|
APPL SKIN SUB EA ADD 100 SQ CM FEET/TOES
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
8013706
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$354.90 |
| Max. Negotiated Rate |
$456.30 |
| Rate for Payer: Aetna of IA Commercial |
$456.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$456.30
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$380.25
|
| Rate for Payer: Medical Associates Commercial |
$380.25
|
| Rate for Payer: Midlands Choice Commercial |
$354.90
|
| Rate for Payer: United Healthcare Commercial |
$456.30
|
|
|
APPL SKIN SUB EA ADD 100 SQ CM FEET/TOES
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
8013706
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$253.40 |
| Max. Negotiated Rate |
$2,985.11 |
| Rate for Payer: Aetna of IA Commercial |
$456.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$456.30
|
| Rate for Payer: Aetna of IA Medicare |
$288.99
|
| Rate for Payer: Amerigroup Medicaid |
$255.88
|
| Rate for Payer: Amerigroup Medicare |
$256.04
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$380.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$253.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$253.40
|
| Rate for Payer: Medical Associates Commercial |
$380.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$253.50
|
| Rate for Payer: Midlands Choice Commercial |
$354.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$257.30
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$257.15
|
| Rate for Payer: Oscar Health of IA Commercial |
$380.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$380.25
|
| Rate for Payer: United Healthcare Commercial |
$456.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$299.13
|
| Rate for Payer: Wellmark IA HMO |
$2,713.74
|
| Rate for Payer: Wellmark IA PPO |
$2,985.11
|
|
|
APPL SKIN SUB EA ADD 100 SQ CM LEG/ANKLE
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
8013702
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.98 |
| Max. Negotiated Rate |
$2,985.11 |
| Rate for Payer: Aetna of IA Commercial |
$70.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$70.20
|
| Rate for Payer: Aetna of IA Medicare |
$44.46
|
| Rate for Payer: Amerigroup Medicaid |
$39.37
|
| Rate for Payer: Amerigroup Medicare |
$39.39
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$39.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.98
|
| Rate for Payer: Medical Associates Commercial |
$58.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$39.00
|
| Rate for Payer: Midlands Choice Commercial |
$54.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.58
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$39.56
|
| Rate for Payer: Oscar Health of IA Commercial |
$58.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$58.50
|
| Rate for Payer: United Healthcare Commercial |
$70.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$46.02
|
| Rate for Payer: Wellmark IA HMO |
$2,713.74
|
| Rate for Payer: Wellmark IA PPO |
$2,985.11
|
|
|
APPL SKIN SUB EA ADD 100 SQ CM LEG/ANKLE
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
8013702
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna of IA Commercial |
$70.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$70.20
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.50
|
| Rate for Payer: Medical Associates Commercial |
$58.50
|
| Rate for Payer: Midlands Choice Commercial |
$54.60
|
| Rate for Payer: United Healthcare Commercial |
$70.20
|
|
|
APPL SKIN SUB EA ADD 1ST 25 CM FEET/TOES
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
8013704
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.47 |
| Max. Negotiated Rate |
$2,985.11 |
| Rate for Payer: Aetna of IA Commercial |
$155.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$155.70
|
| Rate for Payer: Aetna of IA Medicare |
$98.61
|
| Rate for Payer: Amerigroup Medicaid |
$87.31
|
| Rate for Payer: Amerigroup Medicare |
$87.36
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$129.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$86.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$86.47
|
| Rate for Payer: Medical Associates Commercial |
$129.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$86.50
|
| Rate for Payer: Midlands Choice Commercial |
$121.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$87.80
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$87.75
|
| Rate for Payer: Oscar Health of IA Commercial |
$129.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$129.75
|
| Rate for Payer: United Healthcare Commercial |
$155.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$102.07
|
| Rate for Payer: Wellmark IA HMO |
$2,713.74
|
| Rate for Payer: Wellmark IA PPO |
$2,985.11
|
|
|
APPL SKIN SUB EA ADD 1ST 25 CM FEET/TOES
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
8013704
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$155.70 |
| Rate for Payer: Aetna of IA Commercial |
$155.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$155.70
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$129.75
|
| Rate for Payer: Medical Associates Commercial |
$129.75
|
| Rate for Payer: Midlands Choice Commercial |
$121.10
|
| Rate for Payer: United Healthcare Commercial |
$155.70
|
|
|
APPL SKIN SUB EA ADD 1ST 25 CM LEG/ANKLE
|
Facility
|
IP
|
$1,357.00
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
7440782
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$949.90 |
| Max. Negotiated Rate |
$1,221.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,221.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,221.30
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,017.75
|
| Rate for Payer: Medical Associates Commercial |
$1,017.75
|
| Rate for Payer: Midlands Choice Commercial |
$949.90
|
| Rate for Payer: United Healthcare Commercial |
$1,221.30
|
|
|
APPL SKIN SUB EA ADD 1ST 25 CM LEG/ANKLE
|
Facility
|
OP
|
$1,357.00
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
7440782
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$678.23 |
| Max. Negotiated Rate |
$2,985.11 |
| Rate for Payer: Aetna of IA Commercial |
$1,221.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,221.30
|
