|
TOTAL PROTEIN
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
633818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
|
|
TOTAL PROTEIN
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
633818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Aetna of IA Medicare |
$22.80
|
| Rate for Payer: Amerigroup Medicaid |
$23.07
|
| Rate for Payer: Amerigroup Medicare |
$18.18
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.85
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.70
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.60
|
|
|
TOTAL PROTEIN
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
8093946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Aetna of IA Medicare |
$22.80
|
| Rate for Payer: Amerigroup Medicaid |
$23.07
|
| Rate for Payer: Amerigroup Medicare |
$18.18
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.85
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.70
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.60
|
|
|
T Pallidum Particle Agglutination DMCL
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
8037803
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
T Pallidum Particle Agglutination DMCL
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
8037803
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$65.76
|
| Rate for Payer: Amerigroup Medicare |
$51.81
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.12
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.30
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$58.99
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
|
|
T-PLATE 3 HOLE 53MM OBLIQUE ANGLE
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.25 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Aetna of IA Commercial |
$328.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$328.50
|
| Rate for Payer: Aetna of IA Medicare |
$208.05
|
| Rate for Payer: Amerigroup Medicaid |
$210.53
|
| Rate for Payer: Amerigroup Medicare |
$165.89
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$273.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$164.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$208.49
|
| Rate for Payer: Medical Associates Commercial |
$273.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$164.25
|
| Rate for Payer: Midlands Choice Commercial |
$255.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$211.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$188.89
|
| Rate for Payer: United Healthcare Commercial |
$328.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$215.35
|
|
|
T-PLATE 3 HOLE 53MM OBLIQUE ANGLE
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.50 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Aetna of IA Commercial |
$328.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$328.50
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$273.75
|
| Rate for Payer: Medical Associates Commercial |
$273.75
|
| Rate for Payer: Midlands Choice Commercial |
$255.50
|
| Rate for Payer: United Healthcare Commercial |
$328.50
|
|
|
T-PLATE 3 HOLE 75MM SHAFT OBLIQUE ANGLE
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of IA Commercial |
$360.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$360.00
|
| Rate for Payer: Aetna of IA Medicare |
$228.00
|
| Rate for Payer: Amerigroup Medicaid |
$230.72
|
| Rate for Payer: Amerigroup Medicare |
$181.80
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$300.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$180.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$228.48
|
| Rate for Payer: Medical Associates Commercial |
$300.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$180.00
|
| Rate for Payer: Midlands Choice Commercial |
$280.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$231.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$207.00
|
| Rate for Payer: United Healthcare Commercial |
$360.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$236.00
|
|
|
T-PLATE 3 HOLE 75MM SHAFT OBLIQUE ANGLE
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of IA Commercial |
$360.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$360.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$300.00
|
| Rate for Payer: Medical Associates Commercial |
$300.00
|
| Rate for Payer: Midlands Choice Commercial |
$280.00
|
| Rate for Payer: United Healthcare Commercial |
$360.00
|
|
|
trace elements with selenium 10 mcg-1 mg-0.5 mg-60 mcg-5 mg/mL IV Sol 1 mL [VDMC]
|
Facility
|
OP
|
$64.49
|
|
|
Service Code
|
NDC 00517-8201-25
|
| Hospital Charge Code |
10425639
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.02 |
| Max. Negotiated Rate |
$58.04 |
| Rate for Payer: Aetna of IA Commercial |
$58.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.04
|
| Rate for Payer: Aetna of IA Medicare |
$36.76
|
| Rate for Payer: Amerigroup Medicaid |
$37.20
|
| Rate for Payer: Amerigroup Medicare |
$29.31
|
| Rate for Payer: Cash Price |
$51.59
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.37
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.84
|
| Rate for Payer: Medical Associates Commercial |
$48.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.02
|
| Rate for Payer: Midlands Choice Commercial |
$45.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.37
|
| Rate for Payer: United Healthcare Commercial |
$58.04
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.05
|
|
|
trace elements with selenium 10 mcg-1 mg-0.5 mg-60 mcg-5 mg/mL IV Sol 1 mL [VDMC]
|
Facility
|
IP
|
$64.49
|
|
|
Service Code
|
NDC 00517-8201-25
|
| Hospital Charge Code |
10425639
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$45.14 |
| Max. Negotiated Rate |
$58.04 |
| Rate for Payer: Aetna of IA Commercial |
$58.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.04
|
| Rate for Payer: Cash Price |
$51.59
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.37
|
| Rate for Payer: Medical Associates Commercial |
$48.37
|
| Rate for Payer: Midlands Choice Commercial |
$45.14
|
| Rate for Payer: United Healthcare Commercial |
$58.04
|
|
|
traMADol 50 mg Tab [VDMC]
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10425771
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Aetna of IA Commercial |
$3.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.03
