|
senna-docusate-8.6 mg-50 mg Tab [VDMC]
|
Facility
|
OP
|
$1.38
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10384311
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Aetna of IA Commercial |
$1.25
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.25
|
| Rate for Payer: Aetna of IA Medicare |
$0.79
|
| Rate for Payer: Amerigroup Medicaid |
$0.80
|
| Rate for Payer: Amerigroup Medicare |
$0.63
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.79
|
| Rate for Payer: Medical Associates Commercial |
$1.04
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.62
|
| Rate for Payer: Midlands Choice Commercial |
$0.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.72
|
| Rate for Payer: United Healthcare Commercial |
$1.25
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.82
|
|
|
SENSITIVITY
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
4210782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Aetna of IA Medicare |
$40.47
|
| Rate for Payer: Amerigroup Medicaid |
$40.95
|
| Rate for Payer: Amerigroup Medicare |
$32.27
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.56
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.95
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$36.74
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.89
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
|
SENSITIVITY
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
4210782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
|
|
SENSITIVITY
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
294946
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Aetna of IA Medicare |
$40.47
|
| Rate for Payer: Amerigroup Medicaid |
$40.95
|
| Rate for Payer: Amerigroup Medicare |
$32.27
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.56
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.95
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$36.74
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.89
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
|
SENSITIVITY
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
294946
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
|
|
SENSORY INTEGRATION/15 MIN
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 97533 GO
|
| Hospital Charge Code |
1373568
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna of IA Commercial |
$137.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$137.70
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.75
|
| Rate for Payer: Medical Associates Commercial |
$114.75
|
| Rate for Payer: Midlands Choice Commercial |
$107.10
|
| Rate for Payer: United Healthcare Commercial |
$137.70
|
|
|
SENSORY INTEGRATION/15 MIN
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 97533 GO
|
| Hospital Charge Code |
1373568
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$165.57 |
| Rate for Payer: Aetna of IA Commercial |
$137.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$137.70
|
| Rate for Payer: Aetna of IA Medicare |
$87.21
|
| Rate for Payer: Amerigroup Medicaid |
$88.25
|
| Rate for Payer: Amerigroup Medicare |
$69.54
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$68.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$87.39
|
| Rate for Payer: Medical Associates Commercial |
$114.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$68.85
|
| Rate for Payer: Midlands Choice Commercial |
$107.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$88.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$79.18
|
| Rate for Payer: United Healthcare Commercial |
$137.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$90.27
|
| Rate for Payer: Wellmark IA HMO WHPI |
$150.31
|
| Rate for Payer: Wellmark IA PPO |
$165.57
|
|
|
SENSORY INTEGRATIVE 15 MIN
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 97533 GN
|
| Hospital Charge Code |
1373955
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$165.57 |
| Rate for Payer: Aetna of IA Commercial |
$137.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$137.70
|
| Rate for Payer: Aetna of IA Medicare |
$87.21
|
| Rate for Payer: Amerigroup Medicaid |
$88.25
|
| Rate for Payer: Amerigroup Medicare |
$69.54
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$68.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$87.39
|
| Rate for Payer: Medical Associates Commercial |
$114.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$68.85
|
| Rate for Payer: Midlands Choice Commercial |
$107.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$88.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$79.18
|
| Rate for Payer: United Healthcare Commercial |
$137.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$90.27
|
| Rate for Payer: Wellmark IA HMO WHPI |
$150.31
|
| Rate for Payer: Wellmark IA PPO |
$165.57
|
|
|
SENSORY INTEGRATIVE 15 MIN
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 97533 GN
|
| Hospital Charge Code |
1373955
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna of IA Commercial |
$137.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$137.70
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.75
|
| Rate for Payer: Medical Associates Commercial |
$114.75
|
| Rate for Payer: Midlands Choice Commercial |
$107.10
|
| Rate for Payer: United Healthcare Commercial |
$137.70
|
|
|
SEPTIC ARTHRITIS WITH CC
|
Facility
|
IP
|
$9,723.94
|
|
|
Service Code
|
MSDRG 549
|
| Min. Negotiated Rate |
$9,583.01 |
| Max. Negotiated Rate |
$9,723.94 |
| Rate for Payer: Amerigroup Medicaid |
$9,676.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9,583.01
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,723.94
|
|
|
SEPTIC ARTHRITIS WITH MCC
|
Facility
|
IP
|
$22,858.46
|
|
|
Service Code
|
MSDRG 548
|
| Min. Negotiated Rate |
$22,527.17 |
| Max. Negotiated Rate |
$22,858.46 |
| Rate for Payer: Amerigroup Medicaid |
$22,748.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22,527.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22,858.46
|
|
|
SEPTIC ARTHRITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,723.94
|
|
|
Service Code
|
MSDRG 550
|
| Min. Negotiated Rate |
$9,583.01 |
| Max. Negotiated Rate |
$9,723.94 |
| Rate for Payer: Amerigroup Medicaid |
$9,676.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9,583.01
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,723.94
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS
|
Facility
|
IP
|
$70,664.06
|
|
|
Service Code
|
MSDRG 870
|
| Min. Negotiated Rate |
$69,639.92 |
| Max. Negotiated Rate |
$70,664.06 |
| Rate for Payer: Amerigroup Medicaid |
$70,322.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69,639.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70,664.06
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC
|
Facility
|
IP
|
$16,254.60
|
|
|
Service Code
|
