XR Venogram Lower Extremity Left
|
Facility
|
IP
|
$830.00
|
|
Service Code
|
CPT 75820 LT
|
Hospital Charge Code |
1170592
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$581.00 |
Max. Negotiated Rate |
$747.00 |
Rate for Payer: Aetna of IA Commercial |
$747.00
|
Rate for Payer: Aetna of IA Medical Rental Products |
$747.00
|
Rate for Payer: Cash Price |
$664.00
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$622.50
|
Rate for Payer: Medical Associates Commercial |
$622.50
|
Rate for Payer: Midlands Choice Commercial |
$581.00
|
Rate for Payer: United Healthcare Commercial |
$747.00
|
|
XR Venogram Lower Extremity Right
|
Facility
|
OP
|
$830.00
|
|
Service Code
|
CPT 75820 RT
|
Hospital Charge Code |
1170594
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$414.83 |
Max. Negotiated Rate |
$747.00 |
Rate for Payer: Aetna of IA Commercial |
$747.00
|
Rate for Payer: Aetna of IA Medical Rental Products |
$747.00
|
Rate for Payer: Aetna of IA Medicare |
$473.10
|
Rate for Payer: Amerigroup Medicaid |
$418.90
|
Rate for Payer: Amerigroup Medicare |
$419.15
|
Rate for Payer: Cash Price |
$664.00
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$622.50
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$415.00
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$414.83
|
Rate for Payer: Medical Associates Commercial |
$622.50
|
Rate for Payer: Medical Associates Managed Medicare |
$415.00
|
Rate for Payer: Midlands Choice Commercial |
$581.00
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$421.22
|
Rate for Payer: Molina Healthcare Managed Medicare |
$420.98
|
Rate for Payer: Oscar Health of IA Commercial |
$622.50
|
Rate for Payer: Partners Health Alliance Commercial |
$622.50
|
Rate for Payer: United Healthcare Commercial |
$747.00
|
Rate for Payer: United Healthcare Managed Medicare |
$489.70
|
|
XR Venogram Lower Extremity Right
|
Facility
|
IP
|
$830.00
|
|
Service Code
|
CPT 75820 RT
|
Hospital Charge Code |
1170594
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$581.00 |
Max. Negotiated Rate |
$747.00 |
Rate for Payer: Aetna of IA Commercial |
$747.00
|
Rate for Payer: Aetna of IA Medical Rental Products |
$747.00
|
Rate for Payer: Cash Price |
$664.00
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$622.50
|
Rate for Payer: Medical Associates Commercial |
$622.50
|
Rate for Payer: Midlands Choice Commercial |
$581.00
|
Rate for Payer: United Healthcare Commercial |
$747.00
|
|
XR Venogram Upper Extremity Left
|
Facility
|
OP
|
$830.00
|
|
Service Code
|
CPT 75820 LT
|
Hospital Charge Code |
1170598
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$414.83 |
Max. Negotiated Rate |
$747.00 |
Rate for Payer: Aetna of IA Commercial |
$747.00
|
Rate for Payer: Aetna of IA Medical Rental Products |
$747.00
|
Rate for Payer: Aetna of IA Medicare |
$473.10
|
Rate for Payer: Amerigroup Medicaid |
$418.90
|
Rate for Payer: Amerigroup Medicare |
$419.15
|
Rate for Payer: Cash Price |
$664.00
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$622.50
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$415.00
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$414.83
|
Rate for Payer: Medical Associates Commercial |
$622.50
|
Rate for Payer: Medical Associates Managed Medicare |
$415.00
|
Rate for Payer: Midlands Choice Commercial |
$581.00
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$421.22
|
Rate for Payer: Molina Healthcare Managed Medicare |
$420.98
|
Rate for Payer: Oscar Health of IA Commercial |
$622.50
|
Rate for Payer: Partners Health Alliance Commercial |
$622.50
|
Rate for Payer: United Healthcare Commercial |
$747.00
|
Rate for Payer: United Healthcare Managed Medicare |
$489.70
|
|
XR Venogram Upper Extremity Left
