|
bacitracin/neomycin/polymyxin B Top Oint
|
Facility
IP
|
$15.75
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701846
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$14.18 |
| Rate for Payer: Aetna of IA Commercial |
$14.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.18
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.81
|
| Rate for Payer: Medical Associates Commercial |
$11.81
|
| Rate for Payer: Midlands Choice Commercial |
$11.02
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
bacitracin/neomycin/polymyxin B Top Oint
|
Facility
OP
|
$15.75
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701846
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$14.18 |
| Rate for Payer: Aetna of IA Commercial |
$14.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.18
|
| Rate for Payer: Aetna of IA Medicare |
$8.98
|
| Rate for Payer: Amerigroup Medicaid |
$7.95
|
| Rate for Payer: Amerigroup Medicare |
$7.95
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.81
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.87
|
| Rate for Payer: Medical Associates Commercial |
$11.81
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.88
|
| Rate for Payer: Midlands Choice Commercial |
$11.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.81
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Managed Medicare |
$9.29
|
|
|
bacitracin Top 500 units/g Oint
|
Facility
OP
|
$13.09
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701842
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$11.78 |
| Rate for Payer: Aetna of IA Commercial |
$11.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.78
|
| Rate for Payer: Aetna of IA Medicare |
$7.46
|
| Rate for Payer: Amerigroup Medicaid |
$6.61
|
| Rate for Payer: Amerigroup Medicare |
$6.61
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.54
|
| Rate for Payer: Medical Associates Commercial |
$9.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.54
|
| Rate for Payer: Midlands Choice Commercial |
$9.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.82
|
| Rate for Payer: United Healthcare Commercial |
$11.78
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.72
|
|
|
bacitracin Top 500 units/g Oint
|
Facility
IP
|
$13.09
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701842
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$11.78 |
| Rate for Payer: Aetna of IA Commercial |
$11.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.78
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.82
|
| Rate for Payer: Medical Associates Commercial |
$9.82
|
| Rate for Payer: Midlands Choice Commercial |
$9.16
|
| Rate for Payer: United Healthcare Commercial |
$11.78
|
|
|
Back and Neck Procedures Except Spinal Fusion With CC
|
Facility
IP
|
$15,171.10
|
|
|
Service Code
|
MS-DRG 519
|
| Hospital Charge Code |
336
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$15,171.10 |
| Rate for Payer: Amerigroup Medicaid |
$15,097.81
|
| 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 |
$14,951.23
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15,171.10
|
|
|
Back and Neck Procedures Except Spinal Fusion With MCC or Disc Device or Neurostimulator
|
Facility
IP
|
$15,863.02
|
|
|
Service Code
|
MS-DRG 518
|
| Hospital Charge Code |
335
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$15,863.02 |
| Rate for Payer: Amerigroup Medicaid |
$15,786.39
|
| 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 |
$15,633.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15,863.02
|
|
|
Back and Neck Procedures Except Spinal Fusion Without CC/MCC
|
Facility
IP
|
$10,611.11
|
|
|
Service Code
|
MS-DRG 520
|
| Hospital Charge Code |
337
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$10,611.11 |
| Rate for Payer: Amerigroup Medicaid |
$10,559.85
|
| 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 |
$10,457.33
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,611.11
|
|
|
baclofen 10 mg Tab
|
Facility
IP
|
$2.05
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43730001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna of IA Commercial |
$1.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.84
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.54
|
| Rate for Payer: Medical Associates Commercial |
$1.54
|
| Rate for Payer: Midlands Choice Commercial |
$1.44
|
| Rate for Payer: United Healthcare Commercial |
$1.84
|
|
|
baclofen 10 mg Tab
|
Facility
OP
|
$2.05
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43730001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna of IA Commercial |
$1.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.84
|
| Rate for Payer: Aetna of IA Medicare |
$1.17
|
| Rate for Payer: Amerigroup Medicaid |
$1.03
|
| Rate for Payer: Amerigroup Medicare |
$1.04
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.54
