|
WASHER AXSOS SMALL FRAGMENT 9MM
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of IA Commercial |
$34.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.20
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.50
|
| Rate for Payer: Medical Associates Commercial |
$28.50
|
| Rate for Payer: Midlands Choice Commercial |
$26.60
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
|
|
WASHER FOR 4.5 SCREW
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
|
|
WASHER FOR 4.5 SCREW
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.96 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Aetna of IA Medicare |
$102.60
|
| Rate for Payer: Amerigroup Medicaid |
$90.85
|
| Rate for Payer: Amerigroup Medicare |
$90.90
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.96
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.35
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$91.30
|
| Rate for Payer: Oscar Health of IA Commercial |
$135.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.20
|
|
|
water for irrigation sterile bottle SDV 500 mL [VDMC]
|
Facility
|
OP
|
$77.50
|
|
|
Service Code
|
NDC 00338-0004-03
|
| Hospital Charge Code |
10422585
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Aetna of IA Commercial |
$69.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.75
|
| Rate for Payer: Aetna of IA Medicare |
$44.18
|
| Rate for Payer: Amerigroup Medicaid |
$39.11
|
| Rate for Payer: Amerigroup Medicare |
$39.14
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.73
|
| Rate for Payer: Medical Associates Commercial |
$58.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.75
|
| Rate for Payer: Midlands Choice Commercial |
$54.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.33
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$39.31
|
| Rate for Payer: Oscar Health of IA Commercial |
$58.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$58.12
|
| Rate for Payer: United Healthcare Commercial |
$69.75
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.72
|
|
|
water for irrigation sterile bottle SDV 500 mL [VDMC]
|
Facility
|
IP
|
$77.50
|
|
|
Service Code
|
NDC 00338-0004-03
|
| Hospital Charge Code |
10422585
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$54.25 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Aetna of IA Commercial |
$69.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.75
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.12
|
| Rate for Payer: Medical Associates Commercial |
$58.12
|
| Rate for Payer: Midlands Choice Commercial |
$54.25
|
| Rate for Payer: United Healthcare Commercial |
$69.75
|
|
|
water for irrigation sterile bottle Sol 1000 mL [VDMC]
|
Facility
|
IP
|
$71.24
|
|
|
Service Code
|
NDC 00338-0004-04
|
| Hospital Charge Code |
10422443
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$49.87 |
| Max. Negotiated Rate |
$64.12 |
| Rate for Payer: Aetna of IA Commercial |
$64.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.12
|
| Rate for Payer: Cash Price |
$56.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.43
|
| Rate for Payer: Medical Associates Commercial |
$53.43
|
| Rate for Payer: Midlands Choice Commercial |
$49.87
|
| Rate for Payer: United Healthcare Commercial |
$64.12
|
|
|
water for irrigation sterile bottle Sol 1000 mL [VDMC]
|
Facility
|
OP
|
$71.24
|
|
|
Service Code
|
NDC 00338-0004-04
|
| Hospital Charge Code |
10422443
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.61 |
| Max. Negotiated Rate |
$64.12 |
| Rate for Payer: Aetna of IA Commercial |
$64.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.12
|
| Rate for Payer: Aetna of IA Medicare |
$40.61
|
| Rate for Payer: Amerigroup Medicaid |
$35.95
|
| Rate for Payer: Amerigroup Medicare |
$35.98
|
| Rate for Payer: Cash Price |
$56.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.43
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.61
|
| Rate for Payer: Medical Associates Commercial |
$53.43
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.62
|
| Rate for Payer: Midlands Choice Commercial |
$49.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.15
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$36.13
|
| Rate for Payer: Oscar Health of IA Commercial |
$53.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.43
|
| Rate for Payer: United Healthcare Commercial |
$64.12
|
| Rate for Payer: United Healthcare Managed Medicare |
$42.03
|
|
|
water for irrigation sterile bottle Sol 250 mL [VDMC]
|
Facility
|
OP
|
$67.48
|
|
|
Service Code
|
NDC 00338-0004-02
|
| Hospital Charge Code |
10422514
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$60.73 |
| Rate for Payer: Aetna of IA Commercial |
$60.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.73
|
| Rate for Payer: Aetna of IA Medicare |
$38.46
|
| Rate for Payer: Amerigroup Medicaid |
$34.06
|
| Rate for Payer: Amerigroup Medicare |
$34.08
|
| Rate for Payer: Cash Price |
$53.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.61
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.74
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.73
|
| Rate for Payer: Medical Associates Commercial |
$50.61
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.74
|
| Rate for Payer: Midlands Choice Commercial |
$47.24
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.25
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$34.23
|
| Rate for Payer: Oscar Health of IA Commercial |
$50.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.61
|
| Rate for Payer: United Healthcare Commercial |
$60.73
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.81
|
|
|
water for irrigation sterile bottle Sol 250 mL [VDMC]
|
Facility
|
IP
|
$67.48
|
|
|
Service Code
|
NDC 00338-0004-02
|
| Hospital Charge Code |
10422514
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.24 |
| Max. Negotiated Rate |
$60.73 |
| Rate for Payer: Aetna of IA Commercial |
$60.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.73
|
| Rate for Payer: Cash Price |
$53.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.61
|
| Rate for Payer: Medical Associates Commercial |
$50.61
|
| Rate for Payer: Midlands Choice Commercial |
$47.24
|
| Rate for Payer: United Healthcare Commercial |
$60.73
|
|
|
WBC AND AUTO DIFF
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 85004
|
| Hospital Charge Code |
4006784
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$26.49 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna of IA Commercial |
$47.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$47.70
|
| Rate for Payer: Aetna of IA Medicare |
$30.21
|
| Rate for Payer: Amerigroup Medicaid |
$26.75
|
| Rate for Payer: Amerigroup Medicare |
$26.76
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$26.49
|
| Rate for Payer: Medical Associates Commercial |
$39.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.50
|
| Rate for Payer: Midlands Choice Commercial |
$37.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.90
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$26.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$39.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.75
|
| Rate for Payer: United Healthcare Commercial |
$47.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$31.27
