|
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 |
$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: Partners Health Alliance Commercial |
$87.75
|
| 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
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 EXERCISES 15 MINS
|
Facility
OP
|
$181.00
|
|
|
Service Code
|
CPT 97110 GN
|
| Hospital Charge Code |
753741
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$90.46 |
| 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 |
$91.35
|
| Rate for Payer: Amerigroup Medicare |
$91.40
|
| 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 |
$90.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.46
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.50
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.75
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.79
|
|
|
Therapeutic Multiple Vitamins Tab
|
Facility
IP
|
$1.12
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702486
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| 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 |
$0.78
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
|
|
Therapeutic Multiple Vitamins Tab
|
Facility
OP
|
$1.12
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702486
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| 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 |
$0.57
|
| Rate for Payer: Amerigroup Medicare |
$0.57
|
| 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 |
$0.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.56
|
| Rate for Payer: Medical Associates Commercial |
$0.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.56
|
| Rate for Payer: Midlands Choice Commercial |
$0.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.66
|
|
|
THERASKIN 1X1
|
Facility
OP
|
$1,791.00
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
8767259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.14 |
| Max. Negotiated Rate |
$2,069.19 |
| Rate for Payer: Aetna of IA Commercial |
$1,611.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,611.90
|
| Rate for Payer: Aetna of IA Medicare |
$1,020.87
|
| Rate for Payer: Amerigroup Medicaid |
$903.92
|
| Rate for Payer: Amerigroup Medicare |
$904.46
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,343.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$895.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$895.14
|
| Rate for Payer: Medical Associates Commercial |
$1,343.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$895.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,253.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$908.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,343.25
|
| Rate for Payer: United Healthcare Commercial |
$1,611.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,056.69
|
| Rate for Payer: Wellmark IA HMO |
$1,881.08
|
| Rate for Payer: Wellmark IA PPO |
$2,069.19
|
|
|
THERASKIN 1X1
|
Facility
IP
|
$1,791.00
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
8767259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,253.70 |
| Max. Negotiated Rate |
$1,611.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,611.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,611.90
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,343.25
|
| Rate for Payer: Medical Associates Commercial |
$1,343.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,253.70
|
| Rate for Payer: United Healthcare Commercial |
$1,611.90
|
|
|
THERASKIN 1X2
|
Facility
IP
|
$1,944.00
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
8793727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,360.80 |
| Max. Negotiated Rate |
$1,749.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,749.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,749.60
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,458.00
|
| Rate for Payer: Medical Associates Commercial |
$1,458.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,360.80
|
| Rate for Payer: United Healthcare Commercial |
$1,749.60
|
|
|
THERASKIN 1X2
|
Facility
OP
|
$1,944.00
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
8793727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.61 |
| Max. Negotiated Rate |
$2,069.19 |
| Rate for Payer: Aetna of IA Commercial |
$1,749.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,749.60
|
| Rate for Payer: Aetna of IA Medicare |
$1,108.08
|
| Rate for Payer: Amerigroup Medicaid |
$981.14
|
| Rate for Payer: Amerigroup Medicare |
$981.72
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,458.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$972.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$971.61
|
| Rate for Payer: Medical Associates Commercial |
$1,458.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$972.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,360.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$986.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,458.00
|
| Rate for Payer: United Healthcare Commercial |
$1,749.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,146.96
|
| Rate for Payer: Wellmark IA HMO |
$1,881.08
|
| Rate for Payer: Wellmark IA PPO |
$2,069.19
|
|
|
THERA SKIN 2X3
|
Facility
IP
|