| Rate for Payer: Aetna of IA Medicare |
$773.49
|
| Rate for Payer: Amerigroup Medicaid |
$684.88
|
| Rate for Payer: Amerigroup Medicare |
$685.28
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,017.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$678.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$678.23
|
| Rate for Payer: Medical Associates Commercial |
$1,017.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$678.50
|
| Rate for Payer: Midlands Choice Commercial |
$949.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$688.68
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$688.27
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,017.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,017.75
|
| Rate for Payer: United Healthcare Commercial |
$1,221.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$800.63
|
| Rate for Payer: Wellmark IA HMO |
$2,713.74
|
| Rate for Payer: Wellmark IA PPO |
$2,985.11
|
|
|
APPLY FOREARM SPLINT
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
7982789
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$36.55 |
| Max. Negotiated Rate |
$117.60 |
| Rate for Payer: Aetna of IA Medicare |
$36.55
|
| Rate for Payer: Amerigroup Medicaid |
$37.79
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.28
|
| Rate for Payer: Medical Associates Commercial |
$65.79
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.55
|
| Rate for Payer: Midlands Choice Commercial |
$117.60
|
| Rate for Payer: Oscar Health of IA Commercial |
$63.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.82
|
|
|
APPLY LONG ARM SPLINT
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
7982790
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$37.26 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Aetna of IA Medicare |
$37.26
|
| Rate for Payer: Amerigroup Medicaid |
$38.53
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.01
|
| Rate for Payer: Medical Associates Commercial |
$67.07
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.26
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: Oscar Health of IA Commercial |
$64.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.89
|
|
|
APPLY LONG LEG CAST BRACE
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
CPT 29358
|
| Hospital Charge Code |
7982864
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$92.57 |
| Max. Negotiated Rate |
$374.50 |
| Rate for Payer: Aetna of IA Medicare |
$92.57
|
| Rate for Payer: Amerigroup Medicaid |
$95.72
|
| Rate for Payer: Cash Price |
$428.00
|
| Rate for Payer: Cash Price |
$428.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$94.42
|
| Rate for Payer: Medical Associates Commercial |
$166.63
|
| Rate for Payer: Medical Associates Managed Medicare |
$92.57
|
| Rate for Payer: Midlands Choice Commercial |
$374.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$160.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$138.86
|
|
|
APPLY SHORT LEG CAST
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
7982787
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$128.80 |
| Rate for Payer: Aetna of IA Medicare |
$53.25
|
| Rate for Payer: Amerigroup Medicaid |
$55.06
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.32
|
| Rate for Payer: Medical Associates Commercial |
$95.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$53.25
|
| Rate for Payer: Midlands Choice Commercial |
$128.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$92.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$79.88
|
|
|
APPLY TENS UNIT
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 64550 GP
|
| Hospital Charge Code |
4658837
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.49 |
| 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 |
$30.79
|
| Rate for Payer: Amerigroup Medicare |
$30.80
|
| 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 |
$30.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.49
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.50
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.96
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$30.94
|
| Rate for Payer: Oscar Health of IA Commercial |
$45.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
|
|
APPLY TENS UNIT
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 64550 GP
|
| Hospital Charge Code |
4658837
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
aprepitant 130 mg/18 mL EMU SDV [VDMC]
|
Facility
|
OP
|
$992.96
|
|
|
Service Code
|
HCPCS J0185
|
| Hospital Charge Code |
17509893
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$496.28 |
| Max. Negotiated Rate |
$893.66 |
| Rate for Payer: Aetna of IA Commercial |
$893.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$893.66
|
| Rate for Payer: Aetna of IA Medicare |
$565.99
|
| Rate for Payer: Amerigroup Medicaid |
$501.15
|
| Rate for Payer: Amerigroup Medicare |
$501.44
|
| Rate for Payer: Cash Price |
$794.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$744.72
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$496.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$496.28
|
| Rate for Payer: Medical Associates Commercial |
$744.72
|
| Rate for Payer: Medical Associates Managed Medicare |
$496.48
|
| Rate for Payer: Midlands Choice Commercial |
$695.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$503.93
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$503.63
|
| Rate for Payer: Oscar Health of IA Commercial |
$744.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$744.72
|
| Rate for Payer: United Healthcare Commercial |
$893.66
|
| Rate for Payer: United Healthcare Managed Medicare |
$585.85
|
|
|
aprepitant 130 mg/18 mL EMU SDV [VDMC]
|
Facility
|
IP
|
$992.96
|
|
|
Service Code
|
HCPCS J0185
|
| Hospital Charge Code |
17509893
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$695.07 |
| Max. Negotiated Rate |
$893.66 |
| Rate for Payer: Aetna of IA Commercial |
$893.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$893.66
|
| Rate for Payer: Cash Price |
$794.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$744.72
|
| Rate for Payer: Medical Associates Commercial |
$744.72
|
| Rate for Payer: Midlands Choice Commercial |