|
Facility
|
IP
|
$830.00
|
|
Service Code
|
CPT 75820 LT
|
Hospital Charge Code |
1170598
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$581.00 |
Max. Negotiated Rate |
$747.00 |
Rate for Payer: Aetna of IA Commercial |
$747.00
|
Rate for Payer: Aetna of IA Medical Rental Products |
$747.00
|
Rate for Payer: Cash Price |
$664.00
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$622.50
|
Rate for Payer: Medical Associates Commercial |
$622.50
|
Rate for Payer: Midlands Choice Commercial |
$581.00
|
Rate for Payer: United Healthcare Commercial |
$747.00
|
|
XR Venogram Upper Extremity Right
|
Facility
|
IP
|
$830.00
|
|
Service Code
|
CPT 75820 RT
|
Hospital Charge Code |
1170600
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$581.00 |
Max. Negotiated Rate |
$747.00 |
Rate for Payer: Aetna of IA Commercial |
$747.00
|
Rate for Payer: Aetna of IA Medical Rental Products |
$747.00
|
Rate for Payer: Cash Price |
$664.00
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$622.50
|
Rate for Payer: Medical Associates Commercial |
$622.50
|
Rate for Payer: Midlands Choice Commercial |
$581.00
|
Rate for Payer: United Healthcare Commercial |
$747.00
|
|
XR Venogram Upper Extremity Right
|
Facility
|
OP
|
$830.00
|
|
Service Code
|
CPT 75820 RT
|
Hospital Charge Code |
1170600
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$414.83 |
Max. Negotiated Rate |
$747.00 |
Rate for Payer: Aetna of IA Commercial |
$747.00
|
Rate for Payer: Aetna of IA Medical Rental Products |
$747.00
|
Rate for Payer: Aetna of IA Medicare |
$473.10
|
Rate for Payer: Amerigroup Medicaid |
$418.90
|
Rate for Payer: Amerigroup Medicare |
$419.15
|
Rate for Payer: Cash Price |
$664.00
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$622.50
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$415.00
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$414.83
|
Rate for Payer: Medical Associates Commercial |
$622.50
|
Rate for Payer: Medical Associates Managed Medicare |
$415.00
|
Rate for Payer: Midlands Choice Commercial |
$581.00
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$421.22
|
Rate for Payer: Molina Healthcare Managed Medicare |
$420.98
|
Rate for Payer: Oscar Health of IA Commercial |
$622.50
|
Rate for Payer: Partners Health Alliance Commercial |
$622.50
|
Rate for Payer: United Healthcare Commercial |
$747.00
|
Rate for Payer: United Healthcare Managed Medicare |
$489.70
|
|
XR Wrist 2 Views Left
|
Facility
|
IP
|
$127.00
|
|
Service Code
|
CPT 73100 LT
|
Hospital Charge Code |
1170606
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$88.90 |
Max. Negotiated Rate |
$114.30 |
Rate for Payer: Aetna of IA Commercial |
$114.30
|
Rate for Payer: Aetna of IA Medical Rental Products |
$114.30
|
Rate for Payer: Cash Price |
$101.60
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$95.25
|
Rate for Payer: Medical Associates Commercial |
$95.25
|
Rate for Payer: Midlands Choice Commercial |
$88.90
|
Rate for Payer: United Healthcare Commercial |
$114.30
|
|
XR Wrist 2 Views Left
|
Facility
|
OP
|
$127.00
|
|
Service Code
|
CPT 73100 LT
|
Hospital Charge Code |
1170606
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$63.47 |
Max. Negotiated Rate |
$114.30 |
Rate for Payer: Aetna of IA Commercial |
$114.30
|
Rate for Payer: Aetna of IA Medical Rental Products |
$114.30
|
Rate for Payer: Aetna of IA Medicare |
$72.39
|
Rate for Payer: Amerigroup Medicaid |
$64.10
|
Rate for Payer: Amerigroup Medicare |
$64.14
|
Rate for Payer: Cash Price |
$101.60
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$95.25
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$63.50
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$63.47
|
Rate for Payer: Medical Associates Commercial |
