|
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
|
|
|
bisacodyl 5 mg Oral EC Tab [VDMC]
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10370563
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Aetna of IA Commercial |
$0.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.97
|
| Rate for Payer: Aetna of IA Medicare |
$0.62
|
| Rate for Payer: Amerigroup Medicaid |
$0.55
|
| Rate for Payer: Amerigroup Medicare |
$0.55
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.81
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.54
|
| Rate for Payer: Medical Associates Commercial |
$0.81
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.54
|
| Rate for Payer: Midlands Choice Commercial |
$0.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.55
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.55
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$0.97
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.64
|
|
|
bisacodyl 5 mg Oral EC Tab [VDMC]
|
Facility
|
IP
|
$1.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10370563
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Aetna of IA Commercial |
$0.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.97
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.81
|
| Rate for Payer: Medical Associates Commercial |
$0.81
|
| Rate for Payer: Midlands Choice Commercial |
$0.76
|
| Rate for Payer: United Healthcare Commercial |
$0.97
|
|
|
bismuth subsalicylate 262 mg Chew Tab [VDMC]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10370691
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna of IA Commercial |
$1.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.08
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.90
|
| Rate for Payer: Medical Associates Commercial |
$0.90
|
| Rate for Payer: Midlands Choice Commercial |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.08
|
|
|
bismuth subsalicylate 262 mg Chew Tab [VDMC]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10370691
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna of IA Commercial |
$1.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.08
|
| Rate for Payer: Aetna of IA Medicare |
$0.68
|
| Rate for Payer: Amerigroup Medicaid |
$0.61
|
| Rate for Payer: Amerigroup Medicare |
$0.61
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.90
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.60
|
| Rate for Payer: Medical Associates Commercial |
$0.90
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.60
|
| Rate for Payer: Midlands Choice Commercial |
$0.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.61
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.61
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.71
|
|
|
bisoprolol FUMARATE 5 mg Tab [VDMC]
|
Facility
|
IP
|
$3.49
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10370756
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Aetna of IA Commercial |
$3.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.14
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.62
|
| Rate for Payer: Medical Associates Commercial |
$2.62
|
| Rate for Payer: Midlands Choice Commercial |
$2.44
|
| Rate for Payer: United Healthcare Commercial |
$3.14
|
|
|
bisoprolol FUMARATE 5 mg Tab [VDMC]
|
Facility
|
OP
|
$3.49
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10370756
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Aetna of IA Commercial |
$3.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.14
|
| Rate for Payer: Aetna of IA Medicare |
$1.99
|
| Rate for Payer: Amerigroup Medicaid |
$1.76
|
| Rate for Payer: Amerigroup Medicare |
$1.76
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.62
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.74
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.74
|
| Rate for Payer: Medical Associates Commercial |
$2.62
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.74
|
| Rate for Payer: Midlands Choice Commercial |
$2.44
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.77
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.77
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.62
|
| Rate for Payer: United Healthcare Commercial |
$3.14
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.06
|
|
|
BK Virus DNA Quantitation DMCL
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
8505605
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna of IA Commercial |
$306.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$306.00
|
| Rate for Payer: Aetna of IA Medicare |
$193.80
|
| Rate for Payer: Amerigroup Medicaid |
$171.60
|
| Rate for Payer: Amerigroup Medicare |
$171.70
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$255.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$170.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$169.93
|
| Rate for Payer: Medical Associates Commercial |
$255.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$170.00
|
| Rate for Payer: Midlands Choice Commercial |
$238.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$172.55
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$172.45
|
| Rate for Payer: Oscar Health of IA Commercial |
$255.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$255.00
|
| Rate for Payer: United Healthcare Commercial |
$306.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$200.60
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
BK Virus DNA Quantitation DMCL
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
8505605
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$238.00 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna of IA Commercial |
$306.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$306.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$255.00
|
| Rate for Payer: Medical Associates Commercial |
$255.00
|
| Rate for Payer: Midlands Choice Commercial |
$238.00
|
| Rate for Payer: United Healthcare Commercial |
$306.00
|
|
|
BLOOD GAS ARTERIAL, VENOUS, CORD
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
633677
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Aetna of IA Medicare |
$99.75
|
| Rate for Payer: Amerigroup Medicaid |
$88.32
|
| Rate for Payer: Amerigroup Medicare |
$88.38
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$87.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$87.46
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$87.50
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$88.81
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$88.76
|
| Rate for Payer: Oscar Health of IA Commercial |
$131.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$131.25
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.25
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
BLOOD GAS ARTERIAL, VENOUS, CORD
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
633675
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Aetna of IA Medicare |
$99.75
|
| Rate for Payer: Amerigroup Medicaid |
$88.32
|
| Rate for Payer: Amerigroup Medicare |
$88.38
