|
BONE GRAFT HEMI-FEMORAL SHAFT
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.00 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,430.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,430.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,539.00
|
| Rate for Payer: Amerigroup Medicaid |
$1,557.36
|
| Rate for Payer: Amerigroup Medicare |
$1,227.15
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,025.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,215.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,542.24
|
| Rate for Payer: Medical Associates Commercial |
$2,025.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,215.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,890.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,564.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,397.25
|
| Rate for Payer: United Healthcare Commercial |
$2,430.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,593.00
|
|
|
BONE MARROW ASPIRATION
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
4864948
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$532.70 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Aetna of IA Commercial |
$684.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$684.90
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$570.75
|
| Rate for Payer: Medical Associates Commercial |
$570.75
|
| Rate for Payer: Midlands Choice Commercial |
$532.70
|
| Rate for Payer: United Healthcare Commercial |
$684.90
|
|
|
BONE MARROW ASPIRATION
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
4864948
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$342.45 |
| Max. Negotiated Rate |
$1,822.85 |
| Rate for Payer: Aetna of IA Commercial |
$684.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$684.90
|
| Rate for Payer: Aetna of IA Medicare |
$433.77
|
| Rate for Payer: Amerigroup Medicaid |
$438.94
|
| Rate for Payer: Amerigroup Medicare |
$345.87
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$570.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$342.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$434.68
|
| Rate for Payer: Medical Associates Commercial |
$570.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$342.45
|
| Rate for Payer: Midlands Choice Commercial |
$532.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$441.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$393.82
|
| Rate for Payer: United Healthcare Commercial |
$684.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$448.99
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,654.81
|
| Rate for Payer: Wellmark IA PPO |
$1,822.85
|
|
|
BONE MARROW BIOPSY
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
4864949
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$532.70 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Aetna of IA Commercial |
$684.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$684.90
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$570.75
|
| Rate for Payer: Medical Associates Commercial |
$570.75
|
| Rate for Payer: Midlands Choice Commercial |
$532.70
|
| Rate for Payer: United Healthcare Commercial |
$684.90
|
|
|
BONE MARROW BIOPSY
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
4864949
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$342.45 |
| Max. Negotiated Rate |
$1,822.85 |
| Rate for Payer: Aetna of IA Commercial |
$684.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$684.90
|
| Rate for Payer: Aetna of IA Medicare |
$433.77
|
| Rate for Payer: Amerigroup Medicaid |
$438.94
|
| Rate for Payer: Amerigroup Medicare |
$345.87
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$570.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$342.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$434.68
|
| Rate for Payer: Medical Associates Commercial |
$570.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$342.45
|
| Rate for Payer: Midlands Choice Commercial |
$532.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$441.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$393.82
|
| Rate for Payer: United Healthcare Commercial |
$684.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$448.99
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,654.81
|
| Rate for Payer: Wellmark IA PPO |
$1,822.85
|
|
|
Bone Marrow Procedure
|
Facility
|
OP
|
$1,390.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
8060783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$625.50 |
| Max. Negotiated Rate |
$1,822.85 |
| Rate for Payer: Aetna of IA Commercial |
$1,251.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,251.00
|
| Rate for Payer: Aetna of IA Medicare |
$792.30
|
| Rate for Payer: Amerigroup Medicaid |
$801.75
|
| Rate for Payer: Amerigroup Medicare |
$631.76
|
| Rate for Payer: Cash Price |
$1,112.00
|
| Rate for Payer: Cash Price |
$1,112.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,042.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$625.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$793.97
|
| Rate for Payer: Medical Associates Commercial |
$1,042.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$625.50
|
| Rate for Payer: Midlands Choice Commercial |
$973.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$805.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$719.32
|
| Rate for Payer: United Healthcare Commercial |
$1,251.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$820.10
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,654.81
|
| Rate for Payer: Wellmark IA PPO |
$1,822.85
|
|
|
Bone Marrow Procedure
|
Facility
|
IP
|
$1,390.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
