
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.85
|
| Rate for Payer: Medical Associates Commercial |
$48.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.03
|
| Rate for Payer: Midlands Choice Commercial |
$45.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.39
|
| Rate for Payer: United Healthcare Commercial |
$58.06
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.06
|
|
|
Thawing Fee
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
8018868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Aetna of IA Medicare |
$29.64
|
| Rate for Payer: Amerigroup Medicaid |
$29.99
|
| Rate for Payer: Amerigroup Medicare |
$23.63
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.70
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.40
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.91
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.68
|
|
|
Thawing Fee
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
8018868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
|
|
theophylline 100 mg/24 hours ER Cap [VDMC]
|
Facility
|
IP
|
$12.79
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10610890
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$11.51 |
| Rate for Payer: Aetna of IA Commercial |
$11.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.51
|
| Rate for Payer: Cash Price |
$10.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.59
|
| Rate for Payer: Medical Associates Commercial |
$9.59
|
| Rate for Payer: Midlands Choice Commercial |
$8.95
|
| Rate for Payer: United Healthcare Commercial |
$11.51
|
|
|
theophylline 100 mg/24 hours ER Cap [VDMC]
|
Facility
|
OP
|
$12.79
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10610890
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$11.51 |
| Rate for Payer: Aetna of IA Commercial |
$11.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.51
|
| Rate for Payer: Aetna of IA Medicare |
$7.29
|
| Rate for Payer: Amerigroup Medicaid |
$7.38
|
| Rate for Payer: Amerigroup Medicare |
$5.81
|
| Rate for Payer: Cash Price |
$10.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.59
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.30
|
| Rate for Payer: Medical Associates Commercial |
$9.59
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.75
|
| Rate for Payer: Midlands Choice Commercial |
$8.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$6.62
|
| Rate for Payer: United Healthcare Commercial |
$11.51
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.55
|
|
|
Theophylline DMCL
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
8037811
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna of IA Commercial |
$86.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$86.40
|
| Rate for Payer: Aetna of IA Medicare |
$54.72
|
| Rate for Payer: Amerigroup Medicaid |
$55.37
|
| Rate for Payer: Amerigroup Medicare |
$43.63
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$72.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$43.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.84
|
| Rate for Payer: Medical Associates Commercial |
$72.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$43.20
|
| Rate for Payer: Midlands Choice Commercial |
$67.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.68
|
| Rate for Payer: United Healthcare Commercial |
$86.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.64
|
|
|
Theophylline DMCL
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
8037811
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna of IA Commercial |
$86.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$86.40
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$72.00
|
| Rate for Payer: Medical Associates Commercial |
$72.00
|
| Rate for Payer: Midlands Choice Commercial |
$67.20
|
| Rate for Payer: United Healthcare Commercial |
$86.40
|
|
|
THERA ACTIVITIES 15 MIN, DIRECT
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 97530 GP
|
| Hospital Charge Code |
1374031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of IA Commercial |
$98.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$98.10
|
| Rate for Payer: Aetna of IA Medicare |
$62.13
|
| Rate for Payer: Amerigroup Medicaid |
$62.87
|
| Rate for Payer: Amerigroup Medicare |
$49.54
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$62.26
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.05
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$63.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.41
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.31
|
|
|
THERA ACTIVITIES 15 MIN, DIRECT
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 97530 GP
|
| Hospital Charge Code |
1374031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of IA Commercial |
$98.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$98.10
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.75
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
|
|
THER ACTIVITIES DIRECT PER 15 MIN
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 97530 GO
|
| Hospital Charge Code |
1373450
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of IA Commercial |
$98.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$98.10
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.75
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
|
|
THER ACTIVITIES DIRECT PER 15 MIN
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 97530 GO
|
| Hospital Charge Code |
1373450
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of IA Commercial |
$98.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$98.10
|
| Rate for Payer: Aetna of IA Medicare |
$62.13
|
| Rate for Payer: Amerigroup Medicaid |
$62.87
|
| Rate for Payer: Amerigroup Medicare |
$49.54
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$62.26
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.05
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$63.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.41