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.02
|
| Rate for Payer: Medical Associates Commercial |
$1.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.02
|
| Rate for Payer: Midlands Choice Commercial |
$1.44
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.54
|
| Rate for Payer: United Healthcare Commercial |
$1.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.21
|
|
|
Bacterial and Tuberculous Infections of Nervous System With CC
|
Facility
IP
|
$18,889.57
|
|
|
Service Code
|
MS-DRG 095
|
| Hospital Charge Code |
775
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$18,889.57 |
| Rate for Payer: Amerigroup Medicaid |
$18,798.31
|
| 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 |
$18,615.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18,889.57
|
|
|
Bacterial and Tuberculous Infections of Nervous System With MCC
|
Facility
IP
|
$34,765.38
|
|
|
Service Code
|
MS-DRG 094
|
| Hospital Charge Code |
774
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$34,765.38 |
| Rate for Payer: Amerigroup Medicaid |
$34,597.43
|
| 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 |
$34,261.53
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34,765.38
|
|
|
Bacterial and Tuberculous Infections of Nervous System Without CC/MCC
|
Facility
IP
|
$18,889.57
|
|
|
Service Code
|
MS-DRG 096
|
| Hospital Charge Code |
776
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$18,889.57 |
| Rate for Payer: Amerigroup Medicaid |
$18,798.31
|
| 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 |
$18,615.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18,889.57
|
|
|
BACTERIAL IDENTIFICATION
|
Facility
IP
|
$59.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
297663
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna of IA Commercial |
$53.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.10
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.25
|
| Rate for Payer: Medical Associates Commercial |
$44.25
|
| Rate for Payer: Midlands Choice Commercial |
$41.30
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
|
|
BACTERIAL IDENTIFICATION
|
Facility
IP
|
$59.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
297662
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna of IA Commercial |
$53.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.10
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.25
|
| Rate for Payer: Medical Associates Commercial |
$44.25
|
| Rate for Payer: Midlands Choice Commercial |
$41.30
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
|
|
BACTERIAL IDENTIFICATION
|
Facility
OP
|
$59.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
297662
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna of IA Commercial |
$53.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.10
|
| Rate for Payer: Aetna of IA Medicare |
$33.63
|
| Rate for Payer: Amerigroup Medicaid |
$29.78
|
| Rate for Payer: Amerigroup Medicare |
$29.80
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.49
|
| Rate for Payer: Medical Associates Commercial |
$44.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.50
|
| Rate for Payer: Midlands Choice Commercial |
$41.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.25
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.81
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
BACTERIAL IDENTIFICATION
|
Facility
OP
|
$59.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
7734008
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna of IA Commercial |
$53.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.10
|
| Rate for Payer: Aetna of IA Medicare |
$33.63
|
| Rate for Payer: Amerigroup Medicaid |
$29.78
|
| Rate for Payer: Amerigroup Medicare |
$29.80
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.49
|
| Rate for Payer: Medical Associates Commercial |
$44.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.50
|
| Rate for Payer: Midlands Choice Commercial |
$41.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.25
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.81
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
BACTERIAL IDENTIFICATION
|
Facility
IP
|
$59.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
7734008
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna of IA Commercial |
$53.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.10
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.25
|
| Rate for Payer: Medical Associates Commercial |
$44.25
|
| Rate for Payer: Midlands Choice Commercial |
$41.30
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
|
|
BACTERIAL IDENTIFICATION
|
Facility
OP
|
$59.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
297663
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna of IA Commercial |
$53.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.10
|
| Rate for Payer: Aetna of IA Medicare |
$33.63
|
