|
tamsulosin 0.4 mg Oral Cap
|
Facility
OP
|
$1.73
|
|
|
Service Code
|
CPT J1447
|
| Hospital Charge Code |
43707614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Aetna of IA Commercial |
$1.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.56
|
| Rate for Payer: Aetna of IA Medicare |
$0.99
|
| Rate for Payer: Amerigroup Medicaid |
$0.87
|
| Rate for Payer: Amerigroup Medicare |
$0.87
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.30
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.87
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.86
|
| Rate for Payer: Medical Associates Commercial |
$1.30
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.87
|
| Rate for Payer: Midlands Choice Commercial |
$1.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.30
|
| Rate for Payer: United Healthcare Commercial |
$1.56
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.02
|
|
|
tamsulosin 0.4 mg Oral Cap
|
Facility
IP
|
$1.73
|
|
|
Service Code
|
CPT J1447
|
| Hospital Charge Code |
43707614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Aetna of IA Commercial |
$1.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.56
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.30
|
| Rate for Payer: Medical Associates Commercial |
$1.30
|
| Rate for Payer: Midlands Choice Commercial |
$1.21
|
| Rate for Payer: United Healthcare Commercial |
$1.56
|
|
|
TAP CANCELLOUS BONE SCREW 3.5MM
|
Facility
IP
|
$396.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$356.40 |
| Rate for Payer: Aetna of IA Commercial |
$356.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$356.40
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$297.00
|
| Rate for Payer: Medical Associates Commercial |
$297.00
|
| Rate for Payer: Midlands Choice Commercial |
$277.20
|
| Rate for Payer: United Healthcare Commercial |
$356.40
|
|
|
TAP CANCELLOUS BONE SCREW 3.5MM
|
Facility
OP
|
$396.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.92 |
| Max. Negotiated Rate |
$356.40 |
| Rate for Payer: Aetna of IA Commercial |
$356.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$356.40
|
| Rate for Payer: Aetna of IA Medicare |
$225.72
|
| Rate for Payer: Amerigroup Medicaid |
$199.86
|
| Rate for Payer: Amerigroup Medicare |
$199.98
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$297.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$198.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$197.92
|
| Rate for Payer: Medical Associates Commercial |
$297.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$198.00
|
| Rate for Payer: Midlands Choice Commercial |
$277.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$200.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$297.00
|
| Rate for Payer: United Healthcare Commercial |
$356.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$233.64
|
|
|
tbo-filgrastim 300 mcg/0.5 mL SD Syringe Sol
|
Facility
IP
|
$343.50
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43753128
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.45 |
| Max. Negotiated Rate |
$309.15 |
| Rate for Payer: Aetna of IA Commercial |
$309.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.15
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$257.62
|
| Rate for Payer: Medical Associates Commercial |
$257.62
|
| Rate for Payer: Midlands Choice Commercial |
$240.45
|
| Rate for Payer: United Healthcare Commercial |
$309.15
|
|
|
tbo-filgrastim 300 mcg/0.5 mL SD Syringe Sol
|
Facility
OP
|
$343.50
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43753128
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.68 |
| Max. Negotiated Rate |
$309.15 |
| Rate for Payer: Aetna of IA Commercial |
$309.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.15
|
| Rate for Payer: Aetna of IA Medicare |
$195.80
|
| Rate for Payer: Amerigroup Medicaid |
$173.36
|
| Rate for Payer: Amerigroup Medicare |
$173.47
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$257.62
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$171.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$171.68
|
| Rate for Payer: Medical Associates Commercial |
$257.62
|
| Rate for Payer: Medical Associates Managed Medicare |
$171.75
|
| Rate for Payer: Midlands Choice Commercial |
$240.45
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$174.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$257.62
|
| Rate for Payer: United Healthcare Commercial |
$309.15
|
| Rate for Payer: United Healthcare Managed Medicare |
$202.66
|
|
|
TCOM/SPP - COMPLETE 2-3 LEVELS
|
Facility
IP
|
$380.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
8013709
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of IA Commercial |
$342.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$342.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$285.00
|
| Rate for Payer: Medical Associates Commercial |
$285.00
|
| Rate for Payer: Midlands Choice Commercial |
$266.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
|
|
TCOM/SPP - COMPLETE 2-3 LEVELS
|
Facility
OP
|
$380.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
8013709
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$189.92 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of IA Commercial |
$342.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$342.00
|
| Rate for Payer: Aetna of IA Medicare |
$216.60
|
| Rate for Payer: Amerigroup Medicaid |
$191.79
|
| Rate for Payer: Amerigroup Medicare |
$191.90
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$285.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$190.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$189.92
|
| Rate for Payer: Medical Associates Commercial |