$2,180.00
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
8823254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,526.00 |
| Max. Negotiated Rate |
$1,962.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,962.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,962.00
|
| Rate for Payer: Cash Price |
$1,744.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,635.00
|
| Rate for Payer: Medical Associates Commercial |
$1,635.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,526.00
|
| Rate for Payer: United Healthcare Commercial |
$1,962.00
|
|
|
THERA SKIN 2X3
|
Facility
OP
|
$2,180.00
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
8823254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.56 |
| Max. Negotiated Rate |
$2,069.19 |
| Rate for Payer: Aetna of IA Commercial |
$1,962.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,962.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,242.60
|
| Rate for Payer: Amerigroup Medicaid |
$1,100.25
|
| Rate for Payer: Amerigroup Medicare |
$1,100.90
|
| Rate for Payer: Cash Price |
$1,744.00
|
| Rate for Payer: Cash Price |
$1,744.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,635.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,090.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,089.56
|
| Rate for Payer: Medical Associates Commercial |
$1,635.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,090.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,526.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,106.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,635.00
|
| Rate for Payer: United Healthcare Commercial |
$1,962.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,286.20
|
| Rate for Payer: Wellmark IA HMO |
$1,881.08
|
| Rate for Payer: Wellmark IA PPO |
$2,069.19
|
|
|
THER EXERCISES PER 15 MIN
|
Facility
IP
|
$117.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
1374020
|
|
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
|
|
|
THER EXERCISES PER 15 MIN
|
Facility
OP
|
$117.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
1374020
|
|
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: Partners Health Alliance Commercial |
$87.75
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.03
|
|
|
THER INJECTION CARP TUNNEL
|
Professional
|
$257.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
7982746
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$179.90 |
| Rate for Payer: Aetna of IA Medicare |
$50.96
|
| Rate for Payer: Amerigroup Medicaid |
$52.69
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$96.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.96
|
| Rate for Payer: Midlands Choice Commercial |
$179.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$76.44
|
| Rate for Payer: Wellmark IA HMO |
$102.00
|
| Rate for Payer: Wellmark IA PPO |
$119.00
|
|
|
THERMA CHOICE CATHETER
|
Facility
IP
|
$1,780.00
|
|
| Hospital Charge Code |
8025932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.00 |
| Max. Negotiated Rate |
$1,602.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,602.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,602.00
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,335.00
|
| Rate for Payer: Medical Associates Commercial |
$1,335.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,246.00
|
| Rate for Payer: United Healthcare Commercial |
$1,602.00
|
|
|
THERMA CHOICE CATHETER
|
Facility
OP
|
$1,780.00
|
|
| Hospital Charge Code |
8025932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.64 |
| Max. Negotiated Rate |
$1,602.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,602.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,602.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,014.60
|
| Rate for Payer: Amerigroup Medicaid |
$898.37
|
| Rate for Payer: Amerigroup Medicare |
$898.90
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,335.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$890.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$889.64
|
| Rate for Payer: Medical Associates Commercial |
$1,335.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$890.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,246.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$903.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,335.00
|
| Rate for Payer: United Healthcare Commercial |
$1,602.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,050.20
|
|
|
THERMAL ENDOMETR TUMOR ABL
|
Professional
|
$3,314.00
|
|
|
Service Code
|
CPT 58353
|
| Hospital Charge Code |
8069108
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$209.67 |
| Max. Negotiated Rate |
$2,319.80 |
| Rate for Payer: Aetna of IA Medicare |
$209.67
|
| Rate for Payer: Amerigroup Medicaid |
$216.80
|
| Rate for Payer: Cash Price |
$2,651.20
|
| Rate for Payer: Cash Price |
$2,651.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$251.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$213.86
|
| Rate for Payer: Medical Associates Commercial |
$398.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$209.67
|
| Rate for Payer: Midlands Choice Commercial |
$2,319.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$314.50
|
| Rate for Payer: Wellmark IA HMO |