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.31
|
|
|
THER ACTIVITY DIRECT 15 MIN
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97530 GN
|
| Hospital Charge Code |
752354
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Aetna of IA Medicare |
$103.17
|
| Rate for Payer: Amerigroup Medicaid |
$104.40
|
| Rate for Payer: Amerigroup Medicare |
$82.26
|
| 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
|
|
|
THER ACTIVITY DIRECT 15 MIN
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97530 GN
|
| Hospital Charge Code |
752354
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
THERA EXERCISES PER 15 MIN
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 97110 GO
|
| Hospital Charge Code |
1373449
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of IA Commercial |
$105.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.30
|
| Rate for Payer: Aetna of IA Medicare |
$66.69
|
| Rate for Payer: Amerigroup Medicaid |
$67.49
|
| Rate for Payer: Amerigroup Medicare |
$53.18
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$66.83
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.65
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$67.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$60.55
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.03
|
|
|
THERA EXERCISES PER 15 MIN
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 97110 GO
|
| Hospital Charge Code |
1373449
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of IA Commercial |
$105.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.30
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.75
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
|
|
THERAPEUTIC EXERCISES 15 MINS
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97110 GN
|
| Hospital Charge Code |
753741
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Aetna of IA Medicare |
$103.17
|
| Rate for Payer: Amerigroup Medicaid |
$104.40
|
| Rate for Payer: Amerigroup Medicare |
$82.26
|
| 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
|
|
|
THERAPEUTIC EXERCISES 15 MINS
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97110 GN
|
| Hospital Charge Code |
753741
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
Therapeutic Multiple Vitamins Tab [VDMC]
|
Facility
|
OP
|
$1.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10424736
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Aetna of IA Commercial |
$1.01
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.01
|
| Rate for Payer: Aetna of IA Medicare |
$0.64
|
| Rate for Payer: Amerigroup Medicaid |
$0.65
|
| Rate for Payer: Amerigroup Medicare |
$0.51
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.84
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.51
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.64
|
| Rate for Payer: Medical Associates Commercial |
$0.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.51
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.58
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.66
|
|
|
Therapeutic Multiple Vitamins Tab [VDMC]
|
Facility
|
IP
|
$1.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10424736
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Aetna of IA Commercial |
$1.01
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.01
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.84
|
| Rate for Payer: Medical Associates Commercial |
$0.84
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
|
|
therapeutic multivitamin liqd [VDMC]
|
Facility
|
OP
|
$22.95
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10430580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$20.66 |
| Rate for Payer: Aetna of IA Commercial |
$20.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.66
|
| Rate for Payer: Aetna of IA Medicare |
$13.08
|
| Rate for Payer: Amerigroup Medicaid |
$13.24
|
| Rate for Payer: Amerigroup Medicare |
$10.43
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.33
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.11
|
| Rate for Payer: Medical Associates Commercial |
$17.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.33
|
| Rate for Payer: Midlands Choice Commercial |
$16.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.88
|
| Rate for Payer: United Healthcare Commercial |
$20.66
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.54
|
|
|
therapeutic multivitamin liqd [VDMC]
|
Facility
|
IP
|
$22.95
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10430580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$20.66 |
| Rate for Payer: Aetna of IA Commercial |
$20.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.66
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.22
|
| Rate for Payer: Medical Associates Commercial |
$17.22
|
| Rate for Payer: Midlands Choice Commercial |
$16.07
|
| Rate for Payer: United Healthcare Commercial |
$20.66
|
|
|
THERAPEUTIC SERVICES FOR USE OF SPEECH GENERATING DEVICE
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 92609 GN
|
| Hospital Charge Code |
5536782
|
|
Hospital Revenue Code
|
441
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
|
|
THERAPEUTIC SERVICES FOR USE OF SPEECH GENERATING DEVICE
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 92609 GN
|
| Hospital Charge Code |
5536782
|
|
Hospital Revenue Code
|
441
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Aetna of IA Medicare |
$131.10
|
| Rate for Payer: Amerigroup Medicaid |
$132.66
|
| Rate for Payer: Amerigroup Medicare |
$104.53
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$103.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$131.38
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$103.50
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$133.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$119.03
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$135.70
|
|
