|
Bill UA Auto with Micro
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
7813898
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Aetna of IA Commercial |
$27.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.90
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.25
|
| Rate for Payer: Medical Associates Commercial |
$23.25
|
| Rate for Payer: Midlands Choice Commercial |
$21.70
|
| Rate for Payer: United Healthcare Commercial |
$27.90
|
|
|
Bill Venipuncture
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
7845731
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$45.69 |
| Rate for Payer: Aetna of IA Commercial |
$18.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.90
|
| Rate for Payer: Aetna of IA Medicare |
$11.97
|
| Rate for Payer: Amerigroup Medicaid |
$10.60
|
| Rate for Payer: Amerigroup Medicare |
$10.60
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.50
|
| Rate for Payer: Medical Associates Commercial |
$15.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.50
|
| Rate for Payer: Midlands Choice Commercial |
$14.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.66
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$10.65
|
| Rate for Payer: Oscar Health of IA Commercial |
$15.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$15.75
|
| Rate for Payer: United Healthcare Commercial |
$18.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.39
|
| Rate for Payer: Wellmark IA HMO |
$41.54
|
| Rate for Payer: Wellmark IA PPO |
$45.69
|
|
|
Bill Venipuncture
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
7845731
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna of IA Commercial |
$18.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.90
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.75
|
| Rate for Payer: Medical Associates Commercial |
$15.75
|
| Rate for Payer: Midlands Choice Commercial |
$14.70
|
| Rate for Payer: United Healthcare Commercial |
$18.90
|
|
|
BILL WARM ABSORPTION EA
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
8015155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Aetna of IA Commercial |
$71.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$71.10
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$59.25
|
| Rate for Payer: Medical Associates Commercial |
$59.25
|
| Rate for Payer: Midlands Choice Commercial |
$55.30
|
| Rate for Payer: United Healthcare Commercial |
$71.10
|
|
|
BILL WARM ABSORPTION EA
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
8015155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Aetna of IA Commercial |
$71.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$71.10
|
| Rate for Payer: Aetna of IA Medicare |
$45.03
|
| Rate for Payer: Amerigroup Medicaid |
$39.87
|
| Rate for Payer: Amerigroup Medicare |
$39.90
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$59.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$39.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$39.48
|
| Rate for Payer: Medical Associates Commercial |
$59.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$39.50
|
| Rate for Payer: Midlands Choice Commercial |
$55.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$40.09
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$40.07
|
| Rate for Payer: Oscar Health of IA Commercial |
$59.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$59.25
|
| Rate for Payer: United Healthcare Commercial |
$71.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$46.61
|
| Rate for Payer: Wellmark IA HMO |
$55.18
|
| Rate for Payer: Wellmark IA PPO |
$60.70
|
|
|
Bill WBC Stool Lactoferrin 89055
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
8098793
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.49 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Aetna of IA Medicare |
$23.37
|
| Rate for Payer: Amerigroup Medicaid |
$20.69
|
| Rate for Payer: Amerigroup Medicare |
$20.70
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.49
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.50
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.81
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$20.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$30.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.75
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.19
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
|
Bill WBC Stool Lactoferrin 89055
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
8098793
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
|
|
bimatoprost ophthalmic 0.01% Sol [VDMC]
|
Facility
|
IP
|
$939.44
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433412
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$657.61 |
| Max. Negotiated Rate |
$845.50 |
| Rate for Payer: Aetna of IA Commercial |
$845.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$845.50
|
| Rate for Payer: Cash Price |
$751.55
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$704.58
|
| Rate for Payer: Medical Associates Commercial |
$704.58
|
| Rate for Payer: Midlands Choice Commercial |
$657.61
|
| Rate for Payer: United Healthcare Commercial |
$845.50
|
|
|
bimatoprost ophthalmic 0.01% Sol [VDMC]
|
Facility
|
OP
|
$939.44
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433412
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$469.53 |
| Max. Negotiated Rate |
$845.50 |
| Rate for Payer: Aetna of IA Commercial |
$845.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$845.50
|
| Rate for Payer: Aetna of IA Medicare |
$535.48
|
| Rate for Payer: Amerigroup Medicaid |
$474.14
|
| Rate for Payer: Amerigroup Medicare |
$474.42
|
| Rate for Payer: Cash Price |
$751.55
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$704.58
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$469.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$469.53
|
| Rate for Payer: Medical Associates Commercial |
$704.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$469.72
|
| Rate for Payer: Midlands Choice Commercial |
$657.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$476.77
