|
balsam Peru-castor oil topical 87 mg-788 mg/g Oin
|
Facility
|
IP
|
$9.22
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23072734
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$8.30 |
| Rate for Payer: Aetna of IA Commercial |
$8.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8.30
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6.92
|
| Rate for Payer: Medical Associates Commercial |
$6.92
|
| Rate for Payer: Midlands Choice Commercial |
$6.46
|
| Rate for Payer: United Healthcare Commercial |
$8.30
|
|
|
balsam Peru-castor oil topical 87 mg-788 mg/g Oin
|
Facility
|
OP
|
$9.22
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23072734
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$8.30 |
| Rate for Payer: Aetna of IA Commercial |
$8.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8.30
|
| Rate for Payer: Aetna of IA Medicare |
$5.26
|
| Rate for Payer: Amerigroup Medicaid |
$5.32
|
| Rate for Payer: Amerigroup Medicare |
$4.19
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6.92
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5.27
|
| Rate for Payer: Medical Associates Commercial |
$6.92
|
| Rate for Payer: Medical Associates Managed Medicare |
$4.15
|
| Rate for Payer: Midlands Choice Commercial |
$6.46
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$4.77
|
| Rate for Payer: United Healthcare Commercial |
$8.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$5.44
|
|
|
bamlanivimab
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
CPT M0239
|
| Hospital Charge Code |
8814037
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$260.55 |
| 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 |
$333.97
|
| Rate for Payer: Amerigroup Medicare |
$263.16
|
| 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 |
$260.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$330.72
|
| Rate for Payer: Medical Associates Commercial |
$434.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$260.55
|
| Rate for Payer: Midlands Choice Commercial |
$405.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$335.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$299.63
|
| 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: 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
|
HCPCS M0239
|
| Hospital Charge Code |
8819966
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$260.55 |
| 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 |
$333.97
|
| Rate for Payer: Amerigroup Medicare |
$263.16
|
| 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 |
$260.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$330.72
|
| Rate for Payer: Medical Associates Commercial |
$434.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$260.55
|
| Rate for Payer: Midlands Choice Commercial |
$405.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$335.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$299.63
|
| Rate for Payer: United Healthcare Commercial |
$521.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$341.61
|
|
|
Bamlanivimab Infusion
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
HCPCS 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
|
|
|
BARD PERMESH LARGE
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8999689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$770.00 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Aetna of IA Commercial |
$990.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$990.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$825.00
|
| Rate for Payer: Medical Associates Commercial |
$825.00
|
| Rate for Payer: Midlands Choice Commercial |
$770.00
|
| Rate for Payer: United Healthcare Commercial |
$990.00
|
|
|
BARD PERMESH LARGE
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8999689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$495.00 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Aetna of IA Commercial |
$990.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$990.00
|
| Rate for Payer: Aetna of IA Medicare |
$627.00
|
| Rate for Payer: Amerigroup Medicaid |
$634.48
|
| Rate for Payer: Amerigroup Medicare |
$499.95
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$825.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$495.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$628.32
|
| Rate for Payer: Medical Associates Commercial |
$825.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$495.00
|
| Rate for Payer: Midlands Choice Commercial |
$770.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$637.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$569.25
|
| Rate for Payer: United Healthcare Commercial |
$990.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$649.00
|
|
|
BARD SOFT MESH 3X6
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
8026288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.45 |
| 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 |
$46.72
|
| Rate for Payer: Amerigroup Medicare |
$36.81
|
| 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 |
$36.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$46.27
|
| Rate for Payer: Medical Associates Commercial |
$60.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.45
|
| Rate for Payer: Midlands Choice Commercial |
$56.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$46.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$41.92
|
| 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
|
HCPCS 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
|
HCPCS 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
|
HCPCS C1781
|
| Hospital Charge Code |
8026132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.85 |
| 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 |
$76.71
|
| Rate for Payer: Amerigroup Medicare |
$60.45
|
| 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 |
$59.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$75.97
|
| Rate for Payer: Medical Associates Commercial |
