|
tetanus immune globulin 250 units IM SD Sol 1 EA [VDMC]
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
10424180
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$659.40 |
| Max. Negotiated Rate |
$847.80 |
| Rate for Payer: Aetna of IA Commercial |
$847.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$847.80
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$706.50
|
| Rate for Payer: Medical Associates Commercial |
$706.50
|
| Rate for Payer: Midlands Choice Commercial |
$659.40
|
| Rate for Payer: United Healthcare Commercial |
$847.80
|
|
|
tetanus immune globulin 250 units IM SD Sol 1 EA [VDMC]
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
10424180
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$470.81 |
| Max. Negotiated Rate |
$847.80 |
| Rate for Payer: Aetna of IA Commercial |
$847.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$847.80
|
| Rate for Payer: Aetna of IA Medicare |
$536.94
|
| Rate for Payer: Amerigroup Medicaid |
$475.43
|
| Rate for Payer: Amerigroup Medicare |
$475.71
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$706.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$471.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$470.81
|
| Rate for Payer: Medical Associates Commercial |
$706.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$471.00
|
| Rate for Payer: Midlands Choice Commercial |
$659.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$478.06
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$477.78
|
| Rate for Payer: Oscar Health of IA Commercial |
$706.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$706.50
|
| Rate for Payer: United Healthcare Commercial |
$847.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$555.78
|
|
|
tetracaine ophthalmic 0.5% 4 ml Sol [VDMC]
|
Facility
|
OP
|
$62.39
|
|
|
Service Code
|
NDC 00065-0741-12
|
| Hospital Charge Code |
12719136
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.18 |
| Max. Negotiated Rate |
$56.15 |
| Rate for Payer: Aetna of IA Commercial |
$56.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$56.15
|
| Rate for Payer: Aetna of IA Medicare |
$35.56
|
| Rate for Payer: Amerigroup Medicaid |
$31.49
|
| Rate for Payer: Amerigroup Medicare |
$31.51
|
| Rate for Payer: Cash Price |
$49.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.79
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.18
|
| Rate for Payer: Medical Associates Commercial |
$46.79
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.20
|
| Rate for Payer: Midlands Choice Commercial |
$43.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$31.66
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$31.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$46.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$46.79
|
| Rate for Payer: United Healthcare Commercial |
$56.15
|
| Rate for Payer: United Healthcare Managed Medicare |
$36.81
|
|
|
tetracaine ophthalmic 0.5% 4 ml Sol [VDMC]
|
Facility
|
IP
|
$62.39
|
|
|
Service Code
|
NDC 00065-0741-12
|
| Hospital Charge Code |
12719136
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$56.15 |
| Rate for Payer: Aetna of IA Commercial |
$56.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$56.15
|
| Rate for Payer: Cash Price |
$49.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.79
|
| Rate for Payer: Medical Associates Commercial |
$46.79
|
| Rate for Payer: Midlands Choice Commercial |
$43.67
|
| Rate for Payer: United Healthcare Commercial |
$56.15
|
|
|
Thawing Fee
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
8018868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
|
|
Thawing Fee
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
8018868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$60.70 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Aetna of IA Medicare |
$29.64
|
| Rate for Payer: Amerigroup Medicaid |
$26.24
|
| Rate for Payer: Amerigroup Medicare |
$26.26
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.99
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.39
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$26.37
|
| Rate for Payer: Oscar Health of IA Commercial |
$39.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.00
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.68
|
| Rate for Payer: Wellmark IA HMO |
$55.18
|
| Rate for Payer: Wellmark IA PPO |
$60.70
|
|
|
theophylline 100 mg/24 hours ER Cap [VDMC]
|
Facility
|
OP
|
$12.79
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10610890
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$11.51 |
| Rate for Payer: Aetna of IA Commercial |
$11.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.51
|
| Rate for Payer: Aetna of IA Medicare |
$7.29
|
| Rate for Payer: Amerigroup Medicaid |
$6.46
|
| Rate for Payer: Amerigroup Medicare |
$6.46
|
| Rate for Payer: Cash Price |
$10.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.59
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.39
|
| Rate for Payer: Medical Associates Commercial |
$9.59
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.40
|
| Rate for Payer: Midlands Choice Commercial |
$8.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.49
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$6.49
|
| Rate for Payer: Oscar Health of IA Commercial |
$9.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.59
|
| Rate for Payer: United Healthcare Commercial |
$11.51
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.55
|
|
|
theophylline 100 mg/24 hours ER Cap [VDMC]
|
Facility
|
IP
|
$12.79
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10610890
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$11.51 |
| Rate for Payer: Aetna of IA Commercial |
$11.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.51
|
| Rate for Payer: Cash Price |
$10.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.59
|
| Rate for Payer: Medical Associates Commercial |
$9.59
|
| Rate for Payer: Midlands Choice Commercial |
$8.95
|
| Rate for Payer: United Healthcare Commercial |
$11.51
|
|
|
Theophylline DMCL
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
8037811
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.98 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna of IA Commercial |
$86.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$86.40
|
| Rate for Payer: Aetna of IA Medicare |
$54.72
|
| Rate for Payer: Amerigroup Medicaid |
$48.45
|
| Rate for Payer: Amerigroup Medicare |
$48.48
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$72.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$48.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.98
|
| Rate for Payer: Medical Associates Commercial |
$72.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$48.00
|
| Rate for Payer: Midlands Choice Commercial |
$67.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$48.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$48.69
|
| Rate for Payer: Oscar Health of IA Commercial |
$72.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$72.00
|
| Rate for Payer: United Healthcare Commercial |
$86.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.64
|
| Rate for Payer: Wellmark IA HMO |
