|
Stool Pathogen PCR Panel
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
7812190
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$314.34 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna of IA Commercial |
$675.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$675.00
|
| Rate for Payer: Aetna of IA Medicare |
$427.50
|
| Rate for Payer: Amerigroup Medicaid |
$378.52
|
| Rate for Payer: Amerigroup Medicare |
$378.75
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$562.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$375.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$374.85
|
| Rate for Payer: Medical Associates Commercial |
$562.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$375.00
|
| Rate for Payer: Midlands Choice Commercial |
$525.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$380.62
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$380.40
|
| Rate for Payer: Oscar Health of IA Commercial |
$562.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$562.50
|
| Rate for Payer: United Healthcare Commercial |
$675.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$442.50
|
| Rate for Payer: Wellmark IA HMO |
$314.34
|
| Rate for Payer: Wellmark IA PPO |
$345.77
|
|
|
Stool Pathogen PCR Panel
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
7812190
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Aetna of IA Commercial |
$675.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$675.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$562.50
|
| Rate for Payer: Medical Associates Commercial |
$562.50
|
| Rate for Payer: Midlands Choice Commercial |
$525.00
|
| Rate for Payer: United Healthcare Commercial |
$675.00
|
|
|
Stool Pathogen PCR Panel Shortened
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 87505
|
| Hospital Charge Code |
8906330
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$168.93 |
| Max. Negotiated Rate |
$345.77 |
| Rate for Payer: Aetna of IA Commercial |
$304.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$304.20
|
| Rate for Payer: Aetna of IA Medicare |
$192.66
|
| Rate for Payer: Amerigroup Medicaid |
$170.59
|
| Rate for Payer: Amerigroup Medicare |
$170.69
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$253.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$169.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$168.93
|
| Rate for Payer: Medical Associates Commercial |
$253.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$169.00
|
| Rate for Payer: Midlands Choice Commercial |
$236.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$171.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$171.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$253.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$253.50
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$199.42
|
| Rate for Payer: Wellmark IA HMO |
$314.34
|
| Rate for Payer: Wellmark IA PPO |
$345.77
|
|
|
Stool Pathogen PCR Panel Shortened
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 87505
|
| Hospital Charge Code |
8906330
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna of IA Commercial |
$304.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$304.20
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$253.50
|
| Rate for Payer: Medical Associates Commercial |
$253.50
|
| Rate for Payer: Midlands Choice Commercial |
$236.60
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
|
|
STRAPPING ANKLE FOOT
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 29540 GP
|
| Hospital Charge Code |
6344976
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
STRAPPING ANKLE FOOT
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 29540 GP
|
| Hospital Charge Code |
6344976
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.48 |
| 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 |
$59.05
|
| Rate for Payer: Amerigroup Medicare |
$59.08
|
| 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 |
$58.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$58.48
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.50
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$59.38
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$59.34
|
| Rate for Payer: Oscar Health of IA Commercial |
$87.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$87.75
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.03
|
|
|
STRAPPING HAND/FINGER
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 29280 GO
|
| Hospital Charge Code |
1374354
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna of IA Commercial |
$91.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$91.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$76.50
|
| Rate for Payer: Medical Associates Commercial |
$76.50
|
| Rate for Payer: Midlands Choice Commercial |
$71.40
|
| Rate for Payer: United Healthcare Commercial |
$91.80
|
|
|
STRAPPING HAND/FINGER
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 29280 GO
|
| Hospital Charge Code |
1374354
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$50.98 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna of IA Commercial |
$91.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$91.80
|
| Rate for Payer: Aetna of IA Medicare |
$58.14
|
| Rate for Payer: Amerigroup Medicaid |
$51.48
|
| Rate for Payer: Amerigroup Medicare |
$51.51
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$76.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$50.98
|
| Rate for Payer: Medical Associates Commercial |
$76.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.00
|
| Rate for Payer: Midlands Choice Commercial |
$71.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$51.76
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$51.73
|
| Rate for Payer: Oscar Health of IA Commercial |
$76.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$76.50
|
| Rate for Payer: United Healthcare Commercial |
$91.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$60.18
|
|
|
STRAPPING KNEE
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 29530 GP
|
| Hospital Charge Code |
1374356
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna of IA Commercial |
$95.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$95.40
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$79.50
|
| Rate for Payer: Medical Associates Commercial |
$79.50
|
| Rate for Payer: Midlands Choice Commercial |
$74.20