$99.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.85
|
| Rate for Payer: Midlands Choice Commercial |
$93.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$77.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$68.83
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$78.47
|
|
|
BASIC METABOLIC PROFILE
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
633628
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.97 |
| 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 |
$81.33
|
| Rate for Payer: Amerigroup Medicare |
$64.08
|
| 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 |
$63.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.54
|
| Rate for Payer: Medical Associates Commercial |
$105.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$63.45
|
| Rate for Payer: Midlands Choice Commercial |
$98.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$72.97
|
| Rate for Payer: United Healthcare Commercial |
$126.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$83.19
|
| Rate for Payer: Wellmark IA HMO WHPI |
$60.97
|
| Rate for Payer: Wellmark IA PPO |
$67.17
|
|
|
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
|
OP
|
$77.00
|
|
| Hospital Charge Code |
8047045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.65 |
| 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 |
$44.41
|
| Rate for Payer: Amerigroup Medicare |
$35.00
|
| 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 |
$34.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.98
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.65
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.85
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.43
|
|
|
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
|
|
|
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 |
$137.25 |
| 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 |
$175.92
|
| Rate for Payer: Amerigroup Medicare |
$138.62
|
| 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 |
$137.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$174.22
|
| Rate for Payer: Medical Associates Commercial |
$228.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$137.25
|
| Rate for Payer: Midlands Choice Commercial |
$213.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$176.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$157.84
|
| Rate for Payer: United Healthcare Commercial |
$274.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$179.95
|
| Rate for Payer: Wellmark IA HMO WHPI |
$221.21
|
| Rate for Payer: Wellmark IA PPO |
$243.67
|
|
|
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 |
$159.75 |
| 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 |
$204.76
|
| Rate for Payer: Amerigroup Medicare |
$161.35
|
| 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 |
$159.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.78
|
| Rate for Payer: Medical Associates Commercial |
$266.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$159.75
|
| Rate for Payer: Midlands Choice Commercial |
$248.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$205.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$183.71
|
| Rate for Payer: United Healthcare Commercial |
$319.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$209.45
|
| Rate for Payer: Wellmark IA HMO WHPI |
$221.21
|
| Rate for Payer: Wellmark IA PPO |
$243.67
|
|
|
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
|
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 App Skeleton Charge
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
8431525
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.75 |
| 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 |
$204.76
|
| Rate for Payer: Amerigroup Medicare |
$161.35
|
| 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 |
$159.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.78
|
| Rate for Payer: Medical Associates Commercial |
$266.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$159.75
|
| Rate for Payer: Midlands Choice Commercial |
$248.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$205.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$183.71
|
| Rate for Payer: United Healthcare Commercial |
$319.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$209.45
|
| Rate for Payer: Wellmark IA HMO WHPI |
$221.21
|
| Rate for Payer: Wellmark IA PPO |
$243.67
|
|
|
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 |
$159.75 |
| 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 |
$204.76
|
| Rate for Payer: Amerigroup Medicare |
$161.35
|
| 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 |
$159.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.78
|
| Rate for Payer: Medical Associates Commercial |
$266.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$159.75
|
| Rate for Payer: Midlands Choice Commercial |
$248.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$205.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$183.71
|
| Rate for Payer: United Healthcare Commercial |
$319.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$209.45
|
| Rate for Payer: Wellmark IA HMO WHPI |
$221.21
|
| Rate for Payer: Wellmark IA PPO |
$243.67
|
|
|
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 |
$159.75 |
| 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 |
$204.76
|
| Rate for Payer: Amerigroup Medicare |
$161.35
|
| 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 |
$159.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.78
|
| Rate for Payer: Medical Associates Commercial |
$266.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$159.75
|
| Rate for Payer: Midlands Choice Commercial |
$248.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$205.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$183.71
|
| Rate for Payer: United Healthcare Commercial |
$319.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$209.45
|
| Rate for Payer: Wellmark IA HMO WHPI |
$221.21
|
| Rate for Payer: Wellmark IA PPO |
$243.67
|
|