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$87.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$87.46
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$87.50
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$88.81
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$88.76
|
| Rate for Payer: Oscar Health of IA Commercial |
$131.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$131.25
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.25
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
BLOOD GAS ARTERIAL, VENOUS, CORD
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
633675
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
|
|
BLOOD GAS ARTERIAL, VENOUS, CORD
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
633677
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
|
|
BLOOD PH
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
4106782
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of IA Commercial |
$69.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.30
|
| Rate for Payer: Aetna of IA Medicare |
$43.89
|
| Rate for Payer: Amerigroup Medicaid |
$38.86
|
| Rate for Payer: Amerigroup Medicare |
$38.88
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.48
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.50
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.08
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$39.05
|
| Rate for Payer: Oscar Health of IA Commercial |
$57.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$57.75
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.43
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
BLOOD PH
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
4110801
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
BLOOD PH
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
4110801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of IA Commercial |
$69.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.30
|
| Rate for Payer: Aetna of IA Medicare |
$43.89
|
| Rate for Payer: Amerigroup Medicaid |
$38.86
|
| Rate for Payer: Amerigroup Medicare |
$38.88
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.48
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.50
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.08
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$39.05
|
| Rate for Payer: Oscar Health of IA Commercial |
$57.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$57.75
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.43
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
BLOOD PH
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
4106782
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
BLOOD TRANSFUSION-ED
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
4864934
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$395.34 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$711.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$711.90
|
| Rate for Payer: Aetna of IA Medicare |
$450.87
|
| Rate for Payer: Amerigroup Medicaid |
$399.22
|
| Rate for Payer: Amerigroup Medicare |
$399.46
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$593.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$395.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$395.34
|
| Rate for Payer: Medical Associates Commercial |
$593.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$395.50
|
| Rate for Payer: Midlands Choice Commercial |
$553.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$401.43
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$401.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$593.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$593.25
|
| Rate for Payer: United Healthcare Commercial |
$711.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$466.69
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
BLOOD TRANSFUSION-ED
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
4864934
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$553.70 |
| Max. Negotiated Rate |
$711.90 |
| Rate for Payer: Aetna of IA Commercial |
$711.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$711.90
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$593.25
|
| Rate for Payer: Medical Associates Commercial |
$593.25
|
| Rate for Payer: Midlands Choice Commercial |
$553.70
|
| Rate for Payer: United Healthcare Commercial |
$711.90
|
|
|
BLOOD TRANSFUSION-OB
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
7763434
|
|
Hospital Revenue Code
|
391
|
| 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
|
|
|
BLOOD TRANSFUSION-OB
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
7763434
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$341.86 |
| Max. Negotiated Rate |
$1,444.48 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
BLOOD TRANSFUSION, SCHEDULED
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
8012930
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$341.86 |
| Max. Negotiated Rate |
$1,444.48 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
BLOOD TRANSFUSION, SCHEDULED
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
8012930
|
|
Hospital Revenue Code
|
391
|
| 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
|
|
|
BLS EMERGENCY
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT A0429 QN
|
| Hospital Charge Code |
5230785
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$298.88 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Aetna of IA Commercial |
$538.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$538.20
|
| Rate for Payer: Aetna of IA Medicare |
$340.86
|
| Rate for Payer: Amerigroup Medicaid |
$301.81
|
| Rate for Payer: Amerigroup Medicare |
$301.99
|
| Rate for Payer: Cash Price |
$478.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$448.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$299.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$298.88
|
| Rate for Payer: Medical Associates Commercial |
$448.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$299.00
|
| Rate for Payer: Midlands Choice Commercial |
$418.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$303.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$303.31
|
| Rate for Payer: Oscar Health of IA Commercial |
$448.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$448.50
|
| Rate for Payer: United Healthcare Commercial |
$538.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$508.30
|
|
|
BLS EMERGENCY
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT A0429 QN
|
| Hospital Charge Code |
5230785
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$418.60 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Aetna of IA Commercial |
$538.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$538.20
|
| Rate for Payer: Cash Price |
$478.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$448.50
|
| Rate for Payer: Medical Associates Commercial |
$448.50
|
| Rate for Payer: Midlands Choice Commercial |
$418.60
|
| Rate for Payer: United Healthcare Commercial |
$538.20
|
|