$443.00
|
| Rate for Payer: Wellmark IA PPO |
$520.00
|
|
|
thiamine 100 mg/ml 2ml MDV Inj
|
Facility
IP
|
$35.04
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700125
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.53 |
| Max. Negotiated Rate |
$31.54 |
| Rate for Payer: Aetna of IA Commercial |
$31.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.54
|
| Rate for Payer: Cash Price |
$28.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.28
|
| Rate for Payer: Medical Associates Commercial |
$26.28
|
| Rate for Payer: Midlands Choice Commercial |
$24.53
|
| Rate for Payer: United Healthcare Commercial |
$31.54
|
|
|
thiamine 100 mg/ml 2ml MDV Inj
|
Facility
OP
|
$35.04
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700125
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$31.54 |
| Rate for Payer: Aetna of IA Commercial |
$31.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.54
|
| Rate for Payer: Aetna of IA Medicare |
$19.97
|
| Rate for Payer: Amerigroup Medicaid |
$17.68
|
| Rate for Payer: Amerigroup Medicare |
$17.70
|
| Rate for Payer: Cash Price |
$28.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.51
|
| Rate for Payer: Medical Associates Commercial |
$26.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.52
|
| Rate for Payer: Midlands Choice Commercial |
$24.53
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.28
|
| Rate for Payer: United Healthcare Commercial |
$31.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.67
|
|
|
thiamine 100 mg Tab
|
Facility
OP
|
$1.13
|
|
|
Service Code
|
CPT J3411
|
| Hospital Charge Code |
43701130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of IA Commercial |
$1.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.02
|
| Rate for Payer: Aetna of IA Medicare |
$0.64
|
| Rate for Payer: Amerigroup Medicaid |
$0.57
|
| Rate for Payer: Amerigroup Medicare |
$0.57
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.85
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.56
|
| Rate for Payer: Medical Associates Commercial |
$0.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.57
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.67
|
|
|
thiamine 100 mg Tab
|
Facility
IP
|
$1.13
|
|
|
Service Code
|
CPT J3411
|
| Hospital Charge Code |
43701130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of IA Commercial |
$1.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.02
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.85
|
| Rate for Payer: Medical Associates Commercial |
$0.85
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
|
|
Thoracentesis Procedure
|
Facility
IP
|
$528.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
8060785
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna of IA Commercial |
$475.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$475.20
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$396.00
|
| Rate for Payer: Medical Associates Commercial |
$396.00
|
| Rate for Payer: Midlands Choice Commercial |
$369.60
|
| Rate for Payer: United Healthcare Commercial |
$475.20
|
|
|
Thoracentesis Procedure
|
Facility
OP
|
$528.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
8060785
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.89 |
| Max. Negotiated Rate |
$1,703.64 |
| Rate for Payer: Aetna of IA Commercial |
$475.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$475.20
|
| Rate for Payer: Aetna of IA Medicare |
$300.96
|
| Rate for Payer: Amerigroup Medicaid |
$266.48
|
| Rate for Payer: Amerigroup Medicare |
$266.64
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$396.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$264.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$263.89
|
| Rate for Payer: Medical Associates Commercial |
$396.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$264.00
|
| Rate for Payer: Midlands Choice Commercial |
$369.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$267.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$396.00
|
| Rate for Payer: United Healthcare Commercial |
$475.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$311.52
|
| Rate for Payer: Wellmark IA HMO |
$1,548.76
|
| Rate for Payer: Wellmark IA PPO |
$1,703.64
|
|
|
THP Albuterol Inhaler
|
Facility
OP
|
$82.88
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43799942
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.42 |
| Max. Negotiated Rate |
$74.59 |
| Rate for Payer: Aetna of IA Commercial |
$74.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$74.59
|
| Rate for Payer: Aetna of IA Medicare |
$47.24
|
| Rate for Payer: Amerigroup Medicaid |
$41.83
|
| Rate for Payer: Amerigroup Medicare |
$41.85
|
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$62.16
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$41.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.42
|
| Rate for Payer: Medical Associates Commercial |
$62.16
|
| Rate for Payer: Medical Associates Managed Medicare |
$41.44
|
| Rate for Payer: Midlands Choice Commercial |
$58.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$62.16
|
| Rate for Payer: United Healthcare Commercial |
$74.59
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.90
|
|