|
| Rate for Payer: United Healthcare Commercial |
$95.40
|
|
|
STRAPPING KNEE
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 29530 GP
|
| Hospital Charge Code |
1374356
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.98 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna of IA Commercial |
$95.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$95.40
|
| Rate for Payer: Aetna of IA Medicare |
$60.42
|
| Rate for Payer: Amerigroup Medicaid |
$53.50
|
| Rate for Payer: Amerigroup Medicare |
$53.53
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$79.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$53.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$52.98
|
| Rate for Payer: Medical Associates Commercial |
$79.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$53.00
|
| Rate for Payer: Midlands Choice Commercial |
$74.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$53.80
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$53.76
|
| Rate for Payer: Oscar Health of IA Commercial |
$79.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$79.50
|
| Rate for Payer: United Healthcare Commercial |
$95.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$62.54
|
|
|
STRAPPING OF SHOULDER
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
7822785
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$16.66 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Aetna of IA Medicare |
$16.66
|
| Rate for Payer: Amerigroup Medicaid |
$17.23
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.99
|
| Rate for Payer: Medical Associates Commercial |
$29.99
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.66
|
| Rate for Payer: Midlands Choice Commercial |
$53.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$28.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.99
|
|
|
STRAPPING SHOULDER
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 29240 GP
|
| Hospital Charge Code |
1374352
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.47 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Aetna of IA Medicare |
$73.53
|
| Rate for Payer: Amerigroup Medicaid |
$65.11
|
| Rate for Payer: Amerigroup Medicare |
$65.14
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.47
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$65.47
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$65.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$96.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$96.75
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.11
|
|
|
STRAPPING SHOULDER
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 29240 GP
|
| Hospital Charge Code |
1374352
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
|
|
STRAPPING TOES
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 29550 GP
|
| Hospital Charge Code |
1374358
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of IA Commercial |
$84.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$84.60
|
| Rate for Payer: Aetna of IA Medicare |
$53.58
|
| Rate for Payer: Amerigroup Medicaid |
$47.44
|
| Rate for Payer: Amerigroup Medicare |
$47.47
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$70.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$47.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$46.98
|
| Rate for Payer: Medical Associates Commercial |
$70.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.00
|
| Rate for Payer: Midlands Choice Commercial |
$65.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$47.70
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$47.68
|
| Rate for Payer: Oscar Health of IA Commercial |
$70.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$70.50
|
| Rate for Payer: United Healthcare Commercial |
$84.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$55.46
|
|
|
STRAPPING TOES
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 29550 GP
|
| Hospital Charge Code |
1374358
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of IA Commercial |
$84.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$84.60
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$70.50
|
| Rate for Payer: Medical Associates Commercial |
$70.50
|
| Rate for Payer: Midlands Choice Commercial |
$65.80
|
| Rate for Payer: United Healthcare Commercial |
$84.60
|
|
|
STREP A TEST, THROAT
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
633913
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.49 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of IA Commercial |
$44.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$44.10
|
| Rate for Payer: Aetna of IA Medicare |
$27.93
|
| Rate for Payer: Amerigroup Medicaid |
$24.73
|
| Rate for Payer: Amerigroup Medicare |
$24.74
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$24.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$24.49
|
| Rate for Payer: Medical Associates Commercial |
$36.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$24.50
|
| Rate for Payer: Midlands Choice Commercial |
$34.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24.87
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$24.85
|
| Rate for Payer: Oscar Health of IA Commercial |
$36.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$36.75
|
| Rate for Payer: United Healthcare Commercial |
$44.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$28.91
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
STREP A TEST, THROAT
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
633913
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of IA Commercial |
$44.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$44.10
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.75
|
| Rate for Payer: Medical Associates Commercial |
$36.75
|
| Rate for Payer: Midlands Choice Commercial |
$34.30
|
| Rate for Payer: United Healthcare Commercial |
$44.10
|
|
|
STRESS TEST
|
Facility
|
OP
|
$738.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
8012934
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$368.85 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Aetna of IA Commercial |
$664.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$664.20
|
| Rate for Payer: Aetna of IA Medicare |
$420.66
|
| Rate for Payer: Amerigroup Medicaid |
$372.47
|
| Rate for Payer: Amerigroup Medicare |
$372.69
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$553.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$369.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$368.85