$95.25
|
Rate for Payer: Medical Associates Managed Medicare |
$63.50
|
Rate for Payer: Midlands Choice Commercial |
$88.90
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$64.45
|
Rate for Payer: Molina Healthcare Managed Medicare |
$64.41
|
Rate for Payer: Oscar Health of IA Commercial |
$95.25
|
Rate for Payer: Partners Health Alliance Commercial |
$95.25
|
Rate for Payer: United Healthcare Commercial |
$114.30
|
Rate for Payer: United Healthcare Managed Medicare |
$74.93
|
|
XR Wrist 2 Views Right
|
Facility
|
OP
|
$127.00
|
|
Service Code
|
CPT 73100 RT
|
Hospital Charge Code |
1170608
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$63.47 |
Max. Negotiated Rate |
$114.30 |
Rate for Payer: Aetna of IA Commercial |
$114.30
|
Rate for Payer: Aetna of IA Medical Rental Products |
$114.30
|
Rate for Payer: Aetna of IA Medicare |
$72.39
|
Rate for Payer: Amerigroup Medicaid |
$64.10
|
Rate for Payer: Amerigroup Medicare |
$64.14
|
Rate for Payer: Cash Price |
$101.60
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$95.25
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$63.50
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$63.47
|
Rate for Payer: Medical Associates Commercial |
$95.25
|
Rate for Payer: Medical Associates Managed Medicare |
$63.50
|
Rate for Payer: Midlands Choice Commercial |
$88.90
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$64.45
|
Rate for Payer: Molina Healthcare Managed Medicare |
$64.41
|
Rate for Payer: Oscar Health of IA Commercial |
$95.25
|
Rate for Payer: Partners Health Alliance Commercial |
$95.25
|
Rate for Payer: United Healthcare Commercial |
$114.30
|
Rate for Payer: United Healthcare Managed Medicare |
$74.93
|
|
XR Wrist 2 Views Right
|
Facility
|
IP
|
$127.00
|
|
Service Code
|
CPT 73100 RT
|
Hospital Charge Code |
1170608
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$88.90 |
Max. Negotiated Rate |
$114.30 |
Rate for Payer: Aetna of IA Commercial |
$114.30
|
Rate for Payer: Aetna of IA Medical Rental Products |
$114.30
|
Rate for Payer: Cash Price |
$101.60
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$95.25
|
Rate for Payer: Medical Associates Commercial |
$95.25
|
Rate for Payer: Midlands Choice Commercial |
$88.90
|
Rate for Payer: United Healthcare Commercial |
$114.30
|
|
XR Wrist Complete Left
|
Facility
|
OP
|
$146.00
|
|
Service Code
|
CPT 73110 LT
|
Hospital Charge Code |
1170612
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$72.97 |
Max. Negotiated Rate |
$131.40 |
Rate for Payer: Aetna of IA Commercial |
$131.40
|
Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
Rate for Payer: Aetna of IA Medicare |
$83.22
|
Rate for Payer: Amerigroup Medicaid |
$73.69
|
Rate for Payer: Amerigroup Medicare |
$73.73
|
Rate for Payer: Cash Price |
$116.80
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.00
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$72.97
|
Rate for Payer: Medical Associates Commercial |
$109.50
|
Rate for Payer: Medical Associates Managed Medicare |
$73.00
|
Rate for Payer: Midlands Choice Commercial |
$102.20
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$74.10
|
Rate for Payer: Molina Healthcare Managed Medicare |
$74.05
|
Rate for Payer: Oscar Health of IA Commercial |
$109.50
|
Rate for Payer: Partners Health Alliance Commercial |
$109.50
|
Rate for Payer: United Healthcare Commercial |
$131.40
|
Rate for Payer: United Healthcare Managed Medicare |
$86.14
|
|
XR Wrist Complete Left
|
Facility
|
IP
|
$146.00
|
|
Service Code
|
CPT 73110 LT
|
Hospital Charge Code |
1170612
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$102.20 |
Max. Negotiated Rate |
$131.40 |
Rate for Payer: Aetna of IA Commercial |
$131.40
|
Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
Rate for Payer: Cash Price |
$116.80
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
Rate for Payer: Medical Associates Commercial |
$109.50
|
Rate for Payer: Midlands Choice Commercial |
$102.20
|
Rate for Payer: United Healthcare Commercial |
$131.40
|
|
XR Wrist Complete Right
|
Facility
|
IP
|
$146.00
|
|
Service Code
|
CPT 73110 RT
|
Hospital Charge Code |
1170614
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$102.20 |
Max. Negotiated Rate |
$131.40 |
Rate for Payer: Aetna of IA Commercial |
$131.40
|
Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
Rate for Payer: Cash Price |
$116.80
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
Rate for Payer: Medical Associates Commercial |
$109.50
|
Rate for Payer: Midlands Choice Commercial |
$102.20
|
Rate for Payer: United Healthcare Commercial |
$131.40
|
|
XR Wrist Complete Right
|
Facility
|
OP
|
$146.00
|
|
Service Code
|
CPT 73110 RT
|
Hospital Charge Code |
1170614
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$72.97 |
Max. Negotiated Rate |
$131.40 |
Rate for Payer: Aetna of IA Commercial |
$131.40
|
Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
Rate for Payer: Aetna of IA Medicare |
$83.22
|
Rate for Payer: Amerigroup Medicaid |
$73.69
|
Rate for Payer: Amerigroup Medicare |
$73.73
|
Rate for Payer: Cash Price |
$116.80
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.00
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$72.97
|
Rate for Payer: Medical Associates Commercial |
$109.50
|
Rate for Payer: Medical Associates Managed Medicare |
$73.00
|
Rate for Payer: Midlands Choice Commercial |
$102.20
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$74.10
|
Rate for Payer: Molina Healthcare Managed Medicare |
$74.05
|
Rate for Payer: Oscar Health of IA Commercial |
$109.50
|
Rate for Payer: Partners Health Alliance Commercial |
$109.50
|
Rate for Payer: United Healthcare Commercial |
$131.40
|
Rate for Payer: United Healthcare Managed Medicare |
$86.14
|
|
Zinc Level DMCL
|
Facility
|
OP
|
$62.00
|
|
Service Code
|
CPT 84630
|
Hospital Charge Code |
8519183
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$30.99 |
Max. Negotiated Rate |
$55.80 |
Rate for Payer: Aetna of IA Commercial |
$55.80
|
Rate for Payer: Aetna of IA Medical Rental Products |
$55.80
|
Rate for Payer: Aetna of IA Medicare |
$35.34
|
Rate for Payer: Amerigroup Medicaid |
$31.29
|
Rate for Payer: Amerigroup Medicare |
$31.31
|
Rate for Payer: Cash Price |
$49.60
|
Rate for Payer: Cash Price |
$49.60
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.50
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.00
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$30.99
|
Rate for Payer: Medical Associates Commercial |
$46.50
|
Rate for Payer: Medical Associates Managed Medicare |
$31.00
|
Rate for Payer: Midlands Choice Commercial |
$43.40
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$31.46
|
Rate for Payer: Molina Healthcare Managed Medicare |
$31.45
|
Rate for Payer: Oscar Health of IA Commercial |
$46.50
|
Rate for Payer: Partners Health Alliance Commercial |
$46.50
|
Rate for Payer: United Healthcare Commercial |
$55.80
|
Rate for Payer: United Healthcare Managed Medicare |
$36.58
|
Rate for Payer: Wellmark IA HMO |
$37.20
|
Rate for Payer: Wellmark IA PPO |
$40.92
|
|
Zinc Level DMCL
|
Facility
|
IP
|
$62.00
|
|
Service Code
|
CPT 84630
|
Hospital Charge Code |
8519183
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$43.40 |
Max. Negotiated Rate |
$55.80 |
Rate for Payer: Aetna of IA Commercial |
$55.80
|
Rate for Payer: Aetna of IA Medical Rental Products |
$55.80
|
Rate for Payer: Cash Price |
$49.60
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.50