8060783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$1,251.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,251.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,251.00
|
| Rate for Payer: Cash Price |
$1,112.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,042.50
|
| Rate for Payer: Medical Associates Commercial |
$1,042.50
|
| Rate for Payer: Midlands Choice Commercial |
$973.00
|
| Rate for Payer: United Healthcare Commercial |
$1,251.00
|
|
|
bortezomib 3.5 mg Powder-Inj SDV [VDMC]
|
Facility
|
IP
|
$114.80
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
24162939
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$103.32 |
| Rate for Payer: Aetna of IA Commercial |
$103.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$103.32
|
| Rate for Payer: Cash Price |
$91.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$86.10
|
| Rate for Payer: Medical Associates Commercial |
$86.10
|
| Rate for Payer: Midlands Choice Commercial |
$80.36
|
| Rate for Payer: United Healthcare Commercial |
$103.32
|
|
|
bortezomib 3.5 mg Powder-Inj SDV [VDMC]
|
Facility
|
OP
|
$114.80
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
24162939
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$51.66 |
| Max. Negotiated Rate |
$103.32 |
| Rate for Payer: Aetna of IA Commercial |
$103.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$103.32
|
| Rate for Payer: Aetna of IA Medicare |
$65.44
|
| Rate for Payer: Amerigroup Medicaid |
$66.22
|
| Rate for Payer: Amerigroup Medicare |
$52.18
|
| Rate for Payer: Cash Price |
$91.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$86.10
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.57
|
| Rate for Payer: Medical Associates Commercial |
$86.10
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.66
|
| Rate for Payer: Midlands Choice Commercial |
$80.36
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$59.41
|
| Rate for Payer: United Healthcare Commercial |
$103.32
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.73
|
|
|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$15,957.35
|
|
|
Service Code
|
MSDRG 584
|
| Min. Negotiated Rate |
$15,726.07 |
| Max. Negotiated Rate |
$15,957.35 |
| Rate for Payer: Amerigroup Medicaid |
$15,880.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15,726.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15,957.35
|
|
|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$15,957.35
|
|
|
Service Code
|
MSDRG 585
|
| Min. Negotiated Rate |
$15,726.07 |
| Max. Negotiated Rate |
$15,957.35 |
| Rate for Payer: Amerigroup Medicaid |
$15,880.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15,726.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15,957.35
|
|
|
brimonidine Ophth 0.15% Sol 5 ml [VDMC]
|
Facility
|
OP
|
$519.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433477
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$233.78 |
| Max. Negotiated Rate |
$467.57 |
| Rate for Payer: Aetna of IA Commercial |
$467.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$467.57
|
| Rate for Payer: Aetna of IA Medicare |
$296.13
|
| Rate for Payer: Amerigroup Medicaid |
$299.66
|
| Rate for Payer: Amerigroup Medicare |
$236.12
|
| Rate for Payer: Cash Price |
$415.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$389.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$233.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$296.75
|
| Rate for Payer: Medical Associates Commercial |
$389.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$233.78
|
| Rate for Payer: Midlands Choice Commercial |
$363.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$301.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$268.85
|
| Rate for Payer: United Healthcare Commercial |
$467.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$306.52
|
|
|
brimonidine Ophth 0.15% Sol 5 ml [VDMC]
|
Facility
|
IP
|
$519.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433477
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$363.66 |
| Max. Negotiated Rate |
$467.57 |
| Rate for Payer: Aetna of IA Commercial |
$467.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$467.57
|
| Rate for Payer: Cash Price |
$415.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$389.64
|
| Rate for Payer: Medical Associates Commercial |
$389.64
|
| Rate for Payer: Midlands Choice Commercial |
$363.66
|
| Rate for Payer: United Healthcare Commercial |
$467.57
|
|
|
brimonidine Ophth 0.2% Sol 5 ml [VDMC]
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433542
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna of IA Commercial |
$22.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.03
|
| Rate for Payer: Aetna of IA Medicare |
$13.95
|
| Rate for Payer: Amerigroup Medicaid |
$14.12
|
| Rate for Payer: Amerigroup Medicare |
$11.13
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.98
|
| Rate for Payer: Medical Associates Commercial |
$18.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.02
|
| Rate for Payer: Midlands Choice Commercial |
$17.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.67
|
| Rate for Payer: United Healthcare Commercial |
$22.03
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.44
|
|
|
brimonidine Ophth 0.2% Sol 5 ml [VDMC]
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433542
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna of IA Commercial |
$22.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.03
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.36
|
| Rate for Payer: Medical Associates Commercial |
$18.36
|
| Rate for Payer: Midlands Choice Commercial |
$17.14
|
| Rate for Payer: United Healthcare Commercial |