$285.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$190.00
|
| Rate for Payer: Midlands Choice Commercial |
$266.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$192.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$285.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$224.20
|
| Rate for Payer: Wellmark IA HMO |
$281.48
|
| Rate for Payer: Wellmark IA PPO |
$309.63
|
|
|
TCOM/SPP - LIMITED 1-2 LEVELS
|
Facility
OP
|
$380.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
8013708
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$189.92 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of IA Commercial |
$342.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$342.00
|
| Rate for Payer: Aetna of IA Medicare |
$216.60
|
| Rate for Payer: Amerigroup Medicaid |
$191.79
|
| Rate for Payer: Amerigroup Medicare |
$191.90
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$285.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$190.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$189.92
|
| Rate for Payer: Medical Associates Commercial |
$285.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$190.00
|
| Rate for Payer: Midlands Choice Commercial |
$266.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$192.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$285.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$224.20
|
| Rate for Payer: Wellmark IA HMO |
$281.48
|
| Rate for Payer: Wellmark IA PPO |
$309.63
|
|
|
TCOM/SPP - LIMITED 1-2 LEVELS
|
Facility
IP
|
$380.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
8013708
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of IA Commercial |
$342.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$342.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$285.00
|
| Rate for Payer: Medical Associates Commercial |
$285.00
|
| Rate for Payer: Midlands Choice Commercial |
$266.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
|
|
TELEHEALTH FACILITY FEE
|
Facility
IP
|
$65.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
7855053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna of IA Commercial |
$58.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.50
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.75
|
| Rate for Payer: Medical Associates Commercial |
$48.75
|
| Rate for Payer: Midlands Choice Commercial |
$45.50
|
| Rate for Payer: United Healthcare Commercial |
$58.50
|
|
|
TELEHEALTH FACILITY FEE
|
Facility
OP
|
$65.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
7855053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$100.25 |
| Rate for Payer: Aetna of IA Commercial |
$58.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.50
|
| Rate for Payer: Aetna of IA Medicare |
$37.05
|
| Rate for Payer: Amerigroup Medicaid |
$32.81
|
| Rate for Payer: Amerigroup Medicare |
$32.82
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.49
|
| Rate for Payer: Medical Associates Commercial |
$48.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.50
|
| Rate for Payer: Midlands Choice Commercial |
$45.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.75
|
| Rate for Payer: United Healthcare Commercial |
$58.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.35
|
| Rate for Payer: Wellmark IA HMO |
$91.14
|
| Rate for Payer: Wellmark IA PPO |
$100.25
|
|
|
Telemetry
|
Facility
IP
|
$230.00
|
|
| Hospital Charge Code |
7466783
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$2,339.10 |
| 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 |
$2,258.00
|
| Rate for Payer: Amerigroup Medicare |
$2,054.34
|
| Rate for Payer: Cash Price |
$184.00
|
| 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: Medical Associates Managed Medicare |
$2,034.00
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,339.10
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,306.00
|
|
|
Telemetry
|
Facility
OP
|
$230.00
|
|
| Hospital Charge Code |
7466783
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$114.95 |
| 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 |
$116.08
|
| Rate for Payer: Amerigroup Medicare |
$116.15
|
| 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 |
$115.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$114.95
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$115.00
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$116.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$172.50
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
|
|
Telemetry Daily Charge
|
Facility
OP
|
$230.00
|
|
| Hospital Charge Code |
7863885
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$114.95 |
| 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 |
$116.08
|
| Rate for Payer: Amerigroup Medicare |
$116.15
|
| 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 |
$115.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$114.95
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$115.00
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$116.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$172.50
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
|
|
Telemetry Daily Charge
|
Facility
IP
|
$230.00
|
|
| Hospital Charge Code |
7863885
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$2,339.10 |
| 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 |
$2,258.00
|
| Rate for Payer: Amerigroup Medicare |
$2,054.34
|
| Rate for Payer: Cash Price |
$184.00
|
| 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: Medical Associates Managed Medicare |
$2,034.00
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,339.10
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,306.00
|
|
|
telmisartan 40 mg Tab
|
Facility
IP
|
$2.63
