|
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
|
|
|
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: 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
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 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: 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 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: Partners Health Alliance Commercial |
$99.75
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$78.47
|
|
|
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
|
|
|
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: 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
|
|
|
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
|
|
|
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: Partners Health Alliance Commercial |
$57.75
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.43
|
|
|
BD Bone Density Axial + Vertebral Fx
|
Facility
IP
|
$305.00
|
|
|
Service Code
|
CPT 77085
|
| Hospital Charge Code |
7820763
|
|
Hospital Revenue Code
|
320
|
| 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
|
|
|
BD Bone Density Axial + Vertebral Fx
|
Facility
OP
|
$305.00
|
|
|
Service Code
|
CPT 77085
|
| Hospital Charge Code |
7820763
|
|
Hospital Revenue Code
|
320
|
| 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: 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: Partners Health Alliance Commercial |
$228.75
|
| Rate for Payer: United Healthcare Commercial |
$274.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$179.95
|
| Rate for Payer: Wellmark IA HMO |
$245.52
|
| Rate for Payer: Wellmark IA PPO |
$270.07
|
|
|
BD Bone Density DEXA App Skeleton
|
Facility
OP
|
$355.00
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
1167837
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$177.43 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Aetna of IA Commercial |
$319.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$319.50
|
| Rate for Payer: Aetna of IA Medicare |
$202.35
|
| Rate for Payer: Amerigroup Medicaid |
$179.17
|
| Rate for Payer: Amerigroup Medicare |
$179.28
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$266.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$177.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$177.43
|
| Rate for Payer: Medical Associates Commercial |
$266.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$177.50
|
| Rate for Payer: Midlands Choice Commercial |
$248.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$180.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$266.25
|
| Rate for Payer: United Healthcare Commercial |
$319.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$209.45
|
| Rate for Payer: Wellmark IA HMO |
$245.52
|
| Rate for Payer: Wellmark IA PPO |
$270.07
|
|
|
BD Bone Density DEXA App Skeleton
|
Facility
IP
|
$355.00
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
1167837
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Aetna of IA Commercial |
$319.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$319.50
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$266.25
|
| Rate for Payer: Medical Associates Commercial |
$266.25
|
| Rate for Payer: Midlands Choice Commercial |
$248.50
|
| Rate for Payer: United Healthcare Commercial |
$319.50
|
|
|
BD Bone Density DEXA App Skeleton Charge
|
Facility
OP
|
$355.00
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
8431525
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$177.43 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Aetna of IA Commercial |
$319.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$319.50
|
| Rate for Payer: Aetna of IA Medicare |
$202.35
|
| Rate for Payer: Amerigroup Medicaid |
$179.17
|
| Rate for Payer: Amerigroup Medicare |
$179.28
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$266.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$177.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$177.43
|
| Rate for Payer: Medical Associates Commercial |
$266.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$177.50
|
| Rate for Payer: Midlands Choice Commercial |
$248.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$180.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$266.25
|
| Rate for Payer: United Healthcare Commercial |
$319.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$209.45
|
| Rate for Payer: Wellmark IA HMO |
$245.52
|
| Rate for Payer: Wellmark IA PPO |
$270.07
|
|
|
BD Bone Density DEXA App Skeleton Charge
|
Facility
IP
|
$355.00
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
8431525
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Aetna of IA Commercial |
$319.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$319.50
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$266.25
|
| Rate for Payer: Medical Associates Commercial |
$266.25
|
| Rate for Payer: Midlands Choice Commercial |
$248.50
|
| Rate for Payer: United Healthcare Commercial |
$319.50
|
|
|
BD Bone Density DEXA Axial Skeleton
|
Facility
IP
|
$355.00
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
1167839
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Aetna of IA Commercial |
$319.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$319.50
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$266.25
|
| Rate for Payer: Medical Associates Commercial |
$266.25
|
| Rate for Payer: Midlands Choice Commercial |
$248.50
|
| Rate for Payer: United Healthcare Commercial |
$319.50
|
|
|
BD Bone Density DEXA Axial Skeleton
|
Facility
OP
|
$355.00
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
1167839
