|
ascorbic acid 500 mg/mL 50ml SDV Sol [VDMC]
|
Facility
|
OP
|
$1,015.60
|
|
|
Service Code
|
NDC 67157-0101-50
|
| Hospital Charge Code |
22372240
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$457.02 |
| Max. Negotiated Rate |
$914.04 |
| Rate for Payer: Aetna of IA Commercial |
$914.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$914.04
|
| Rate for Payer: Aetna of IA Medicare |
$578.89
|
| Rate for Payer: Amerigroup Medicaid |
$585.80
|
| Rate for Payer: Amerigroup Medicare |
$461.59
|
| Rate for Payer: Cash Price |
$812.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$761.70
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$457.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$580.11
|
| Rate for Payer: Medical Associates Commercial |
$761.70
|
| Rate for Payer: Medical Associates Managed Medicare |
$457.02
|
| Rate for Payer: Midlands Choice Commercial |
$710.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$588.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$525.57
|
| Rate for Payer: United Healthcare Commercial |
$914.04
|
| Rate for Payer: United Healthcare Managed Medicare |
$599.20
|
|
|
ascorbic acid 500 mg Tab [VDMC]
|
Facility
|
IP
|
$1.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10367689
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of IA Commercial |
$1.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.00
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.83
|
| Rate for Payer: Medical Associates Commercial |
$0.83
|
| Rate for Payer: Midlands Choice Commercial |
$0.77
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
|
|
ascorbic acid 500 mg Tab [VDMC]
|
Facility
|
OP
|
$1.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10367689
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of IA Commercial |
$1.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.00
|
| Rate for Payer: Aetna of IA Medicare |
$0.63
|
| Rate for Payer: Amerigroup Medicaid |
$0.64
|
| Rate for Payer: Amerigroup Medicare |
$0.50
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.83
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.63
|
| Rate for Payer: Medical Associates Commercial |
$0.83
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.50
|
| Rate for Payer: Midlands Choice Commercial |
$0.77
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.57
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.65
|
|
|
Aspergillus Galactomannan Antigen DMCL
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
8037500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.03 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna of IA Commercial |
$88.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.20
|
| Rate for Payer: Aetna of IA Medicare |
$55.86
|
| Rate for Payer: Amerigroup Medicaid |
$56.53
|
| Rate for Payer: Amerigroup Medicare |
$44.54
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$44.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$55.98
|
| Rate for Payer: Medical Associates Commercial |
$73.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.10
|
| Rate for Payer: Midlands Choice Commercial |
$68.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$56.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.72
|
| Rate for Payer: United Healthcare Commercial |
$88.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$57.82
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
|
Aspergillus Galactomannan Antigen DMCL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
8037500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna of IA Commercial |
$88.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.20
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.50
|
| Rate for Payer: Medical Associates Commercial |
$73.50
|
| Rate for Payer: Midlands Choice Commercial |
$68.60
|
| Rate for Payer: United Healthcare Commercial |
$88.20
|
|
|
ASPIRATE/INJ GANGLION CYST
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
7982750
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$50.11 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Amerigroup Medicaid |
$50.60
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$50.11
|
| Rate for Payer: Medical Associates Commercial |
$107.25
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$107.25
|
| Rate for Payer: United Healthcare Commercial |
$93.42
|
| Rate for Payer: Wellmark IA HMO WHPI |
$123.30
|
| Rate for Payer: Wellmark IA PPO |
$145.00
|
|
|
ASPIRATE/INJ GANGLION CYST
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
7983048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna of IA Commercial |
$256.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$256.50
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$213.75
|
| Rate for Payer: Medical Associates Commercial |
$213.75
|
| Rate for Payer: Midlands Choice Commercial |
$199.50
|
| Rate for Payer: United Healthcare Commercial |
$256.50
|
|
|
ASPIRATE/INJ GANGLION CYST
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
7983048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.25 |
| Max. Negotiated Rate |
$782.56 |
| Rate for Payer: Aetna of IA Commercial |
$256.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$256.50
|
| Rate for Payer: Aetna of IA Medicare |
$162.45
|
| Rate for Payer: Amerigroup Medicaid |
$164.39
|
| Rate for Payer: Amerigroup Medicare |
$129.53
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$213.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$128.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$162.79
|
| Rate for Payer: Medical Associates Commercial |
$213.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$128.25
|
| Rate for Payer: Midlands Choice Commercial |
$199.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$165.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$147.49
