|
trastuzumab dttb 420 mg Pow MDV
|
Facility
IP
|
$6,305.98
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43782711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,414.19 |
| Max. Negotiated Rate |
$5,675.38 |
| Rate for Payer: Aetna of IA Commercial |
$5,675.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,675.38
|
| Rate for Payer: Cash Price |
$5,044.78
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,729.48
|
| Rate for Payer: Medical Associates Commercial |
$4,729.48
|
| Rate for Payer: Midlands Choice Commercial |
$4,414.19
|
| Rate for Payer: United Healthcare Commercial |
$5,675.38
|
|
|
Traumatic Injury With MCC
|
Facility
IP
|
$16,110.06
|
|
|
Service Code
|
MS-DRG 913
|
| Hospital Charge Code |
631
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$16,110.06 |
| Rate for Payer: Amerigroup Medicaid |
$16,032.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15,876.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16,110.06
|
|
|
Traumatic Injury Without MCC
|
Facility
IP
|
$5,406.44
|
|
|
Service Code
|
MS-DRG 914
|
| Hospital Charge Code |
632
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,406.44 |
| Rate for Payer: Amerigroup Medicaid |
$5,380.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5,328.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,406.44
|
|
|
Traumatic Stupor and Coma <1 Hour With CC
|
Facility
IP
|
$7,867.05
|
|
|
Service Code
|
MS-DRG 086
|
| Hospital Charge Code |
766
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,867.05 |
| Rate for Payer: Amerigroup Medicaid |
$7,829.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,753.03
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,867.05
|
|
|
Traumatic Stupor and Coma >1 Hour With CC
|
Facility
IP
|
$8,774.51
|
|
|
Service Code
|
MS-DRG 083
|
| Hospital Charge Code |
763
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,774.51 |
| Rate for Payer: Amerigroup Medicaid |
$8,732.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,647.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,774.51
|
|
|
Traumatic Stupor and Coma <1 Hour With MCC
|
Facility
IP
|
$13,141.59
|
|
|
Service Code
|
MS-DRG 085
|
| Hospital Charge Code |
765
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$13,141.59 |
| Rate for Payer: Amerigroup Medicaid |
$13,078.11
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12,951.13
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,141.59
|
|
|
Traumatic Stupor and Coma >1 Hour With MCC
|
Facility
IP
|
$23,574.56
|
|
|
Service Code
|
MS-DRG 082
|
| Hospital Charge Code |
762
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$23,574.56 |
| Rate for Payer: Amerigroup Medicaid |
$23,460.67
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23,232.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23,574.56
|
|
|
Traumatic Stupor and Coma <1 Hour Without CC/MCC
|
Facility
IP
|
$4,856.25
|
|
|
Service Code
|
MS-DRG 087
|
| Hospital Charge Code |
767
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$4,856.25 |
| Rate for Payer: Amerigroup Medicaid |
$4,832.79
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,785.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,856.25
|
|
|
Traumatic Stupor and Coma >1 Hour Without CC/MCC
|
Facility
IP
|
$5,261.75
|
|
|
Service Code
|
MS-DRG 084
|
| Hospital Charge Code |
764
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,261.75 |
| Rate for Payer: Amerigroup Medicaid |
$5,236.33
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5,185.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,261.75
|
|
|
Trauma to the Skin, Subcutaneous Tissue and Breast With MCC
|
Facility
IP
|
$8,740.07
|
|
|
Service Code
|
MS-DRG 604
|
| Hospital Charge Code |
402
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,740.07 |
| Rate for Payer: Amerigroup Medicaid |
$8,697.85
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,613.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,740.07
|
|
|
Trauma to the Skin, Subcutaneous Tissue and Breast Without MCC
|
Facility
IP
|
$6,174.15
|
|
|
Service Code
|
MS-DRG 605
|
| Hospital Charge Code |
403
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,174.15 |
| Rate for Payer: Amerigroup Medicaid |
$6,144.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,084.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,174.15
|
|
|
travoprost 0.004% Ophth Sol
|
Facility
IP
|
$595.88
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$417.12 |
| Max. Negotiated Rate |
$536.29 |
| Rate for Payer: Aetna of IA Commercial |
$536.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$536.29
|
| Rate for Payer: Cash Price |
$476.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$446.91
|
| Rate for Payer: Medical Associates Commercial |
$446.91
|
| Rate for Payer: Midlands Choice Commercial |
$417.12
|
| Rate for Payer: United Healthcare Commercial |
$536.29
|
|
|
travoprost 0.004% Ophth Sol
|
Facility
OP
|
$595.88
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.82 |
| Max. Negotiated Rate |
$536.29 |
| Rate for Payer: Aetna of IA Commercial |
$536.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$536.29