$49.60
|
| Rate for Payer: Wellmark IA PPO |
$54.56
|
|
|
Theophylline DMCL
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
8037811
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna of IA Commercial |
$86.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$86.40
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$72.00
|
| Rate for Payer: Medical Associates Commercial |
$72.00
|
| Rate for Payer: Midlands Choice Commercial |
$67.20
|
| Rate for Payer: United Healthcare Commercial |
$86.40
|
|
|
THERA ACTIVITIES 15 MIN, DIRECT
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 97530 GP
|
| Hospital Charge Code |
1374031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of IA Commercial |
$98.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$98.10
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.75
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
|
|
THERA ACTIVITIES 15 MIN, DIRECT
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 97530 GP
|
| Hospital Charge Code |
1374031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of IA Commercial |
$98.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$98.10
|
| Rate for Payer: Aetna of IA Medicare |
$62.13
|
| Rate for Payer: Amerigroup Medicaid |
$55.01
|
| Rate for Payer: Amerigroup Medicare |
$55.04
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$54.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.48
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$54.50
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.32
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$55.28
|
| Rate for Payer: Oscar Health of IA Commercial |
$81.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.75
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.31
|
|
|
THER ACTIVITIES DIRECT PER 15 MIN
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 97530 GO
|
| Hospital Charge Code |
1373450
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of IA Commercial |
$98.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$98.10
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.75
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
|
|
THER ACTIVITIES DIRECT PER 15 MIN
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 97530 GO
|
| Hospital Charge Code |
1373450
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of IA Commercial |
$98.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$98.10
|
| Rate for Payer: Aetna of IA Medicare |
$62.13
|
| Rate for Payer: Amerigroup Medicaid |
$55.01
|
| Rate for Payer: Amerigroup Medicare |
$55.04
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$54.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.48
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$54.50
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.32
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$55.28
|
| Rate for Payer: Oscar Health of IA Commercial |
$81.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.75
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.31
|
|
|
THER ACTIVITY DIRECT 15 MIN
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97530 GN
|
| Hospital Charge Code |
752354
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.75
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
|
|
THER ACTIVITY DIRECT 15 MIN
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97530 GN
|
| Hospital Charge Code |
752354
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$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: Molina Healthcare Managed Medicare |
$91.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$135.75
|
| 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
|
|
|
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: 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
|
|
|
THERA EXERCISES PER 15 MIN
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 97110 GO
|
| Hospital Charge Code |
1373449
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of IA Commercial |
$105.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.30
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.75
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
|
|
THERAPEUTIC EXERCISES 15 MINS
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97110 GN
|
| Hospital Charge Code |
753741
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$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: Molina Healthcare Managed Medicare |
$91.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$135.75
|
| 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 EXERCISES 15 MINS
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97110 GN
|
| Hospital Charge Code |
753741
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.75
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
|
|
Therapeutic Multiple Vitamins Tab [VDMC]
|
Facility
|
OP
|
$1.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10424736
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| 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: Molina Healthcare Managed Medicare |
$0.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.84
|
| 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
|
|
|
Therapeutic Multiple Vitamins Tab [VDMC]
|
Facility
|
IP
|
$1.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10424736
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| 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 multivitamin liqd [VDMC]
|
Facility
|
IP
|
$22.95
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10430580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$20.66 |
| Rate for Payer: Aetna of IA Commercial |
$20.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.66
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.21
|
| Rate for Payer: Medical Associates Commercial |
$17.21
|
| Rate for Payer: Midlands Choice Commercial |
$16.06
|
| Rate for Payer: United Healthcare Commercial |
$20.66
|
|
|
therapeutic multivitamin liqd [VDMC]
|
Facility
|
OP
|
$22.95
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10430580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$20.66 |
| Rate for Payer: Aetna of IA Commercial |
$20.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.66
|
| Rate for Payer: Aetna of IA Medicare |
$13.08
|
| Rate for Payer: Amerigroup Medicaid |
$11.58
|
| Rate for Payer: Amerigroup Medicare |
$11.59
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.21
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.47
|
| Rate for Payer: Medical Associates Commercial |
$17.21
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.48
|
| Rate for Payer: Midlands Choice Commercial |
$16.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.65
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$11.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$17.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$17.21
|
| Rate for Payer: United Healthcare Commercial |
$20.66
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.54
|
|
|
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: Molina Healthcare Managed Medicare |
$908.40
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,343.25
|
| 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
|
|