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$2.37 |
| Rate for Payer: Aetna of IA Commercial |
$2.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.37
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.97
|
| Rate for Payer: Medical Associates Commercial |
$1.97
|
| Rate for Payer: Midlands Choice Commercial |
$1.84
|
| Rate for Payer: United Healthcare Commercial |
$2.37
|
|
|
telmisartan 40 mg Tab
|
Facility
OP
|
$2.63
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$2.37 |
| Rate for Payer: Aetna of IA Commercial |
$2.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.37
|
| Rate for Payer: Aetna of IA Medicare |
$1.50
|
| Rate for Payer: Amerigroup Medicaid |
$1.33
|
| Rate for Payer: Amerigroup Medicare |
$1.33
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.31
|
| Rate for Payer: Medical Associates Commercial |
$1.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.32
|
| Rate for Payer: Midlands Choice Commercial |
$1.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.97
|
| Rate for Payer: United Healthcare Commercial |
$2.37
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.55
|
|
|
temazepam 15 mg Cap
|
Facility
IP
|
$3.29
|
|
|
Service Code
|
CPT J3101
|
| Hospital Charge Code |
43705977
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna of IA Commercial |
$2.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.96
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.47
|
| Rate for Payer: Medical Associates Commercial |
$2.47
|
| Rate for Payer: Midlands Choice Commercial |
$2.30
|
| Rate for Payer: United Healthcare Commercial |
$2.96
|
|
|
temazepam 15 mg Cap
|
Facility
OP
|
$3.29
|
|
|
Service Code
|
CPT J3101
|
| Hospital Charge Code |
43705977
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna of IA Commercial |
$2.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.96
|
| Rate for Payer: Aetna of IA Medicare |
$1.88
|
| Rate for Payer: Amerigroup Medicaid |
$1.66
|
| Rate for Payer: Amerigroup Medicare |
$1.66
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.47
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.64
|
| Rate for Payer: Medical Associates Commercial |
$2.47
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.64
|
| Rate for Payer: Midlands Choice Commercial |
$2.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.47
|
| Rate for Payer: United Healthcare Commercial |
$2.96
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.94
|
|
|
TEMP EXTERNAL PACING
|
Professional
|
$4.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
7982757
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna of IA Medicare |
$0.78
|
| Rate for Payer: Amerigroup Medicaid |
$0.81
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.80
|
| Rate for Payer: Medical Associates Commercial |
$1.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.78
|
| Rate for Payer: Midlands Choice Commercial |
$2.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.17
|
| Rate for Payer: Wellmark IA HMO |
$2.00
|
| Rate for Payer: Wellmark IA PPO |
$2.00
|
|
|
TEMPORAL ARTERY PROCEDURE
|
Facility
IP
|
$815.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
7982929
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$570.50 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
|
|
TEMPORAL ARTERY PROCEDURE
|
Facility
OP
|
$815.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
7982929
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$407.34 |
| Max. Negotiated Rate |
$1,451.30 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Aetna of IA Medicare |
$464.55
|
| Rate for Payer: Amerigroup Medicaid |
$411.33
|
| Rate for Payer: Amerigroup Medicare |
$411.58
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$407.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$407.34
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$407.50
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$413.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$611.25
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$480.85
|
| Rate for Payer: Wellmark IA HMO |
$1,319.36
|
| Rate for Payer: Wellmark IA PPO |
$1,451.30
|
|
|
TENDON GRACILIS
|
Facility
OP
|
$2,835.00
|
|
| Hospital Charge Code |
8047299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,416.93 |
| Max. Negotiated Rate |
$2,551.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,551.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,551.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,615.95
|
| Rate for Payer: Amerigroup Medicaid |
$1,430.82
|
| Rate for Payer: Amerigroup Medicare |
$1,431.68
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,126.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,417.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,416.93
|
| Rate for Payer: Medical Associates Commercial |
$2,126.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,417.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,984.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,438.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,126.25
|
| Rate for Payer: United Healthcare Commercial |
$2,551.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,672.65
|
|
|
TENDON GRACILIS
|
Facility
IP
|
$2,835.00
|
|
| Hospital Charge Code |
8047299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,984.50 |
| Max. Negotiated Rate |
$2,551.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,551.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,551.50
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,126.25
|
| Rate for Payer: Medical Associates Commercial |
$2,126.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,984.50
|
| Rate for Payer: United Healthcare Commercial |
$2,551.50
|
|