|
| Rate for Payer: Aetna of IA Medicare |
$339.65
|
| Rate for Payer: Amerigroup Medicaid |
$300.74
|
| Rate for Payer: Amerigroup Medicare |
$300.92
|
| Rate for Payer: Cash Price |
$476.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$446.91
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$297.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$297.82
|
| Rate for Payer: Medical Associates Commercial |
$446.91
|
| Rate for Payer: Medical Associates Managed Medicare |
$297.94
|
| Rate for Payer: Midlands Choice Commercial |
$417.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$302.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$446.91
|
| Rate for Payer: United Healthcare Commercial |
$536.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$351.57
|
|
|
traZODone 50 mg Tab
|
Facility
OP
|
$1.14
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
43705797
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Aetna of IA Commercial |
$1.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.03
|
| Rate for Payer: Aetna of IA Medicare |
$0.65
|
| Rate for Payer: Amerigroup Medicaid |
$0.58
|
| Rate for Payer: Amerigroup Medicare |
$0.58
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.86
|
| 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 |
$0.57
|
| Rate for Payer: Medical Associates Commercial |
$0.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.57
|
| Rate for Payer: Midlands Choice Commercial |
$0.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.86
|
| Rate for Payer: United Healthcare Commercial |
$1.03
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.67
|
|
|
traZODone 50 mg Tab
|
Facility
IP
|
$1.14
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
43705797
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Aetna of IA Commercial |
$1.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.03
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.86
|
| Rate for Payer: Medical Associates Commercial |
$0.86
|
| Rate for Payer: Midlands Choice Commercial |
$0.80
|
| Rate for Payer: United Healthcare Commercial |
$1.03
|
|
|
TREAT CLAVICLE FRACTURE
|
Professional
|
$424.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
7982813
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$214.38 |
| Max. Negotiated Rate |
$527.00 |
| Rate for Payer: Aetna of IA Medicare |
$214.38
|
| Rate for Payer: Amerigroup Medicaid |
$221.67
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$257.26
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$218.67
|
| Rate for Payer: Medical Associates Commercial |
$407.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$214.38
|
| Rate for Payer: Midlands Choice Commercial |
$296.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$321.57
|
| Rate for Payer: Wellmark IA HMO |
$449.00
|
| Rate for Payer: Wellmark IA PPO |
$527.00
|
|
|
TREAT DISLOCATION/FRACTURE
|
Professional
|
$1,228.00
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
7982871
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$371.29 |
| Max. Negotiated Rate |
$914.00 |
| Rate for Payer: Aetna of IA Medicare |
$371.29
|
| Rate for Payer: Amerigroup Medicaid |
$383.91
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$445.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$378.72
|
| Rate for Payer: Medical Associates Commercial |
$705.45
|
| Rate for Payer: Medical Associates Managed Medicare |
$371.29
|
| Rate for Payer: Midlands Choice Commercial |
$859.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$556.94
|
| Rate for Payer: Wellmark IA HMO |
$779.00
|
| Rate for Payer: Wellmark IA PPO |
$914.00
|
|
|
TREAT FINGER DISLOCATION
|
Professional
|
$788.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
7982797
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$246.35 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Aetna of IA Medicare |
$246.35
|
| Rate for Payer: Amerigroup Medicaid |
$254.73
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$295.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$251.28
|
| Rate for Payer: Medical Associates Commercial |
$468.06
|
| Rate for Payer: Medical Associates Managed Medicare |
$246.35
|
| Rate for Payer: Midlands Choice Commercial |
$551.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$369.52
|
| Rate for Payer: Wellmark IA HMO |
$514.00
|
| Rate for Payer: Wellmark IA PPO |
$603.00
|
|
|
TREAT FINGER FRACTURE EACH
|
Professional
|
$1,670.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
7982798
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,169.00 |
| Rate for Payer: Aetna of IA Medicare |
$462.60
|
| Rate for Payer: Amerigroup Medicaid |
$478.33
|
| Rate for Payer: Cash Price |
$1,336.00
|
| Rate for Payer: Cash Price |
$1,336.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$555.12
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$471.85
|
| Rate for Payer: Medical Associates Commercial |
$878.94
|
| Rate for Payer: Medical Associates Managed Medicare |
$462.60
|
| Rate for Payer: Midlands Choice Commercial |