|
| Rate for Payer: United Healthcare Commercial |
$256.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$168.15
|
| Rate for Payer: Wellmark IA HMO WHPI |
$710.42
|
| Rate for Payer: Wellmark IA PPO |
$782.56
|
|
|
ASPIRATE PLEURA W/ IMAGING
|
Professional
|
Both
|
$961.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
7982777
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$470.40 |
| Max. Negotiated Rate |
$720.75 |
| Rate for Payer: Amerigroup Medicaid |
$577.92
|
| Rate for Payer: Cash Price |
$768.80
|
| Rate for Payer: Cash Price |
$768.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$572.31
|
| Rate for Payer: Medical Associates Commercial |
$720.75
|
| Rate for Payer: Midlands Choice Commercial |
$672.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$575.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$720.75
|
| Rate for Payer: United Healthcare Commercial |
$470.40
|
| Rate for Payer: Wellmark IA HMO WHPI |
$588.10
|
| Rate for Payer: Wellmark IA PPO |
$691.90
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
IP
|
$626.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
4864923
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$438.20 |
| Max. Negotiated Rate |
$563.40 |
| Rate for Payer: Aetna of IA Commercial |
$563.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$563.40
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$469.50
|
| Rate for Payer: Medical Associates Commercial |
$469.50
|
| Rate for Payer: Midlands Choice Commercial |
$438.20
|
| Rate for Payer: United Healthcare Commercial |
$563.40
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
OP
|
$626.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
4864923
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$281.70 |
| Max. Negotiated Rate |
$1,640.88 |
| Rate for Payer: Aetna of IA Commercial |
$563.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$563.40
|
| Rate for Payer: Aetna of IA Medicare |
$356.82
|
| Rate for Payer: Amerigroup Medicaid |
$361.08
|
| Rate for Payer: Amerigroup Medicare |
$284.52
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$469.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$281.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$357.57
|
| Rate for Payer: Medical Associates Commercial |
$469.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$281.70
|
| Rate for Payer: Midlands Choice Commercial |
$438.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$362.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$323.96
|
| Rate for Payer: United Healthcare Commercial |
$563.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$369.34
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,489.61
|
| Rate for Payer: Wellmark IA PPO |
$1,640.88
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
7982778
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$331.80 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Amerigroup Medicaid |
$501.02
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$496.16
|
| Rate for Payer: Medical Associates Commercial |
$355.50
|
| Rate for Payer: Midlands Choice Commercial |
$331.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$498.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$355.50
|
| Rate for Payer: United Healthcare Commercial |
$336.00
|
| Rate for Payer: Wellmark IA HMO WHPI |
$440.90
|
| Rate for Payer: Wellmark IA PPO |
$518.70
|
|
|
ASPIRATION OF HYDROCELE CHARGE
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
8068938
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$89.56 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Amerigroup Medicaid |
$90.43
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.56
|
| Rate for Payer: Medical Associates Commercial |
$208.50
|
| Rate for Payer: Midlands Choice Commercial |
$194.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$90.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$208.50
|
| Rate for Payer: United Healthcare Commercial |
$180.21
|
| Rate for Payer: Wellmark IA HMO WHPI |
$227.70
|
| Rate for Payer: Wellmark IA PPO |
$267.90
|
|
|
Aspirin 300 mg Supp [VDMC]
|
Facility
|
OP
|
$6.84
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
22434372
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna of IA Commercial |
$6.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.15
|
| Rate for Payer: Aetna of IA Medicare |
$3.90
|
| Rate for Payer: Amerigroup Medicaid |
$3.94
|
| Rate for Payer: Amerigroup Medicare |
$3.11
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.13
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.91
|
| Rate for Payer: Medical Associates Commercial |
$5.13
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.08
|
| Rate for Payer: Midlands Choice Commercial |
$4.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.54
|
| Rate for Payer: United Healthcare Commercial |
$6.15
|
| Rate for Payer: United Healthcare Managed Medicare |
$4.03
|
|
|
Aspirin 300 mg Supp [VDMC]
|
Facility
|
IP
|
$6.84
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
22434372
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna of IA Commercial |
$6.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.15
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.13
|
| Rate for Payer: Medical Associates Commercial |
$5.13
|
| Rate for Payer: Midlands Choice Commercial |
$4.79
|
| Rate for Payer: United Healthcare Commercial |
$6.15
|
|
|
aspirin-dipyridamole 25 mg-200 mg ER Cap [VDMC]
|
Facility
|
OP
|
$3.68
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10368034
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Aetna of IA Commercial |
$3.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.31
|
| Rate for Payer: Aetna of IA Medicare |
$2.10
|
| Rate for Payer: Amerigroup Medicaid |