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$177.43 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Aetna of IA Commercial |
$319.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$319.50
|
| Rate for Payer: Aetna of IA Medicare |
$202.35
|
| Rate for Payer: Amerigroup Medicaid |
$179.17
|
| Rate for Payer: Amerigroup Medicare |
$179.28
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$266.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$177.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$177.43
|
| Rate for Payer: Medical Associates Commercial |
$266.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$177.50
|
| Rate for Payer: Midlands Choice Commercial |
$248.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$180.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$266.25
|
| Rate for Payer: United Healthcare Commercial |
$319.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$209.45
|
| Rate for Payer: Wellmark IA HMO |
$245.52
|
| Rate for Payer: Wellmark IA PPO |
$270.07
|
|
|
BD Bone Density DEXA Axial Skeleton Charge
|
Facility
IP
|
$355.00
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
8431526
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Aetna of IA Commercial |
$319.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$319.50
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$266.25
|
| Rate for Payer: Medical Associates Commercial |
$266.25
|
| Rate for Payer: Midlands Choice Commercial |
$248.50
|
| Rate for Payer: United Healthcare Commercial |
$319.50
|
|
|
BD Bone Density DEXA Axial Skeleton Charge
|
Facility
OP
|
$355.00
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
8431526
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$177.43 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Aetna of IA Commercial |
$319.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$319.50
|
| Rate for Payer: Aetna of IA Medicare |
$202.35
|
| Rate for Payer: Amerigroup Medicaid |
$179.17
|
| Rate for Payer: Amerigroup Medicare |
$179.28
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$266.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$177.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$177.43
|
| Rate for Payer: Medical Associates Commercial |
$266.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$177.50
|
| Rate for Payer: Midlands Choice Commercial |
$248.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$180.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$266.25
|
| Rate for Payer: United Healthcare Commercial |
$319.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$209.45
|
| Rate for Payer: Wellmark IA HMO |
$245.52
|
| Rate for Payer: Wellmark IA PPO |
$270.07
|
|
|
BD Bone Density Vetebral Fracture
|
Facility
IP
|
$122.00
|
|
|
Service Code
|
CPT 77086
|
| Hospital Charge Code |
1167841
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Aetna of IA Commercial |
$109.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$109.80
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$91.50
|
| Rate for Payer: Medical Associates Commercial |
$91.50
|
| Rate for Payer: Midlands Choice Commercial |
$85.40
|
| Rate for Payer: United Healthcare Commercial |
$109.80
|
|
|
BD Bone Density Vetebral Fracture
|
Facility
OP
|
$122.00
|
|
|
Service Code
|
CPT 77086
|
| Hospital Charge Code |
1167841
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$60.98 |
| Max. Negotiated Rate |
$270.07 |
| Rate for Payer: Aetna of IA Commercial |
$109.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$109.80
|
| Rate for Payer: Aetna of IA Medicare |
$69.54
|
| Rate for Payer: Amerigroup Medicaid |
$61.57
|
| Rate for Payer: Amerigroup Medicare |
$61.61
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$91.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$61.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$60.98
|
| Rate for Payer: Medical Associates Commercial |
$91.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$61.00
|
| Rate for Payer: Midlands Choice Commercial |
$85.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$61.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$91.50
|
| Rate for Payer: United Healthcare Commercial |
$109.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$71.98
|
| Rate for Payer: Wellmark IA HMO |
$245.52
|
| Rate for Payer: Wellmark IA PPO |
$270.07
|
|
|
BEHAV CHNG SMOKING >=11 MIN
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
4770837
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of IA Commercial |
$27.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.00
|
| Rate for Payer: Aetna of IA Medicare |
$17.10
|
| Rate for Payer: Amerigroup Medicaid |
$15.14
|
| Rate for Payer: Amerigroup Medicare |
$15.15
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.99
|
| Rate for Payer: Medical Associates Commercial |
$22.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.00
|
| Rate for Payer: Midlands Choice Commercial |
$21.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.50
|
| Rate for Payer: United Healthcare Commercial |
$27.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$17.70
|
| Rate for Payer: Wellmark IA HMO |
$17.98
|
| Rate for Payer: Wellmark IA PPO |
$19.78
|
|
|
BEHAV CHNG SMOKING >=11 MIN
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
4770837
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of IA Commercial |
$27.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.50
|
| Rate for Payer: Medical Associates Commercial |
$22.50
|
| Rate for Payer: Midlands Choice Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$27.00
|
|