MSDRG 871
|
| Min. Negotiated Rate |
$16,019.02 |
| Max. Negotiated Rate |
$16,254.60 |
| Rate for Payer: Amerigroup Medicaid |
$16,176.07
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16,019.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16,254.60
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC
|
Facility
|
IP
|
$8,967.28
|
|
|
Service Code
|
MSDRG 872
|
| Min. Negotiated Rate |
$8,837.32 |
| Max. Negotiated Rate |
$8,967.28 |
| Rate for Payer: Amerigroup Medicaid |
$8,923.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,837.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,967.28
|
|
|
sertraline 50 mg Tab [VDMC]
|
Facility
|
OP
|
$1.90
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10420378
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Aetna of IA Commercial |
$1.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.71
|
| Rate for Payer: Aetna of IA Medicare |
$1.08
|
| Rate for Payer: Amerigroup Medicaid |
$1.10
|
| Rate for Payer: Amerigroup Medicare |
$0.87
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.43
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.09
|
| Rate for Payer: Medical Associates Commercial |
$1.43
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.86
|
| Rate for Payer: Midlands Choice Commercial |
$1.33
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.98
|
| Rate for Payer: United Healthcare Commercial |
$1.71
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.12
|
|
|
sertraline 50 mg Tab [VDMC]
|
Facility
|
IP
|
$1.90
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10420378
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Aetna of IA Commercial |
$1.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.71
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.43
|
| Rate for Payer: Medical Associates Commercial |
$1.43
|
| Rate for Payer: Midlands Choice Commercial |
$1.33
|
| Rate for Payer: United Healthcare Commercial |
$1.71
|
|
|
SESAMOIDECTOMY FIRST TOE CHARGE .
|
Professional
|
Both
|
$1,671.00
|
|
|
Service Code
|
CPT 28315
|
| Hospital Charge Code |
8825536
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$355.80 |
| Max. Negotiated Rate |
$1,253.25 |
| Rate for Payer: Amerigroup Medicaid |
$359.28
|
| Rate for Payer: Cash Price |
$1,336.80
|
| Rate for Payer: Cash Price |
$1,336.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$355.80
|
| Rate for Payer: Medical Associates Commercial |
$1,253.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,169.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$357.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,253.25
|
| Rate for Payer: United Healthcare Commercial |
$740.61
|
| Rate for Payer: Wellmark IA HMO WHPI |
$902.60
|
| Rate for Payer: Wellmark IA PPO |
$1,061.90
|
|
|
sevelamer carbonate 800 mg Tab [VDMC]
|
Facility
|
OP
|
$1.78
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10420449
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Aetna of IA Commercial |
$1.61
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.61
|
| Rate for Payer: Aetna of IA Medicare |
$1.02
|
| Rate for Payer: Amerigroup Medicaid |
$1.03
|
| Rate for Payer: Amerigroup Medicare |
$0.81
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.34
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.02
|
| Rate for Payer: Medical Associates Commercial |
$1.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.80
|
| Rate for Payer: Midlands Choice Commercial |
$1.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.92
|
| Rate for Payer: United Healthcare Commercial |
$1.61
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.05
|
|
|
sevelamer carbonate 800 mg Tab [VDMC]
|
Facility
|
IP
|
$1.78
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10420449
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Aetna of IA Commercial |
$1.61
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.61
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.34
|
| Rate for Payer: Medical Associates Commercial |
$1.34
|
| Rate for Payer: Midlands Choice Commercial |
$1.25
|
| Rate for Payer: United Healthcare Commercial |
$1.61
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
7982917
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$333.49 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$126.90
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.66
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.85
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
| Rate for Payer: Wellmark IA HMO WHPI |
$302.74
|
| Rate for Payer: Wellmark IA PPO |
$333.49
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
7982917
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
|
|
SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
CPT 11313
|
| Hospital Charge Code |
8799080
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$389.00 |
| Rate for Payer: Amerigroup Medicaid |
$112.39
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$111.30
|
| Rate for Payer: Medical Associates Commercial |
$231.75
|
| Rate for Payer: Midlands Choice Commercial |
$216.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$111.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$231.75
|
| Rate for Payer: United Healthcare Commercial |
$280.02
|
| Rate for Payer: Wellmark IA HMO WHPI |
$330.60
|
| Rate for Payer: Wellmark IA PPO |
$389.00
|
|
|
SHIGA TOXINS
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
7780541
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna of IA Commercial |
$88.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.20
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.50
|
| Rate for Payer: Medical Associates Commercial |
$73.50
|
| Rate for Payer: Midlands Choice Commercial |
$68.60
|
| Rate for Payer: United Healthcare Commercial |
$88.20
|
|
|
SHIGA TOXINS
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
7780541
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.03 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna of IA Commercial |
$88.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.20
|
| Rate for Payer: Aetna of IA Medicare |
$55.86
|
| Rate for Payer: Amerigroup Medicaid |
$56.53
|
| Rate for Payer: Amerigroup Medicare |
$44.54
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$44.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$55.98
|
| Rate for Payer: Medical Associates Commercial |
$73.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.10
|
| Rate for Payer: Midlands Choice Commercial |
$68.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$56.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.72
|
| Rate for Payer: United Healthcare Commercial |
$88.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$57.82
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