$2.12
|
| Rate for Payer: Amerigroup Medicare |
$1.67
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.76
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.10
|
| Rate for Payer: Medical Associates Commercial |
$2.76
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.66
|
| Rate for Payer: Midlands Choice Commercial |
$2.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.13
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.90
|
| Rate for Payer: United Healthcare Commercial |
$3.31
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.17
|
|
|
aspirin-dipyridamole 25 mg-200 mg ER Cap [VDMC]
|
Facility
|
IP
|
$3.68
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10368034
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Aetna of IA Commercial |
$3.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.31
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.76
|
| Rate for Payer: Medical Associates Commercial |
$2.76
|
| Rate for Payer: Midlands Choice Commercial |
$2.57
|
| Rate for Payer: United Healthcare Commercial |
$3.31
|
|
|
ASSESSMENT OF APHASIA HR
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 96105 GN
|
| Hospital Charge Code |
1373853
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: Aetna of IA Commercial |
$321.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$321.30
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$267.75
|
| Rate for Payer: Medical Associates Commercial |
$267.75
|
| Rate for Payer: Midlands Choice Commercial |
$249.90
|
| Rate for Payer: United Healthcare Commercial |
$321.30
|
|
|
ASSESSMENT OF APHASIA HR
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 96105 GN
|
| Hospital Charge Code |
1373853
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$160.65 |
| Max. Negotiated Rate |
$503.75 |
| Rate for Payer: Aetna of IA Commercial |
$321.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$321.30
|
| Rate for Payer: Aetna of IA Medicare |
$203.49
|
| Rate for Payer: Amerigroup Medicaid |
$205.92
|
| Rate for Payer: Amerigroup Medicare |
$162.26
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$267.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$160.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$203.92
|
| Rate for Payer: Medical Associates Commercial |
$267.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$160.65
|
| Rate for Payer: Midlands Choice Commercial |
$249.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$206.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$184.75
|
| Rate for Payer: United Healthcare Commercial |
$321.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$210.63
|
| Rate for Payer: Wellmark IA HMO WHPI |
$457.31
|
| Rate for Payer: Wellmark IA PPO |
$503.75
|
|
|
AST (SGOT)
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
633633
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of IA Commercial |
$44.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$44.10
|
| Rate for Payer: Aetna of IA Medicare |
$27.93
|
| Rate for Payer: Amerigroup Medicaid |
$28.26
|
| Rate for Payer: Amerigroup Medicare |
$22.27
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.99
|
| Rate for Payer: Medical Associates Commercial |
$36.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.05
|
| Rate for Payer: Midlands Choice Commercial |
$34.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$25.36
|
| Rate for Payer: United Healthcare Commercial |
$44.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$28.91
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
AST (SGOT)
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
633633
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of IA Commercial |
$44.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$44.10
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.75
|
| Rate for Payer: Medical Associates Commercial |
$36.75
|
| Rate for Payer: Midlands Choice Commercial |
$34.30
|
| Rate for Payer: United Healthcare Commercial |
$44.10
|
|
|
atenolol 50 mg Tab [VDMC]
|
Facility
|
IP
|
$1.29
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10368172
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of IA Commercial |
$1.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.16
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.97
|
| Rate for Payer: Medical Associates Commercial |
$0.97
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.16
|
|
|
atenolol 50 mg Tab [VDMC]
|
Facility
|
OP
|
$1.29
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10368172
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of IA Commercial |
$1.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.16
|
| Rate for Payer: Aetna of IA Medicare |
$0.74
|
| Rate for Payer: Amerigroup Medicaid |
$0.74
|
| Rate for Payer: Amerigroup Medicare |
$0.59
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.74
|
| Rate for Payer: Medical Associates Commercial |
$0.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.58
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.67
|
| Rate for Payer: United Healthcare Commercial |
$1.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.76
|
|
|
ATHEROSCLEROSIS WITH MCC
|
Facility
|
IP
|
$8,010.20
|
|
|
Service Code
|
MSDRG 302
|
| Min. Negotiated Rate |
$7,894.11 |
| Max. Negotiated Rate |
$8,010.20 |
| Rate for Payer: Amerigroup Medicaid |
$7,971.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,894.11
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,010.20
|
|
|
ATHEROSCLEROSIS WITHOUT MCC
|
Facility
|
IP
|
$6,930.39
|
|
|
Service Code
|
MSDRG 303
|
| Min. Negotiated Rate |
$6,829.94 |
| Max. Negotiated Rate |
$6,930.39 |
| Rate for Payer: Amerigroup Medicaid |
$6,896.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,829.94
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,930.39
|
|
