|
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 |
$18,615.81 |
| Max. Negotiated Rate |
$18,889.57 |
| Rate for Payer: Amerigroup Medicaid |
$18,798.31
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18,615.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18,889.57
|
|
|
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: Molina Healthcare Managed Medicare |
$29.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$44.25
|
| 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 |
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
|
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: Molina Healthcare Managed Medicare |
$29.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$44.25
|
| 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 |
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: Molina Healthcare Managed Medicare |
$29.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$44.25
|
| 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 |
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
|
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
|
|
|
balanced Salt irrig Opth 15 ml [VDMC]
|
Facility
|
IP
|
$25.71
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10410623
|
|
Hospital Revenue Code
|
259
|
| 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 [VDMC]
|
Facility
|
OP
|
$25.71
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10410623
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$13.04
|
| Rate for Payer: Oscar Health of IA Commercial |
$19.28
|
| 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 750 mg Cap [VDMC]
|
Facility
|
OP
|
$5.49
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10369471
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$2.78
|
| Rate for Payer: Oscar Health of IA Commercial |
$4.12
|
| 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
|
|
|
balsalazide 750 mg Cap [VDMC]
|
Facility
|
IP
|
$5.49
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10369471
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
|
balsam Peru-castor oil topical 87 mg-788 mg/g Oin
|
Facility
|
OP
|
$9.75
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23072734
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$4.95
|
| Rate for Payer: Oscar Health of IA Commercial |
$7.31
|
| 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 87 mg-788 mg/g Oin
|
Facility
|
IP
|
$9.75
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23072734
|
|
Hospital Revenue Code
|
259
|
| 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
|
OP
|
$579.00
|
|
|
Service Code
|
CPT M0239
|
| Hospital Charge Code |
8814037
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$289.38 |
| 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: Aetna of IA Medicare |
$330.03
|
| Rate for Payer: Amerigroup Medicaid |
$292.22
|
| Rate for Payer: Amerigroup Medicare |
$292.40
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$434.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$289.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$289.38
|
| Rate for Payer: Medical Associates Commercial |
$434.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$289.50
|
| Rate for Payer: Midlands Choice Commercial |
$405.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$293.84
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$293.67
|
| Rate for Payer: Oscar Health of IA Commercial |
$434.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$434.25
|
| Rate for Payer: United Healthcare Commercial |
$521.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$341.61
|
|
|
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: Medical Associates Commercial |
$434.25
|
| 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: Midlands Choice Commercial |
$405.30
|
| Rate for Payer: United Healthcare Commercial |
$521.10
|
|
|
Bamlanivimab Infusion
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
CPT M0239
|
| Hospital Charge Code |
8819966
|
|
Hospital Revenue Code
|
771
|
| 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
|
|
|
Bamlanivimab Infusion
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
CPT M0239
|
| Hospital Charge Code |
8819966
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$289.38 |
| 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: Aetna of IA Medicare |
$330.03
|
| Rate for Payer: Amerigroup Medicaid |
$292.22
|
| Rate for Payer: Amerigroup Medicare |
$292.40
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$434.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$289.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$289.38
|
| Rate for Payer: Medical Associates Commercial |
$434.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$289.50
|
| Rate for Payer: Midlands Choice Commercial |
$405.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$293.84
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$293.67
|
| Rate for Payer: Oscar Health of IA Commercial |
$434.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$434.25
|
| Rate for Payer: United Healthcare Commercial |
$521.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$341.61
|
|
|
BARD SOFT MESH 3X6
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT C1787
|
| Hospital Charge Code |
8026288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.48 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna of IA Commercial |
$72.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$72.90
|
| Rate for Payer: Aetna of IA Medicare |
$46.17
|
| Rate for Payer: Amerigroup Medicaid |
$40.88
|
| Rate for Payer: Amerigroup Medicare |
$40.90
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$60.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$40.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.48
|
| Rate for Payer: Medical Associates Commercial |
$60.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.50
|
| Rate for Payer: Midlands Choice Commercial |
$56.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.11
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$41.08
|
| Rate for Payer: Oscar Health of IA Commercial |
$60.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$60.75
|
| Rate for Payer: United Healthcare Commercial |
$72.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$47.79
|
|
|
BARD SOFT MESH 3X6
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT C1787
|
| Hospital Charge Code |
8026288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna of IA Commercial |
$72.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$72.90
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$60.75
|
| Rate for Payer: Medical Associates Commercial |
$60.75
|
| Rate for Payer: Midlands Choice Commercial |
$56.70
|
| Rate for Payer: United Healthcare Commercial |
$72.90
|
|
|
BARD SOFT MESH 6X6
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8026132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna of IA Commercial |
$119.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$119.70
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$99.75
|
| Rate for Payer: Medical Associates Commercial |
$99.75
|
| Rate for Payer: Midlands Choice Commercial |
$93.10
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
|
|
BARD SOFT MESH 6X6
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8026132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.47 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna of IA Commercial |
$119.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$119.70
|
| Rate for Payer: Aetna of IA Medicare |
$75.81
|
| Rate for Payer: Amerigroup Medicaid |
$67.13
|
| Rate for Payer: Amerigroup Medicare |
$67.16
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$99.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$66.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$66.47
|
| Rate for Payer: Medical Associates Commercial |
$99.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$66.50
|
| Rate for Payer: Midlands Choice Commercial |
$93.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$67.50
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$67.46
|
| Rate for Payer: Oscar Health of IA Commercial |
$99.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$99.75
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$78.47
|
|
|
BASIC METABOLIC PROFILE
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
633628
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna of IA Commercial |
$126.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.90
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.75
|
| Rate for Payer: Medical Associates Commercial |
$105.75
|
| Rate for Payer: Midlands Choice Commercial |
$98.70
|
| Rate for Payer: United Healthcare Commercial |
$126.90
|
|
|
BASIC METABOLIC PROFILE
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
633628
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.08 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna of IA Commercial |
$126.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.90
|
| Rate for Payer: Aetna of IA Medicare |
$80.37
|
| Rate for Payer: Amerigroup Medicaid |
$71.16
|
| Rate for Payer: Amerigroup Medicare |
$71.20
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$70.47
|
| Rate for Payer: Medical Associates Commercial |
$105.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.50
|
| Rate for Payer: Midlands Choice Commercial |
$98.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.56
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$71.52
|
| Rate for Payer: Oscar Health of IA Commercial |
$105.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$105.75
|
| Rate for Payer: United Healthcare Commercial |
$126.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$83.19
|
| Rate for Payer: Wellmark IA HMO |
$52.08
|
| Rate for Payer: Wellmark IA PPO |
$57.29
|
|
|
BB TAK (OLIVE WIRE)
|
Facility
|
IP
|
$77.00
|
|
| Hospital Charge Code |
8047045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of IA Commercial |
$69.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.30
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.75
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
|
|
BB TAK (OLIVE WIRE)
|
Facility
|
OP
|
$77.00
|
|
| Hospital Charge Code |
8047045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of IA Commercial |
$69.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.30
|
| Rate for Payer: Aetna of IA Medicare |
$43.89
|
| Rate for Payer: Amerigroup Medicaid |
$38.86
|
| Rate for Payer: Amerigroup Medicare |
$38.88
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.48
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.50
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.08
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$39.05
|
| Rate for Payer: Oscar Health of IA Commercial |
$57.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$57.75
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.43
|
|