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$476.48
|
| Rate for Payer: Oscar Health of IA Commercial |
$704.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$704.58
|
| Rate for Payer: United Healthcare Commercial |
$845.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$554.27
|
|
|
BIOCARTILAGE KIT SMALL JOINT
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8749295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.41 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna of IA Commercial |
$396.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$396.90
|
| Rate for Payer: Aetna of IA Medicare |
$251.37
|
| Rate for Payer: Amerigroup Medicaid |
$222.57
|
| Rate for Payer: Amerigroup Medicare |
$222.70
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$330.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$220.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$220.41
|
| Rate for Payer: Medical Associates Commercial |
$330.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$220.50
|
| Rate for Payer: Midlands Choice Commercial |
$308.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$223.81
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$223.68
|
| Rate for Payer: Oscar Health of IA Commercial |
$330.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$330.75
|
| Rate for Payer: United Healthcare Commercial |
$396.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$260.19
|
|
|
BIOCARTILAGE KIT SMALL JOINT
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8749295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$308.70 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna of IA Commercial |
$396.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$396.90
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$330.75
|
| Rate for Payer: Medical Associates Commercial |
$330.75
|
| Rate for Payer: Midlands Choice Commercial |
$308.70
|
| Rate for Payer: United Healthcare Commercial |
$396.90
|
|
|
Biopsies of Musculoskeletal System and Connective Tissue With CC
|
Facility
|
IP
|
$16,239.99
|
|
|
Service Code
|
MS-DRG 478
|
| Hospital Charge Code |
298
|
| Min. Negotiated Rate |
$16,004.63 |
| Max. Negotiated Rate |
$16,239.99 |
| Rate for Payer: Amerigroup Medicaid |
$16,161.53
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16,004.63
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16,239.99
|
|
|
Biopsies of Musculoskeletal System and Connective Tissue With MCC
|
Facility
|
IP
|
$19,529.32
|
|
|
Service Code
|
MS-DRG 477
|
| Hospital Charge Code |
297
|
| Min. Negotiated Rate |
$19,246.29 |
| Max. Negotiated Rate |
$19,529.32 |
| Rate for Payer: Amerigroup Medicaid |
$19,434.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19,246.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19,529.32
|
|
|
Biopsies of Musculoskeletal System and Connective Tissue Without CC/MCC
|
Facility
|
IP
|
$13,183.91
|
|
|
Service Code
|
MS-DRG 479
|
| Hospital Charge Code |
299
|
| Min. Negotiated Rate |
$12,992.84 |
| Max. Negotiated Rate |
$13,183.91 |
| Rate for Payer: Amerigroup Medicaid |
$13,120.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12,992.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,183.91
|
|
|
BIOPSY OR EXCISION OF LYMP NODES OPEN ING NODES
|
Professional
|
Both
|
$1,529.00
|
|
|
Service Code
|
CPT 38531
|
| Hospital Charge Code |
8825535
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$399.20 |
| Max. Negotiated Rate |
$1,070.30 |
| Rate for Payer: Aetna of IA Medicare |
$399.20
|
| Rate for Payer: Amerigroup Medicaid |
$412.77
|
| Rate for Payer: Cash Price |
$1,223.20
|
| Rate for Payer: Cash Price |
$1,223.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$479.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$407.18
|
| Rate for Payer: Medical Associates Commercial |
$758.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$399.20
|
| Rate for Payer: Midlands Choice Commercial |
$1,070.30
|
| Rate for Payer: Oscar Health of IA Commercial |
$690.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$598.80
|
|
|
BIOPSY SKIN LESION
|
Professional
|
Both
|
$342.00
|
|
|
Service Code
|
CPT 11100
|
| Hospital Charge Code |
7982852
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$239.40 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Medical Associates Commercial |
$256.50
|
| Rate for Payer: Midlands Choice Commercial |
$239.40
|
|
|
BIO PUSHLOCK 3.5X19.5
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.86 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna of IA Commercial |
$615.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$615.60
|
| Rate for Payer: Aetna of IA Medicare |
$389.88
|
| Rate for Payer: Amerigroup Medicaid |
$345.21
|
| Rate for Payer: Amerigroup Medicare |
$345.42
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$513.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$342.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$341.86
|
| Rate for Payer: Medical Associates Commercial |
$513.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$342.00
|
| Rate for Payer: Midlands Choice Commercial |
$478.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$347.13
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$346.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$513.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$513.00
|
| Rate for Payer: United Healthcare Commercial |
$615.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$403.56
|
|
|
BIO PUSHLOCK 3.5X19.5
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.80 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna of IA Commercial |
$615.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$615.60
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$513.00
|
| Rate for Payer: Medical Associates Commercial |
$513.00
|
| Rate for Payer: Midlands Choice Commercial |
$478.80
|
| Rate for Payer: United Healthcare Commercial |
$615.60
|
|
|
BIPAP/CPAP INITIAL 21%
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4770829
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$364.70 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Aetna of IA Commercial |