|
Rate for Payer: Medical Associates Commercial |
$46.50
|
Rate for Payer: Midlands Choice Commercial |
$43.40
|
Rate for Payer: United Healthcare Commercial |
$55.80
|
|
zinc oxide Top 40% Paste [VDMC]
|
Facility
|
IP
|
$35.40
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
22876909
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$24.78 |
Max. Negotiated Rate |
$31.86 |
Rate for Payer: Aetna of IA Commercial |
$31.86
|
Rate for Payer: Aetna of IA Medical Rental Products |
$31.86
|
Rate for Payer: Cash Price |
$28.32
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.55
|
Rate for Payer: Medical Associates Commercial |
$26.55
|
Rate for Payer: Midlands Choice Commercial |
$24.78
|
Rate for Payer: United Healthcare Commercial |
$31.86
|
|
zinc oxide Top 40% Paste [VDMC]
|
Facility
|
OP
|
$35.40
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
22876909
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$17.69 |
Max. Negotiated Rate |
$31.86 |
Rate for Payer: Aetna of IA Commercial |
$31.86
|
Rate for Payer: Aetna of IA Medical Rental Products |
$31.86
|
Rate for Payer: Aetna of IA Medicare |
$20.18
|
Rate for Payer: Amerigroup Medicaid |
$17.87
|
Rate for Payer: Amerigroup Medicare |
$17.88
|
Rate for Payer: Cash Price |
$28.32
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.55
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.70
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$17.69
|
Rate for Payer: Medical Associates Commercial |
$26.55
|
Rate for Payer: Medical Associates Managed Medicare |
$17.70
|
Rate for Payer: Midlands Choice Commercial |
$24.78
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$17.97
|
Rate for Payer: Molina Healthcare Managed Medicare |
$17.95
|
Rate for Payer: Oscar Health of IA Commercial |
$26.55
|
Rate for Payer: Partners Health Alliance Commercial |
$26.55
|
Rate for Payer: United Healthcare Commercial |
$31.86
|
Rate for Payer: United Healthcare Managed Medicare |
$20.89
|
|
zinc sulfate 50 mg Cap [VDMC]
|
Facility
|
OP
|
$1.31
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10428828
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.65 |
Max. Negotiated Rate |
$1.18 |
Rate for Payer: Aetna of IA Commercial |
$1.18
|
Rate for Payer: Aetna of IA Medical Rental Products |
$1.18
|
Rate for Payer: Aetna of IA Medicare |
$0.75
|
Rate for Payer: Amerigroup Medicaid |
$0.66
|
Rate for Payer: Amerigroup Medicare |
$0.66
|
Rate for Payer: Cash Price |
$1.05
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.98
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.66
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$0.65
|
Rate for Payer: Medical Associates Commercial |
$0.98
|
Rate for Payer: Medical Associates Managed Medicare |
$0.66
|
Rate for Payer: Midlands Choice Commercial |
$0.92
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$0.66
|
Rate for Payer: Molina Healthcare Managed Medicare |
$0.66
|
Rate for Payer: Oscar Health of IA Commercial |
$0.98
|
Rate for Payer: Partners Health Alliance Commercial |
$0.98
|
Rate for Payer: United Healthcare Commercial |
$1.18
|
Rate for Payer: United Healthcare Managed Medicare |
$0.77
|
|
zinc sulfate 50 mg Cap [VDMC]
|
Facility
|
IP
|
$1.31
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10428828
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.92 |
Max. Negotiated Rate |
$1.18 |
Rate for Payer: Aetna of IA Commercial |
$1.18
|
Rate for Payer: Aetna of IA Medical Rental Products |
$1.18
|
Rate for Payer: Cash Price |
$1.05
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.98
|
Rate for Payer: Medical Associates Commercial |
$0.98
|
Rate for Payer: Midlands Choice Commercial |
$0.92
|
Rate for Payer: United Healthcare Commercial |