|
| Rate for Payer: Medical Associates Commercial |
$553.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$369.00
|
| Rate for Payer: Midlands Choice Commercial |
$516.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$374.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$374.31
|
| Rate for Payer: Oscar Health of IA Commercial |
$553.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$553.50
|
| Rate for Payer: United Healthcare Commercial |
$664.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$435.42
|
| Rate for Payer: Wellmark IA HMO |
$403.62
|
| Rate for Payer: Wellmark IA PPO |
$443.98
|
|
|
STRESS TEST
|
Facility
|
IP
|
$738.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
8012934
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$516.60 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Aetna of IA Commercial |
$664.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$664.20
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$553.50
|
| Rate for Payer: Medical Associates Commercial |
$553.50
|
| Rate for Payer: Midlands Choice Commercial |
$516.60
|
| Rate for Payer: United Healthcare Commercial |
$664.20
|
|
|
SUBCUTANEOUS/MUSCLE BONE EA ADD 20 SQ CM
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
8013697
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$335.37 |
| Max. Negotiated Rate |
$3,510.94 |
| Rate for Payer: Aetna of IA Commercial |
$603.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$603.90
|
| Rate for Payer: Aetna of IA Medicare |
$382.47
|
| Rate for Payer: Amerigroup Medicaid |
$338.65
|
| Rate for Payer: Amerigroup Medicare |
$338.86
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$503.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$335.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$335.37
|
| Rate for Payer: Medical Associates Commercial |
$503.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$335.50
|
| Rate for Payer: Midlands Choice Commercial |
$469.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$340.53
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$340.33
|
| Rate for Payer: Oscar Health of IA Commercial |
$503.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$503.25
|
| Rate for Payer: United Healthcare Commercial |
$603.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$395.89
|
| Rate for Payer: Wellmark IA HMO |
$3,191.76
|
| Rate for Payer: Wellmark IA PPO |
$3,510.94
|
|
|
SUBCUTANEOUS/MUSCLE BONE EA ADD 20 SQ CM
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
8013697
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$469.70 |
| Max. Negotiated Rate |
$603.90 |
| Rate for Payer: Aetna of IA Commercial |
$603.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$603.90
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$503.25
|
| Rate for Payer: Medical Associates Commercial |
$503.25
|
| Rate for Payer: Midlands Choice Commercial |
$469.70
|
| Rate for Payer: United Healthcare Commercial |
$603.90
|
|
|
succinylcholine 20 mg/mL 10ml MDV Inj Sol [VDMC]
|
Facility
|
IP
|
$29.42
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
10422656
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.59 |
| Max. Negotiated Rate |
$26.48 |
| Rate for Payer: Aetna of IA Commercial |
$26.48
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$26.48
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.06
|
| Rate for Payer: Medical Associates Commercial |
$22.06
|
| Rate for Payer: Midlands Choice Commercial |
$20.59
|
| Rate for Payer: United Healthcare Commercial |
$26.48
|
|
|
succinylcholine 20 mg/mL 10ml MDV Inj Sol [VDMC]
|
Facility
|
OP
|
$29.42
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
10422656
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$26.48 |
| Rate for Payer: Aetna of IA Commercial |
$26.48
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$26.48
|
| Rate for Payer: Aetna of IA Medicare |
$16.77
|
| Rate for Payer: Amerigroup Medicaid |
$14.85
|
| Rate for Payer: Amerigroup Medicare |
$14.86
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.06
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.70
|
| Rate for Payer: Medical Associates Commercial |
$22.06
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.71
|
| Rate for Payer: Midlands Choice Commercial |
$20.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.93
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$14.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$22.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.06
|
| Rate for Payer: United Healthcare Commercial |
$26.48
|
| Rate for Payer: United Healthcare Managed Medicare |
$17.36
|
|
|
sucralfate 1 g/10 mL Oral Susp [VDMC]
|
Facility
|
IP
|
$29.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10430513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna of IA Commercial |
$26.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$26.68
|
| Rate for Payer: Cash Price |
$23.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.23
|
| Rate for Payer: Medical Associates Commercial |
$22.23
|
| Rate for Payer: Midlands Choice Commercial |
$20.75
|
| Rate for Payer: United Healthcare Commercial |
$26.68
|
|
|
sucralfate 1 g/10 mL Oral Susp [VDMC]
|
Facility
|
OP
|
$29.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10430513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.81 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna of IA Commercial |
$26.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$26.68
|
| Rate for Payer: Aetna of IA Medicare |
$16.89
|
| Rate for Payer: Amerigroup Medicaid |
$14.96
|
| Rate for Payer: Amerigroup Medicare |
$14.97
|
| Rate for Payer: Cash Price |
$23.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.23
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.81
|
| Rate for Payer: Medical Associates Commercial |
$22.23
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.82
|
| Rate for Payer: Midlands Choice Commercial |
$20.75
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.04
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$15.03
|
| Rate for Payer: Oscar Health of IA Commercial |
$22.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.23
|
| Rate for Payer: United Healthcare Commercial |
$26.68
|
| Rate for Payer: United Healthcare Managed Medicare |
$17.49
|
|