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
|
WBC AND AUTO DIFF
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 85004
|
| Hospital Charge Code |
4006784
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna of IA Commercial |
$47.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$47.70
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.75
|
| Rate for Payer: Medical Associates Commercial |
$39.75
|
| Rate for Payer: Midlands Choice Commercial |
$37.10
|
| Rate for Payer: United Healthcare Commercial |
$47.70
|
|
|
WBC AUTOMATED WITHOUT DIFF
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
2038410
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Aetna of IA Medicare |
$19.38
|
| Rate for Payer: Amerigroup Medicaid |
$17.16
|
| Rate for Payer: Amerigroup Medicare |
$17.17
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.99
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.00
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.26
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$17.24
|
| Rate for Payer: Oscar Health of IA Commercial |
$25.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$25.50
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.06
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
|
WBC AUTOMATED WITHOUT DIFF
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
2038410
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
|
|
WBC STOOL LACTOFERRIN
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
7807165
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.49 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Aetna of IA Medicare |
$23.37
|
| Rate for Payer: Amerigroup Medicaid |
$20.69
|
| Rate for Payer: Amerigroup Medicare |
$20.70
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.49
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.50
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.81
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$20.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$30.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.75
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.19
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
|
WBC STOOL LACTOFERRIN
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
7807165
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
|
|
West Nile Virus Panel DMCL
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
8037830
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of IA Commercial |
$124.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$124.20
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.50
|
| Rate for Payer: Medical Associates Commercial |
$103.50
|
| Rate for Payer: Midlands Choice Commercial |
$96.60
|
| Rate for Payer: United Healthcare Commercial |
$124.20
|
|
|
West Nile Virus Panel DMCL
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
8037830
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of IA Commercial |
$124.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$124.20
|
| Rate for Payer: Aetna of IA Medicare |
$78.66
|
| Rate for Payer: Amerigroup Medicaid |
$69.65
|
| Rate for Payer: Amerigroup Medicare |
$69.69
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$68.97
|
| Rate for Payer: Medical Associates Commercial |
$103.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.00
|
| Rate for Payer: Midlands Choice Commercial |
$96.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.04
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$69.99
|
| Rate for Payer: Oscar Health of IA Commercial |
$103.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$103.50
|
| Rate for Payer: United Healthcare Commercial |
$124.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$81.42
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
WET MOUNT VAGINAL
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
7802689
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.49 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Aetna of IA Medicare |
$23.37
|
| Rate for Payer: Amerigroup Medicaid |
$20.69
|
| Rate for Payer: Amerigroup Medicare |
$20.70
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.49
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.50
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.81
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$20.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$30.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.75
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.19
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
WET MOUNT VAGINAL
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
7802689
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
|
|
WHIRLPOOL
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97022 GO
|
| Hospital Charge Code |
1373554
|
|
Hospital Revenue Code
|
430
|
| 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
|
|
|
WHIRLPOOL
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97022 GO
|
| Hospital Charge Code |
1373554
|
|
Hospital Revenue Code
|
430
|
| 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
|
|
|
WHIRLPOOL APPLICATION
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97022 GP
|
| Hospital Charge Code |
4812783
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
WHIRLPOOL APPLICATION
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97022 GP
|
| Hospital Charge Code |
4812783
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
white petrolatum-mineral oil Oint [VDMC]
|
Facility
|
IP
|
$43.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10410004
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.52 |
| Max. Negotiated Rate |
$39.24 |
| Rate for Payer: Medical Associates Commercial |
$32.70
|
| Rate for Payer: Aetna of IA Commercial |
$39.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.24
|
| Rate for Payer: Cash Price |
$34.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.70
|
| Rate for Payer: Midlands Choice Commercial |
$30.52
|
| Rate for Payer: United Healthcare Commercial |
$39.24
|
|
|
white petrolatum-mineral oil Oint [VDMC]
|
Facility
|
OP
|
$43.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10410004
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.79 |
| Max. Negotiated Rate |
$39.24 |
| Rate for Payer: Aetna of IA Commercial |
$39.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.24
|
| Rate for Payer: Aetna of IA Medicare |
$24.85
|
| Rate for Payer: Amerigroup Medicaid |
$22.00
|
| Rate for Payer: Amerigroup Medicare |
$22.02
|
| Rate for Payer: Cash Price |
$34.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.70
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$21.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.79
|
| Rate for Payer: Medical Associates Commercial |
$32.70
|
| Rate for Payer: Medical Associates Managed Medicare |
$21.80
|
| Rate for Payer: Midlands Choice Commercial |
$30.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.13
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$22.11
|
| Rate for Payer: Oscar Health of IA Commercial |
$32.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$32.70
|
| Rate for Payer: United Healthcare Commercial |
$39.24
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.72
|
|