$1.18
|
|
ZioPatch EXT ECG>48HR<7D RECORDING
|
Facility
|
IP
|
$305.00
|
|
Service Code
|
CPT 93242
|
Hospital Charge Code |
8831646
|
Hospital Revenue Code
|
730
|
Min. Negotiated Rate |
$213.50 |
Max. Negotiated Rate |
$274.50 |
Rate for Payer: Aetna of IA Commercial |
$274.50
|
Rate for Payer: Aetna of IA Medical Rental Products |
$274.50
|
Rate for Payer: Cash Price |
$244.00
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$228.75
|
Rate for Payer: Medical Associates Commercial |
$228.75
|
Rate for Payer: Midlands Choice Commercial |
$213.50
|
Rate for Payer: United Healthcare Commercial |
$274.50
|
|
ZioPatch EXT ECG>48HR<7D RECORDING
|
Facility
|
OP
|
$305.00
|
|
Service Code
|
CPT 93242
|
Hospital Charge Code |
8831646
|
Hospital Revenue Code
|
730
|
Min. Negotiated Rate |
$152.44 |
Max. Negotiated Rate |
$274.50 |
Rate for Payer: United Healthcare Commercial |
$274.50
|
Rate for Payer: Aetna of IA Commercial |
$274.50
|
Rate for Payer: Aetna of IA Medical Rental Products |
$274.50
|
Rate for Payer: Aetna of IA Medicare |
$173.85
|
Rate for Payer: Amerigroup Medicaid |
$153.93
|
Rate for Payer: Amerigroup Medicare |
$154.02
|
Rate for Payer: Cash Price |
$244.00
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$228.75
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$152.50
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$152.44
|
Rate for Payer: Medical Associates Commercial |
$228.75
|
Rate for Payer: Medical Associates Managed Medicare |
$152.50
|
Rate for Payer: Midlands Choice Commercial |
$213.50
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$154.79
|
Rate for Payer: Molina Healthcare Managed Medicare |
$154.70
|
Rate for Payer: Oscar Health of IA Commercial |
$228.75
|
Rate for Payer: Partners Health Alliance Commercial |
$228.75
|
Rate for Payer: United Healthcare Managed Medicare |
$179.95
|
|
ZioPatch EXT ECG>7D<15D RECORDING
|
Facility
|
IP
|
$305.00
|
|
Service Code
|
CPT 93246
|
Hospital Charge Code |
8829640
|
Hospital Revenue Code
|
730
|
Min. Negotiated Rate |
$213.50 |
Max. Negotiated Rate |
$274.50 |
Rate for Payer: Aetna of IA Commercial |
$274.50
|
Rate for Payer: Aetna of IA Medical Rental Products |
$274.50
|
Rate for Payer: Cash Price |
$244.00
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$228.75
|
Rate for Payer: Medical Associates Commercial |
$228.75
|
Rate for Payer: Midlands Choice Commercial |
$213.50
|
Rate for Payer: United Healthcare Commercial |
$274.50
|
|
ZioPatch EXT ECG>7D<15D RECORDING
|
Facility
|
OP
|
$305.00
|
|
Service Code
|
CPT 93246
|
Hospital Charge Code |
8829640
|
Hospital Revenue Code
|
730
|
Min. Negotiated Rate |
$152.44 |
Max. Negotiated Rate |
$274.50 |
Rate for Payer: Aetna of IA Commercial |
$274.50
|
Rate for Payer: Aetna of IA Medical Rental Products |
$274.50
|
Rate for Payer: Aetna of IA Medicare |
$173.85
|
Rate for Payer: Amerigroup Medicaid |
$153.93
|
Rate for Payer: Amerigroup Medicare |
$154.02
|
Rate for Payer: Cash Price |
$244.00
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$228.75
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$152.50
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$152.44
|
Rate for Payer: Medical Associates Commercial |
$228.75
|
Rate for Payer: Medical Associates Managed Medicare |
$152.50
|
Rate for Payer: Midlands Choice Commercial |
$213.50
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$154.79
|
Rate for Payer: Molina Healthcare Managed Medicare |
$154.70
|
Rate for Payer: Oscar Health of IA Commercial |
$228.75
|
Rate for Payer: Partners Health Alliance Commercial |
$228.75
|
Rate for Payer: United Healthcare Commercial |
$274.50
|
Rate for Payer: United Healthcare Managed Medicare |
$179.95
|
|