|
BETA HCG
|
Facility
IP
|
$143.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
4017122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Aetna of IA Commercial |
$128.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$128.70
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$107.25
|
| Rate for Payer: Medical Associates Commercial |
$107.25
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: United Healthcare Commercial |
$128.70
|
|
|
BETA HCG
|
Facility
OP
|
$143.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
4017122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Aetna of IA Commercial |
$128.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$128.70
|
| Rate for Payer: Aetna of IA Medicare |
$81.51
|
| Rate for Payer: Amerigroup Medicaid |
$72.17
|
| Rate for Payer: Amerigroup Medicare |
$72.22
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$107.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$71.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.47
|
| Rate for Payer: Medical Associates Commercial |
$107.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.50
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$72.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$107.25
|
| Rate for Payer: United Healthcare Commercial |
$128.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.37
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Beta-hydroxybutyric Acid DMCL
|
Facility
OP
|
$160.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
8804480
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna of IA Commercial |
$144.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.00
|
| Rate for Payer: Aetna of IA Medicare |
$91.20
|
| Rate for Payer: Amerigroup Medicaid |
$80.75
|
| Rate for Payer: Amerigroup Medicare |
$80.80
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$80.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.97
|
| Rate for Payer: Medical Associates Commercial |
$120.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.00
|
| Rate for Payer: Midlands Choice Commercial |
$112.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$120.00
|
| Rate for Payer: United Healthcare Commercial |
$144.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.40
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Beta-hydroxybutyric Acid DMCL
|
Facility
IP
|
$160.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
8804480
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna of IA Commercial |
$144.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.00
|
| Rate for Payer: Medical Associates Commercial |
$120.00
|
| Rate for Payer: Midlands Choice Commercial |
$112.00
|
| Rate for Payer: United Healthcare Commercial |
$144.00
|
|
|
betamethasone acetate-betamethasone sodium phosphate 3 mg-3 mg Inj Susp 5 mL MDV
|
Facility
IP
|
$148.80
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
43701774
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.16 |
| Max. Negotiated Rate |
$133.92 |
| Rate for Payer: Aetna of IA Commercial |
$133.92
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$133.92
|
| Rate for Payer: Cash Price |
$119.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.60
|
| Rate for Payer: Medical Associates Commercial |
$111.60
|
| Rate for Payer: Midlands Choice Commercial |
$104.16
|
| Rate for Payer: United Healthcare Commercial |
$133.92
|
|
|
betamethasone acetate-betamethasone sodium phosphate 3 mg-3 mg Inj Susp 5 mL MDV
|
Facility
OP
|
$148.80
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
43701774
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.37 |
| Max. Negotiated Rate |
$133.92 |
| Rate for Payer: Aetna of IA Commercial |
$133.92
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$133.92
|
| Rate for Payer: Aetna of IA Medicare |
$84.82
|
| Rate for Payer: Amerigroup Medicaid |
$75.10
|
| Rate for Payer: Amerigroup Medicare |
$75.14
|
| Rate for Payer: Cash Price |
$119.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$74.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.37
|
| Rate for Payer: Medical Associates Commercial |
$111.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$74.40
|
| Rate for Payer: Midlands Choice Commercial |
$104.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.60
|
| Rate for Payer: United Healthcare Commercial |
$133.92
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.79
|
|
|
betamethasone-clotrimazole topical 0.05%-1% Cre 45gm
|
Facility
IP
|
$45.64
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43750595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$41.08 |
| Rate for Payer: Aetna of IA Commercial |
$41.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.08
|
| Rate for Payer: Cash Price |
$36.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.23
|
| Rate for Payer: Medical Associates Commercial |
$34.23
|
| Rate for Payer: Midlands Choice Commercial |
$31.95
|
| Rate for Payer: United Healthcare Commercial |
$41.08
|
|
|
betamethasone-clotrimazole topical 0.05%-1% Cre 45gm
|
Facility
OP
|
$45.64
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43750595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$41.08 |
| Rate for Payer: Aetna of IA Commercial |
$41.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.08
|
| Rate for Payer: Aetna of IA Medicare |
$26.01
|
| Rate for Payer: Amerigroup Medicaid |
$23.03
|
| Rate for Payer: Amerigroup Medicare |
$23.05
|
| Rate for Payer: Cash Price |
$36.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.23
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.81
|
| Rate for Payer: Medical Associates Commercial |
$34.23
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.82
|
| Rate for Payer: Midlands Choice Commercial |
$31.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.23
|
| Rate for Payer: United Healthcare Commercial |
$41.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.93
|
|
|
bevacizumab 25 mg/mL Sol 16 ml SDV
|
Facility
IP
|
