|
Viral Illness Without MCC
|
Facility
IP
|
$5,221.40
|
|
|
Service Code
|
MS-DRG 866
|
| Hospital Charge Code |
602
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,221.40 |
| Rate for Payer: Amerigroup Medicaid |
$5,196.17
|
| 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 |
$5,145.73
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,221.40
|
|
|
Viral Meningitis With CC/MCC
|
Facility
IP
|
$8,718.42
|
|
|
Service Code
|
MS-DRG 075
|
| Hospital Charge Code |
755
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,718.42 |
| Rate for Payer: Amerigroup Medicaid |
$8,676.30
|
| 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 |
$8,592.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,718.42
|
|
|
Viral Meningitis Without CC/MCC
|
Facility
IP
|
$5,572.77
|
|
|
Service Code
|
MS-DRG 076
|
| Hospital Charge Code |
756
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,572.77 |
| Rate for Payer: Amerigroup Medicaid |
$5,545.85
|
| 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 |
$5,492.01
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,572.77
|
|
|
Viscosity DMCL
|
Facility
IP
|
$100.00
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
8519256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
|
|
Viscosity DMCL
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
8519256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Aetna of IA Medicare |
$57.00
|
| Rate for Payer: Amerigroup Medicaid |
$50.47
|
| Rate for Payer: Amerigroup Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$50.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.98
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
VITAL CAPACITY, TOTAL
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
7980861
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
|
|
VITAL CAPACITY, TOTAL
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
5338941
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
|
|
VITAL CAPACITY, TOTAL
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
7980861
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$282.35 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Aetna of IA Medicare |
$148.20
|
| Rate for Payer: Amerigroup Medicaid |
$131.22
|
| Rate for Payer: Amerigroup Medicare |
$131.30
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$130.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$129.95
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$130.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$131.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$195.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.40
|
| Rate for Payer: Wellmark IA HMO |
$256.68
|
| Rate for Payer: Wellmark IA PPO |
$282.35
|
|
|
VITAL CAPACITY, TOTAL
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
5338941
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$282.35 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Aetna of IA Medicare |
$148.20
|
| Rate for Payer: Amerigroup Medicaid |
$131.22
|
| Rate for Payer: Amerigroup Medicare |
$131.30
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$130.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$129.95
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$130.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$131.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$195.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.40
|
| Rate for Payer: Wellmark IA HMO |
$256.68
|
| Rate for Payer: Wellmark IA PPO |
$282.35
|
|
|
Vitamin A DMCL
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
8037824
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
Vitamin A DMCL
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
8037824
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
vitamin A & D Top Oint
|
Facility
OP
|
$26.71
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$24.04 |
| Rate for Payer: Aetna of IA Commercial |
$24.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.04
|
| Rate for Payer: Aetna of IA Medicare |
$15.22
|
| Rate for Payer: Amerigroup Medicaid |
$13.48
|
| Rate for Payer: Amerigroup Medicare |
$13.49
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.03
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.35
|
| Rate for Payer: Medical Associates Commercial |
$20.03
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.36
|
| Rate for Payer: Midlands Choice Commercial |
$18.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.03
|
| Rate for Payer: United Healthcare Commercial |
$24.04
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.76
|
|
|
vitamin A & D Top Oint
|
Facility
IP
|
$26.71
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$24.04 |
| Rate for Payer: Aetna of IA Commercial |
$24.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.04
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.03
|
| Rate for Payer: Medical Associates Commercial |
$20.03
|
| Rate for Payer: Midlands Choice Commercial |
$18.70
|
| Rate for Payer: United Healthcare Commercial |
$24.04
|
|
|
Vitamin B-12
|
Facility
IP
|
$103.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
8146790
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of IA Commercial |
$92.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$92.70
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.25
|
| Rate for Payer: Medical Associates Commercial |
$77.25
|
| Rate for Payer: Midlands Choice Commercial |
$72.10
|
| Rate for Payer: United Healthcare Commercial |
$92.70
|
|
|
Vitamin B-12
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
8146790
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of IA Commercial |
$92.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$92.70
|
| Rate for Payer: Aetna of IA Medicare |
$58.71
|
| Rate for Payer: Amerigroup Medicaid |
$51.98
|
| Rate for Payer: Amerigroup Medicare |
$52.02
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.48
|
| Rate for Payer: Medical Associates Commercial |
$77.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.50
|
| Rate for Payer: Midlands Choice Commercial |
$72.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.25
|
| Rate for Payer: United Healthcare Commercial |
$92.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$60.77
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Vitamin B12 and Folate DMCL
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
8037826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of IA Commercial |
$92.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$92.70
|
| Rate for Payer: Aetna of IA Medicare |
$58.71
|
| Rate for Payer: Amerigroup Medicaid |
$51.98
|
| Rate for Payer: Amerigroup Medicare |
$52.02
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.48
|
| Rate for Payer: Medical Associates Commercial |
$77.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.50
|
| Rate for Payer: Midlands Choice Commercial |
$72.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.25
|
| Rate for Payer: United Healthcare Commercial |
$92.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$60.77
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Vitamin B12 and Folate DMCL
|
Facility
IP
|
$103.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
8037826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of IA Commercial |
$92.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$92.70
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.25
|
| Rate for Payer: Medical Associates Commercial |
$77.25
|
| Rate for Payer: Midlands Choice Commercial |
$72.10
|
| Rate for Payer: United Healthcare Commercial |
$92.70
|
|
|
Vitamin B12 Level DMCL
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
8037827
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of IA Commercial |
$92.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$92.70
|
| Rate for Payer: Aetna of IA Medicare |
$58.71
|
| Rate for Payer: Amerigroup Medicaid |
$51.98
|
| Rate for Payer: Amerigroup Medicare |
$52.02
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.48
|
| Rate for Payer: Medical Associates Commercial |
$77.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.50
|
| Rate for Payer: Midlands Choice Commercial |
$72.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.25
|
| Rate for Payer: United Healthcare Commercial |
$92.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$60.77
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Vitamin B12 Level DMCL
|
Facility
IP
|
$103.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
8037827
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of IA Commercial |
$92.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$92.70
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.25
|
| Rate for Payer: Medical Associates Commercial |
$77.25
|
| Rate for Payer: Midlands Choice Commercial |
$72.10
|
| Rate for Payer: United Healthcare Commercial |
$92.70
|
|
|
Vitamin B12 Lvl TMCL
|
Facility
IP
|
$103.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
4008786
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of IA Commercial |
$92.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$92.70
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.25
|
| Rate for Payer: Medical Associates Commercial |
$77.25
|
| Rate for Payer: Midlands Choice Commercial |
$72.10
|
| Rate for Payer: United Healthcare Commercial |
$92.70
|
|
|
Vitamin B12 Lvl TMCL
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
4008786
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of IA Commercial |
$92.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$92.70
|
| Rate for Payer: Aetna of IA Medicare |
$58.71
|
| Rate for Payer: Amerigroup Medicaid |
$51.98
|
| Rate for Payer: Amerigroup Medicare |
$52.02
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.48
|
| Rate for Payer: Medical Associates Commercial |
$77.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.50
|
| Rate for Payer: Midlands Choice Commercial |
$72.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.25
|
| Rate for Payer: United Healthcare Commercial |
$92.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$60.77
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Vitamin B1 Level DMCL
|
Facility
IP
|
$173.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
8037825
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
Vitamin B1 Level DMCL
|
Facility
OP
|
$173.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
8037825
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| 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: 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: 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 |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Vitamin B6 Level
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
8519185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Vitamin B6 Level
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
8519185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