$695.07
|
| Rate for Payer: United Healthcare Commercial |
$893.66
|
|
|
aprepitant 32 mg/4.4 mL EMU [VDMC]
|
Facility
|
IP
|
$233.40
|
|
|
Service Code
|
HCPCS C9145
|
| Hospital Charge Code |
26695660
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$163.38 |
| Max. Negotiated Rate |
$210.06 |
| Rate for Payer: Aetna of IA Commercial |
$210.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$210.06
|
| Rate for Payer: Cash Price |
$186.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$175.05
|
| Rate for Payer: Medical Associates Commercial |
$175.05
|
| Rate for Payer: Midlands Choice Commercial |
$163.38
|
| Rate for Payer: United Healthcare Commercial |
$210.06
|
|
|
aprepitant 32 mg/4.4 mL EMU [VDMC]
|
Facility
|
OP
|
$233.40
|
|
|
Service Code
|
HCPCS C9145
|
| Hospital Charge Code |
26695660
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$116.65 |
| Max. Negotiated Rate |
$210.06 |
| Rate for Payer: Aetna of IA Commercial |
$210.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$210.06
|
| Rate for Payer: Aetna of IA Medicare |
$133.04
|
| Rate for Payer: Amerigroup Medicaid |
$117.80
|
| Rate for Payer: Amerigroup Medicare |
$117.87
|
| Rate for Payer: Cash Price |
$186.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$175.05
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$116.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$116.65
|
| Rate for Payer: Medical Associates Commercial |
$175.05
|
| Rate for Payer: Medical Associates Managed Medicare |
$116.70
|
| Rate for Payer: Midlands Choice Commercial |
$163.38
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$118.45
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$118.38
|
| Rate for Payer: Oscar Health of IA Commercial |
$175.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$175.05
|
| Rate for Payer: United Healthcare Commercial |
$210.06
|
| Rate for Payer: United Healthcare Managed Medicare |
$137.71
|
|
|
arformoterol 15 mcg/2 mL Sol [VDMC]
|
Facility
|
OP
|
$17.98
|
|
|
Service Code
|
HCPCS J7605
|
| Hospital Charge Code |
10606303
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna of IA Commercial |
$16.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.18
|
| Rate for Payer: Aetna of IA Medicare |
$10.25
|
| Rate for Payer: Amerigroup Medicaid |
$9.07
|
| Rate for Payer: Amerigroup Medicare |
$9.08
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.48
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.99
|
| Rate for Payer: Medical Associates Commercial |
$13.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.99
|
| Rate for Payer: Midlands Choice Commercial |
$12.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9.12
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$9.12
|
| Rate for Payer: Oscar Health of IA Commercial |
$13.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$13.48
|
| Rate for Payer: United Healthcare Commercial |
$16.18
|
| Rate for Payer: United Healthcare Managed Medicare |
$10.61
|
|
|
arformoterol 15 mcg/2 mL Sol [VDMC]
|
Facility
|
IP
|
$17.98
|
|
|
Service Code
|
HCPCS J7605
|
| Hospital Charge Code |
10606303
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna of IA Commercial |
$16.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.18
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.48
|
| Rate for Payer: Medical Associates Commercial |
$13.48
|
| Rate for Payer: Midlands Choice Commercial |
$12.59
|
| Rate for Payer: United Healthcare Commercial |
$16.18
|
|
|
ARIPiprazole 5 mg Tab [VDMC]
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10367551
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna of IA Commercial |
$1.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.86
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.55
|
| Rate for Payer: Medical Associates Commercial |
$1.55
|
| Rate for Payer: Midlands Choice Commercial |
$1.45
|
| Rate for Payer: United Healthcare Commercial |
$1.86
|
|
|
ARIPiprazole 5 mg Tab [VDMC]
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10367551
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna of IA Commercial |
$1.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.86
|
| Rate for Payer: Aetna of IA Medicare |
$1.18
|
| Rate for Payer: Amerigroup Medicaid |
$1.04
|
| Rate for Payer: Amerigroup Medicare |
$1.05
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.55
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.03
|
| Rate for Payer: Medical Associates Commercial |
$1.55
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.04
|
| Rate for Payer: Midlands Choice Commercial |
$1.45
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.05
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.05
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.55
|
| Rate for Payer: United Healthcare Commercial |
$1.86
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.22
|
|
|
ARSENIC
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
8093926
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
|
|
ARSENIC
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
8093926
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Aetna of IA Medicare |
$73.53
|
| Rate for Payer: Amerigroup Medicaid |
$65.11
|
| Rate for Payer: Amerigroup Medicare |
$65.14
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.47
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$65.47
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$65.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$96.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$96.75
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.11
|
| Rate for Payer: Wellmark IA HMO |
$37.20
|
| Rate for Payer: Wellmark IA PPO |
$40.92
|
|
|
ARTERIAL PUNCTURE
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
5338932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Aetna of IA Commercial |
$83.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$83.70
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$69.75
|
| Rate for Payer: Medical Associates Commercial |
$69.75
|
| Rate for Payer: Midlands Choice Commercial |
$65.10
|
| Rate for Payer: United Healthcare Commercial |
$83.70
|
|