$6,475.52
|
|
|
Service Code
|
CPT J9035
|
| Hospital Charge Code |
43707612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,532.86 |
| Max. Negotiated Rate |
$5,827.97 |
| Rate for Payer: Aetna of IA Commercial |
$5,827.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,827.97
|
| Rate for Payer: Cash Price |
$5,180.42
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,856.64
|
| Rate for Payer: Medical Associates Commercial |
$4,856.64
|
| Rate for Payer: Midlands Choice Commercial |
$4,532.86
|
| Rate for Payer: United Healthcare Commercial |
$5,827.97
|
|
|
bevacizumab 25 mg/mL Sol 16 ml SDV
|
Facility
OP
|
$6,475.52
|
|
|
Service Code
|
CPT J9035
|
| Hospital Charge Code |
43707612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,236.46 |
| Max. Negotiated Rate |
$5,827.97 |
| Rate for Payer: Aetna of IA Commercial |
$5,827.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,827.97
|
| Rate for Payer: Aetna of IA Medicare |
$3,691.05
|
| Rate for Payer: Amerigroup Medicaid |
$3,268.19
|
| Rate for Payer: Amerigroup Medicare |
$3,270.14
|
| Rate for Payer: Cash Price |
$5,180.42
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,856.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,237.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,236.46
|
| Rate for Payer: Medical Associates Commercial |
$4,856.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,237.76
|
| Rate for Payer: Midlands Choice Commercial |
$4,532.86
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,286.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,856.64
|
| Rate for Payer: United Healthcare Commercial |
$5,827.97
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,820.56
|
|
|
bevacizumab 25 mg/mL Sol 4 ml SDV
|
Facility
OP
|
$1,693.88
|
|
|
Service Code
|
CPT J9035
|
| Hospital Charge Code |
43700129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$846.60 |
| Max. Negotiated Rate |
$1,524.49 |
| Rate for Payer: Aetna of IA Commercial |
$1,524.49
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,524.49
|
| Rate for Payer: Aetna of IA Medicare |
$965.51
|
| Rate for Payer: Amerigroup Medicaid |
$854.90
|
| Rate for Payer: Amerigroup Medicare |
$855.41
|
| Rate for Payer: Cash Price |
$1,355.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,270.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$846.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$846.60
|
| Rate for Payer: Medical Associates Commercial |
$1,270.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$846.94
|
| Rate for Payer: Midlands Choice Commercial |
$1,185.72
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$859.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,270.41
|
| Rate for Payer: United Healthcare Commercial |
$1,524.49
|
| Rate for Payer: United Healthcare Managed Medicare |
$999.39
|
|
|
bevacizumab 25 mg/mL Sol 4 ml SDV
|
Facility
IP
|
$1,693.88
|
|
|
Service Code
|
CPT J9035
|
| Hospital Charge Code |
43700129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,185.72 |
| Max. Negotiated Rate |
$1,524.49 |
| Rate for Payer: Aetna of IA Commercial |
$1,524.49
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,524.49
|
| Rate for Payer: Cash Price |
$1,355.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,270.41
|
| Rate for Payer: Medical Associates Commercial |
$1,270.41
|
| Rate for Payer: Midlands Choice Commercial |
$1,185.72
|
| Rate for Payer: United Healthcare Commercial |
$1,524.49
|
|
|
bevacizumab bvzr 100 mg/4 mL SDV
|
Facility
OP
|
$2,134.96
|
|
|
Service Code
|
CPT Q5118
|
| Hospital Charge Code |
43700569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,067.05 |
| Max. Negotiated Rate |
$1,921.46 |
| Rate for Payer: Aetna of IA Commercial |
$1,921.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,921.46
|
| Rate for Payer: Aetna of IA Medicare |
$1,216.93
|
| Rate for Payer: Amerigroup Medicaid |
$1,077.51
|
| Rate for Payer: Amerigroup Medicare |
$1,078.15
|
| Rate for Payer: Cash Price |
$1,707.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,601.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,067.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,067.05
|
| Rate for Payer: Medical Associates Commercial |
$1,601.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,067.48
|
| Rate for Payer: Midlands Choice Commercial |
$1,494.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,083.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,601.22
|
| Rate for Payer: United Healthcare Commercial |
$1,921.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,259.63
|
|
|
bevacizumab bvzr 100 mg/4 mL SDV
|
Facility
IP
|
$2,134.96
|
|
|
Service Code
|
CPT Q5118
|
| Hospital Charge Code |
43700569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,494.47 |
| Max. Negotiated Rate |
$1,921.46 |
| Rate for Payer: Aetna of IA Commercial |
$1,921.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,921.46
|
| Rate for Payer: Cash Price |
$1,707.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,601.22
|
| Rate for Payer: Medical Associates Commercial |
$1,601.22
|
| Rate for Payer: Midlands Choice Commercial |
$1,494.47
|
| Rate for Payer: United Healthcare Commercial |
$1,921.46
|
|
|
bevacizumab bvzr 400 mg/16mL SDV
|
Facility
IP
|
$8,389.88
|
|
|
Service Code
|
CPT Q5118
|
| Hospital Charge Code |
43700524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,872.92 |
| Max. Negotiated Rate |
$7,550.89 |
| Rate for Payer: Aetna of IA Commercial |
$7,550.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,550.89
|
| Rate for Payer: Cash Price |
$6,711.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,292.41
|
| Rate for Payer: Medical Associates Commercial |
$6,292.41
|
| Rate for Payer: Midlands Choice Commercial |
$5,872.92
|
| Rate for Payer: United Healthcare Commercial |
$7,550.89
|
|
|
bevacizumab bvzr 400 mg/16mL SDV
|
Facility
OP
|
$8,389.88
|
|
|
Service Code
|
CPT Q5118
|
| Hospital Charge Code |