$1,169.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$693.90
|
| Rate for Payer: Wellmark IA HMO |
$973.00
|
| Rate for Payer: Wellmark IA PPO |
$1,143.00
|
|
|
TREAT FINGER FRACTURE EACH
|
Professional
|
$1,038.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
7982799
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$255.85 |
| Max. Negotiated Rate |
$726.60 |
| Rate for Payer: Aetna of IA Medicare |
$255.85
|
| Rate for Payer: Amerigroup Medicaid |
$264.55
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$307.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$260.97
|
| Rate for Payer: Medical Associates Commercial |
$486.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$255.85
|
| Rate for Payer: Midlands Choice Commercial |
$726.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$383.78
|
| Rate for Payer: Wellmark IA HMO |
$540.00
|
| Rate for Payer: Wellmark IA PPO |
$633.00
|
|
|
TREAT FINGER FRACTURE EACH
|
Professional
|
$1,114.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
7982800
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$284.51 |
| Max. Negotiated Rate |
$779.80 |
| Rate for Payer: Aetna of IA Medicare |
$284.51
|
| Rate for Payer: Amerigroup Medicaid |
$294.18
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$341.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$290.20
|
| Rate for Payer: Medical Associates Commercial |
$540.57
|
| Rate for Payer: Medical Associates Managed Medicare |
$284.51
|
| Rate for Payer: Midlands Choice Commercial |
$779.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$426.76
|
| Rate for Payer: Wellmark IA HMO |
$597.00
|
| Rate for Payer: Wellmark IA PPO |
$701.00
|
|
|
TREAT FRACTURE OF RADIUS
|
Professional
|
$1,409.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
7982869
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$427.06 |
| Max. Negotiated Rate |
$1,055.00 |
| Rate for Payer: Aetna of IA Medicare |
$427.06
|
| Rate for Payer: Amerigroup Medicaid |
$441.58
|
| Rate for Payer: Cash Price |
$1,127.20
|
| Rate for Payer: Cash Price |
$1,127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$512.47
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$435.60
|
| Rate for Payer: Medical Associates Commercial |
$811.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$427.06
|
| Rate for Payer: Midlands Choice Commercial |
$986.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$640.59
|
| Rate for Payer: Wellmark IA HMO |
$899.00
|
| Rate for Payer: Wellmark IA PPO |
$1,055.00
|
|
|
TREAT FRACTURE RADIUS ULNA
|
Facility
OP
|
$1,256.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
4864848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$627.75 |
| Max. Negotiated Rate |
$3,346.57 |
| Rate for Payer: Aetna of IA Commercial |
$1,130.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,130.40
|
| Rate for Payer: Aetna of IA Medicare |
$715.92
|
| Rate for Payer: Amerigroup Medicaid |
$633.90
|
| Rate for Payer: Amerigroup Medicare |
$634.28
|
| Rate for Payer: Cash Price |
$1,004.80
|
| Rate for Payer: Cash Price |
$1,004.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$942.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$628.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$627.75
|
| Rate for Payer: Medical Associates Commercial |
$942.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$628.00
|
| Rate for Payer: Midlands Choice Commercial |
$879.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$637.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$942.00
|
| Rate for Payer: United Healthcare Commercial |
$1,130.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$741.04
|
| Rate for Payer: Wellmark IA HMO |
$3,042.34
|
| Rate for Payer: Wellmark IA PPO |
$3,346.57
|
|
|
TREAT FRACTURE RADIUS ULNA
|
Professional
|
$920.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
7982807
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$243.41 |
| Max. Negotiated Rate |
$644.00 |
| Rate for Payer: Aetna of IA Medicare |
$243.41
|
| Rate for Payer: Amerigroup Medicaid |
$251.69
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$292.09
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$248.28
|
| Rate for Payer: Medical Associates Commercial |
$462.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$243.41
|
| Rate for Payer: Midlands Choice Commercial |
$644.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$365.12
|
| Rate for Payer: Wellmark IA HMO |
$509.00
|
| Rate for Payer: Wellmark IA PPO |
$597.00
|
|
|
TREAT FRACTURE RADIUS ULNA
|
Facility
IP
|
$1,256.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
4864848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$879.20 |
| Max. Negotiated Rate |
$1,130.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,130.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,130.40
|
| Rate for Payer: Cash Price |
$1,004.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$942.00
|
| Rate for Payer: Medical Associates Commercial |
$942.00
|
| Rate for Payer: Midlands Choice Commercial |
$879.20
|
| Rate for Payer: United Healthcare Commercial |
$1,130.40
|
|