| Rate for Payer: Amerigroup Medicaid |
$29.78
|
| Rate for Payer: Amerigroup Medicare |
$29.80
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.49
|
| Rate for Payer: Medical Associates Commercial |
$44.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.50
|
| Rate for Payer: Midlands Choice Commercial |
$41.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.25
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.81
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
balanced Salt irrig Opth 15 ml
|
Facility
IP
|
$25.71
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$23.14 |
| Rate for Payer: Aetna of IA Commercial |
$23.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.14
|
| Rate for Payer: Cash Price |
$20.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.28
|
| Rate for Payer: Medical Associates Commercial |
$19.28
|
| Rate for Payer: Midlands Choice Commercial |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$23.14
|
|
|
balanced Salt irrig Opth 15 ml
|
Facility
OP
|
$25.71
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$23.14 |
| Rate for Payer: Aetna of IA Commercial |
$23.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.14
|
| Rate for Payer: Aetna of IA Medicare |
$14.65
|
| Rate for Payer: Amerigroup Medicaid |
$12.98
|
| Rate for Payer: Amerigroup Medicare |
$12.98
|
| Rate for Payer: Cash Price |
$20.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.85
|
| Rate for Payer: Medical Associates Commercial |
$19.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.86
|
| Rate for Payer: Midlands Choice Commercial |
$18.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.28
|
| Rate for Payer: United Healthcare Commercial |
$23.14
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.17
|
|
|
balsalazide
|
Facility
IP
|
$5.49
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of IA Commercial |
$4.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.94
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.12
|
| Rate for Payer: Medical Associates Commercial |
$4.12
|
| Rate for Payer: Midlands Choice Commercial |
$3.84
|
| Rate for Payer: United Healthcare Commercial |
$4.94
|
|
|
balsalazide
|
Facility
OP
|
$5.49
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of IA Commercial |
$4.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.94
|
| Rate for Payer: Aetna of IA Medicare |
$3.13
|
| Rate for Payer: Amerigroup Medicaid |
$2.77
|
| Rate for Payer: Amerigroup Medicare |
$2.77
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.74
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.74
|
| Rate for Payer: Medical Associates Commercial |
$4.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.74
|
| Rate for Payer: Midlands Choice Commercial |
$3.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$4.12
|
| Rate for Payer: United Healthcare Commercial |
$4.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.24
|
|
|
balsam Peru-castor oil topical
|
Facility
OP
|
$9.75
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700549
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$8.78 |
| Rate for Payer: Aetna of IA Commercial |
$8.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8.78
|
| Rate for Payer: Aetna of IA Medicare |
$5.56
|
| Rate for Payer: Amerigroup Medicaid |
$4.92
|
| Rate for Payer: Amerigroup Medicare |
$4.92
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.31
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4.87
|
| Rate for Payer: Medical Associates Commercial |
$7.31
|
| Rate for Payer: Medical Associates Managed Medicare |
$4.88
|
| Rate for Payer: Midlands Choice Commercial |
$6.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.31
|
| Rate for Payer: United Healthcare Commercial |
$8.78
|
| Rate for Payer: United Healthcare Managed Medicare |
$5.75
|
|
|
balsam Peru-castor oil topical
|
Facility
IP
|
$9.75
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700549
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$8.78 |
| Rate for Payer: Aetna of IA Commercial |
$8.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8.78
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.31
|
| Rate for Payer: Medical Associates Commercial |
$7.31
|
| Rate for Payer: Midlands Choice Commercial |
$6.82
|
| Rate for Payer: United Healthcare Commercial |
$8.78
|
|
|
bamlanivimab
|
Facility
IP
|
$579.00
|
|
|
Service Code
|
CPT M0239
|
| Hospital Charge Code |
8814037
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$405.30 |
| Max. Negotiated Rate |
$521.10 |
| Rate for Payer: Aetna of IA Commercial |
$521.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$521.10
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$434.25
|
| Rate for Payer: Medical Associates Commercial |
$434.25
|
| Rate for Payer: Midlands Choice Commercial |
$405.30
|
| Rate for Payer: United Healthcare Commercial |
$521.10
|
|