43700524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,193.26 |
| Max. Negotiated Rate |
$7,550.89 |
| Rate for Payer: Aetna of IA Commercial |
$7,550.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,550.89
|
| Rate for Payer: Aetna of IA Medicare |
$4,782.23
|
| Rate for Payer: Amerigroup Medicaid |
$4,234.37
|
| Rate for Payer: Amerigroup Medicare |
$4,236.89
|
| Rate for Payer: Cash Price |
$6,711.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,292.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4,194.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,193.26
|
| Rate for Payer: Medical Associates Commercial |
$6,292.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$4,194.94
|
| Rate for Payer: Midlands Choice Commercial |
$5,872.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,257.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,292.41
|
| Rate for Payer: United Healthcare Commercial |
$7,550.89
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,950.03
|
|
|
bicalutamide 50 mg Tab
|
Facility
IP
|
$1.74
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43788914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of IA Commercial |
$1.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.57
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.30
|
| Rate for Payer: Medical Associates Commercial |
$1.30
|
| Rate for Payer: Midlands Choice Commercial |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
|
|
bicalutamide 50 mg Tab
|
Facility
OP
|
$1.74
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43788914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of IA Commercial |
$1.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.57
|
| Rate for Payer: Aetna of IA Medicare |
$0.99
|
| Rate for Payer: Amerigroup Medicaid |
$0.88
|
| Rate for Payer: Amerigroup Medicare |
$0.88
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.30
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.87
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.87
|
| Rate for Payer: Medical Associates Commercial |
$1.30
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.87
|
| Rate for Payer: Midlands Choice Commercial |
$1.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.30
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.03
|
|
|
BIER BLOCK ANESTHESIA
|
Facility
OP
|
$422.00
|
|
| Hospital Charge Code |
8059080
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$210.92 |
| Max. Negotiated Rate |
$379.80 |
| Rate for Payer: Aetna of IA Commercial |
$379.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$379.80
|
| Rate for Payer: Aetna of IA Medicare |
$240.54
|
| Rate for Payer: Amerigroup Medicaid |
$212.98
|
| Rate for Payer: Amerigroup Medicare |
$213.11
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$316.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$211.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$210.92
|
| Rate for Payer: Medical Associates Commercial |
$316.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$211.00
|
| Rate for Payer: Midlands Choice Commercial |
$295.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$214.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$316.50
|
| Rate for Payer: United Healthcare Commercial |
$379.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$248.98
|
|
|
BIER BLOCK ANESTHESIA
|
Facility
IP
|
$422.00
|
|
| Hospital Charge Code |
8059080
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$295.40 |
| Max. Negotiated Rate |
$379.80 |
| Rate for Payer: Aetna of IA Commercial |
$379.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$379.80
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$316.50
|
| Rate for Payer: Medical Associates Commercial |
$316.50
|
| Rate for Payer: Midlands Choice Commercial |
$295.40
|
| Rate for Payer: United Healthcare Commercial |
$379.80
|
|
|
Bilateral or Multiple Major Joint Procedures of Lower Extremity With MCC
|
Facility
IP
|
$59,804.48
|
|
|
Service Code
|
MS-DRG 461
|
| Hospital Charge Code |
281
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$59,804.48 |
| Rate for Payer: Amerigroup Medicaid |
$59,515.57
|
| 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 |
$58,937.75
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$59,804.48
|
|
|
Bilateral or Multiple Major Joint Procedures of Lower Extremity Without MCC
|
Facility
IP
|
$32,470.12
|
|
|
Service Code
|
MS-DRG 462
|
| Hospital Charge Code |
282
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$32,470.12 |
| Rate for Payer: Amerigroup Medicaid |
$32,313.26
|
| 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 |
$31,999.54
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32,470.12
|
|
|
Biliary Tract Procedures Except Only Cholecystectomy With or Without C.D.E. With CC
|
Facility
IP
|
$27,863.88
|
|
|
Service Code
|
MS-DRG 409
|
| Hospital Charge Code |
241
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$27,863.88 |
| Rate for Payer: Amerigroup Medicaid |
$27,729.27
|
| 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 |
$27,460.05
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27,863.88
|
|
|
Biliary Tract Procedures Except Only Cholecystectomy With or Without C.D.E. With MCC
|
Facility
IP
|
$27,863.88
|
|
|
Service Code
|
MS-DRG 408
|
| Hospital Charge Code |
240
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$27,863.88 |
| Rate for Payer: Amerigroup Medicaid |
$27,729.27
|
| 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 |
$27,460.05
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27,863.88
|
|
|
Biliary Tract Procedures Except Only Cholecystectomy With or Without C.D.E. Without CC/MCC
|
Facility
IP
|
$16,403.37
|
|
|
Service Code
|
MS-DRG 410
|
| Hospital Charge Code |
242
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$16,403.37 |
| Rate for Payer: Amerigroup Medicaid |
$16,324.13
|
| 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 |
$16,165.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16,403.37
|
|