|
| Rate for Payer: Aetna of IA Medicare |
$1.92
|
| Rate for Payer: Amerigroup Medicaid |
$1.94
|
| Rate for Payer: Amerigroup Medicare |
$1.53
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.51
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.92
|
| Rate for Payer: Medical Associates Commercial |
$2.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.51
|
| Rate for Payer: Midlands Choice Commercial |
$2.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.74
|
| Rate for Payer: United Healthcare Commercial |
$3.03
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.98
|
|
|
traMADol 50 mg Tab [VDMC]
|
Facility
|
IP
|
$3.36
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10425771
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Aetna of IA Commercial |
$3.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.03
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.52
|
| Rate for Payer: Medical Associates Commercial |
$2.52
|
| Rate for Payer: Midlands Choice Commercial |
$2.35
|
| Rate for Payer: United Healthcare Commercial |
$3.03
|
|
|
tranexamic acid 100 mg/mL 10 ml SDV INJ [VDMC]
|
Facility
|
OP
|
$31.86
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10425909
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$28.68 |
| Rate for Payer: Aetna of IA Commercial |
$28.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.68
|
| Rate for Payer: Aetna of IA Medicare |
$18.16
|
| Rate for Payer: Amerigroup Medicaid |
$18.38
|
| Rate for Payer: Amerigroup Medicare |
$14.48
|
| Rate for Payer: Cash Price |
$25.49
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.90
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.20
|
| Rate for Payer: Medical Associates Commercial |
$23.90
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.34
|
| Rate for Payer: Midlands Choice Commercial |
$22.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.49
|
| Rate for Payer: United Healthcare Commercial |
$28.68
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.80
|
|
|
tranexamic acid 100 mg/mL 10 ml SDV INJ [VDMC]
|
Facility
|
IP
|
$31.86
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10425909
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.30 |
| Max. Negotiated Rate |
$28.68 |
| Rate for Payer: Aetna of IA Commercial |
$28.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.68
|
| Rate for Payer: Cash Price |
$25.49
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.90
|
| Rate for Payer: Medical Associates Commercial |
$23.90
|
| Rate for Payer: Midlands Choice Commercial |
$22.30
|
| Rate for Payer: United Healthcare Commercial |
$28.68
|
|
|
tranexamic acid 650 mg Tab [VDMC]
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10425976
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$10.10 |
| Rate for Payer: Aetna of IA Commercial |
$10.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.10
|
| Rate for Payer: Aetna of IA Medicare |
$6.40
|
| Rate for Payer: Amerigroup Medicaid |
$6.48
|
| Rate for Payer: Amerigroup Medicare |
$5.10
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.41
|
| Rate for Payer: Medical Associates Commercial |
$8.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.05
|
| Rate for Payer: Midlands Choice Commercial |
$7.86
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$5.81
|
| Rate for Payer: United Healthcare Commercial |
$10.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$6.62
|
|
|
tranexamic acid 650 mg Tab [VDMC]
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10425976
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$10.10 |
| Rate for Payer: Aetna of IA Commercial |
$10.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.10
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.42
|
| Rate for Payer: Medical Associates Commercial |
$8.42
|
| Rate for Payer: Midlands Choice Commercial |
$7.86
|
| Rate for Payer: United Healthcare Commercial |
$10.10
|
|
|
TRANSCUTANEOUS BILI
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
4882833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$35.18
|
| Rate for Payer: Amerigroup Medicare |
$27.72
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.84
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.45
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.57
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
|
|
TRANSCUTANEOUS BILI
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
8027044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
TRANSCUTANEOUS BILI
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
1099777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$35.18
|
| Rate for Payer: Amerigroup Medicare |
$27.72
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.84
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.45
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.57
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
|
|
TRANSCUTANEOUS BILI
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
1099777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
TRANSCUTANEOUS BILI
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
4882833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
TRANSCUTANEOUS BILI
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
8027044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$35.18
|
| Rate for Payer: Amerigroup Medicare |
$27.72
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.84
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.45
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.57
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
|
|
Transferrin DMCL
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
8037819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Aetna of IA Medicare |
$59.28
|
| Rate for Payer: Amerigroup Medicaid |
$59.99
|
| Rate for Payer: Amerigroup Medicare |
$47.27
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$46.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.40
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$46.80
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.82
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.36
|
|
|
Transferrin DMCL
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
8037819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
|