$468.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$468.90
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$390.75
|
| Rate for Payer: Medical Associates Commercial |
$390.75
|
| Rate for Payer: Midlands Choice Commercial |
$364.70
|
| Rate for Payer: United Healthcare Commercial |
$468.90
|
|
|
BIPAP/CPAP INITIAL 21%
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4770826
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$364.70 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Aetna of IA Commercial |
$468.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$468.90
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$390.75
|
| Rate for Payer: Medical Associates Commercial |
$390.75
|
| Rate for Payer: Midlands Choice Commercial |
$364.70
|
| Rate for Payer: United Healthcare Commercial |
$468.90
|
|
|
BIPAP/CPAP INITIAL 21%
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4770826
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$260.40 |
| Max. Negotiated Rate |
$856.59 |
| Rate for Payer: Aetna of IA Commercial |
$468.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$468.90
|
| Rate for Payer: Aetna of IA Medicare |
$296.97
|
| Rate for Payer: Amerigroup Medicaid |
$262.95
|
| Rate for Payer: Amerigroup Medicare |
$263.10
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$390.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$260.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$260.40
|
| Rate for Payer: Medical Associates Commercial |
$390.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$260.50
|
| Rate for Payer: Midlands Choice Commercial |
$364.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$264.41
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$264.25
|
| Rate for Payer: Oscar Health of IA Commercial |
$390.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$390.75
|
| Rate for Payer: United Healthcare Commercial |
$468.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$307.39
|
| Rate for Payer: Wellmark IA HMO |
$778.72
|
| Rate for Payer: Wellmark IA PPO |
$856.59
|
|
|
BIPAP/CPAP INITIAL 21%
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4770829
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$260.40 |
| Max. Negotiated Rate |
$856.59 |
| Rate for Payer: Aetna of IA Commercial |
$468.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$468.90
|
| Rate for Payer: Aetna of IA Medicare |
$296.97
|
| Rate for Payer: Amerigroup Medicaid |
$262.95
|
| Rate for Payer: Amerigroup Medicare |
$263.10
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$390.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$260.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$260.40
|
| Rate for Payer: Medical Associates Commercial |
$390.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$260.50
|
| Rate for Payer: Midlands Choice Commercial |
$364.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$264.41
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$264.25
|
| Rate for Payer: Oscar Health of IA Commercial |
$390.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$390.75
|
| Rate for Payer: United Healthcare Commercial |
$468.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$307.39
|
| Rate for Payer: Wellmark IA HMO |
$778.72
|
| Rate for Payer: Wellmark IA PPO |
$856.59
|
|
|
BIPAP/CPAP SUBSEQUENT 21%
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4770825
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$260.40 |
| Max. Negotiated Rate |
$856.59 |
| Rate for Payer: Aetna of IA Commercial |
$468.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$468.90
|
| Rate for Payer: Aetna of IA Medicare |
$296.97
|
| Rate for Payer: Amerigroup Medicaid |
$262.95
|
| Rate for Payer: Amerigroup Medicare |
$263.10
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$390.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$260.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$260.40
|
| Rate for Payer: Medical Associates Commercial |
$390.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$260.50
|
| Rate for Payer: Midlands Choice Commercial |
$364.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$264.41
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$264.25
|
| Rate for Payer: Oscar Health of IA Commercial |
$390.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$390.75
|
| Rate for Payer: United Healthcare Commercial |
$468.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$307.39
|
| Rate for Payer: Wellmark IA HMO |
$778.72
|
| Rate for Payer: Wellmark IA PPO |
$856.59
|
|
|
BIPAP/CPAP SUBSEQUENT 21%
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4770825
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$364.70 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Aetna of IA Commercial |
$468.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$468.90
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$390.75
|
| Rate for Payer: Medical Associates Commercial |
$390.75
|
| Rate for Payer: Midlands Choice Commercial |
$364.70
|
| Rate for Payer: United Healthcare Commercial |
$468.90
|
|
|
bisacodyl 10 mg Supp [VDMC]
|
Facility
|
OP
|
$4.16
|
|
|
Service Code
|
NDC 00574-7050-50
|
| Hospital Charge Code |
10370498
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna of IA Commercial |
$3.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.74
|
| Rate for Payer: Aetna of IA Medicare |
$2.37
|
| Rate for Payer: Amerigroup Medicaid |
$2.10
|
| Rate for Payer: Amerigroup Medicare |
$2.10
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.08
|
| Rate for Payer: Medical Associates Commercial |
$3.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.08
|
| Rate for Payer: Midlands Choice Commercial |
$2.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.11
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$2.11
|
| Rate for Payer: Oscar Health of IA Commercial |
$3.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.12
|
| Rate for Payer: United Healthcare Commercial |
$3.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.45
|
|