$22.03
|
|
|
brinzolamide Ophth 1% Susp 10 ml[VDMC]
|
Facility
|
IP
|
$270.23
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433607
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$189.16 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Aetna of IA Commercial |
$243.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.20
|
| Rate for Payer: Cash Price |
$216.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.67
|
| Rate for Payer: Medical Associates Commercial |
$202.67
|
| Rate for Payer: Midlands Choice Commercial |
$189.16
|
| Rate for Payer: United Healthcare Commercial |
$243.20
|
|
|
brinzolamide Ophth 1% Susp 10 ml[VDMC]
|
Facility
|
OP
|
$270.23
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433607
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$121.60 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Aetna of IA Commercial |
$243.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.20
|
| Rate for Payer: Aetna of IA Medicare |
$154.03
|
| Rate for Payer: Amerigroup Medicaid |
$155.87
|
| Rate for Payer: Amerigroup Medicare |
$122.82
|
| Rate for Payer: Cash Price |
$216.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.67
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$121.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$154.35
|
| Rate for Payer: Medical Associates Commercial |
$202.67
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.60
|
| Rate for Payer: Midlands Choice Commercial |
$189.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$156.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$139.84
|
| Rate for Payer: United Healthcare Commercial |
$243.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.43
|
|
|
BRNCDILAT RSPSE SPMTRY PREPOST BRNCDILA
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
5338944
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
|
|
BRNCDILAT RSPSE SPMTRY PREPOST BRNCDILA
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
5338944
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$149.85 |
| Max. Negotiated Rate |
$430.33 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Aetna of IA Medicare |
$189.81
|
| Rate for Payer: Amerigroup Medicaid |
$192.07
|
| Rate for Payer: Amerigroup Medicare |
$151.35
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$149.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$190.21
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$149.85
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$193.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$172.33
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
| Rate for Payer: Wellmark IA HMO WHPI |
$390.66
|
| Rate for Payer: Wellmark IA PPO |
$430.33
|
|
|
BRONCHITIS AND ASTHMA WITH CC/MCC
|
Facility
|
IP
|
$7,459.60
|
|
|
Service Code
|
MSDRG 202
|
| Min. Negotiated Rate |
$7,351.48 |
| Max. Negotiated Rate |
$7,459.60 |
| Rate for Payer: Amerigroup Medicaid |
$7,423.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,351.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,459.60
|
|
|
BRONCHITIS AND ASTHMA WITHOUT CC/MCC
|
Facility
|
IP
|
$5,422.71
|
|
|
Service Code
|
MSDRG 203
|
| Min. Negotiated Rate |
$5,344.11 |
| Max. Negotiated Rate |
$5,422.71 |
| Rate for Payer: Amerigroup Medicaid |
$5,396.51
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5,344.11
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,422.71
|
|
|
BRONCHOSCOPY DX
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
8059061
|
|
Hospital Revenue Code
|
964
|
| 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
|
|
|
BRONCHOSCOPY DX
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
8059061
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$355.95 |
| Max. Negotiated Rate |
$2,901.42 |
| 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 |
$456.25
|
| Rate for Payer: Amerigroup Medicare |
$359.51
|
| 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 |
$355.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$451.82
|
| Rate for Payer: Medical Associates Commercial |
$593.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$355.95
|
| Rate for Payer: Midlands Choice Commercial |
$553.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$458.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$409.34
|
| Rate for Payer: United Healthcare Commercial |
$711.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,633.94
|
| Rate for Payer: Wellmark IA PPO |
$2,901.42
|
|
|
BRONCHOSCOPY DX
|
Professional
|
Both
|
$804.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
8059061
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$286.84 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Amerigroup Medicaid |
$289.66
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$286.84
|
| Rate for Payer: Medical Associates Commercial |
$603.00
|
| Rate for Payer: Midlands Choice Commercial |
$562.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$288.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$603.00
|
| Rate for Payer: United Healthcare Commercial |
$366.91
|
| Rate for Payer: Wellmark IA HMO WHPI |
$470.50
|
| Rate for Payer: Wellmark IA PPO |
$553.50
|
|
|
budesonide 0.25 mg/2 mL neb Sol SDV [VDMC]
|
Facility
|
IP
|
$20.32
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10370896
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$18.29 |
| Rate for Payer: Aetna of IA Commercial |
$18.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.29
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.24
|
| Rate for Payer: Medical Associates Commercial |
$15.24
|
| Rate for Payer: Midlands Choice Commercial |
$14.23
|
| Rate for Payer: United Healthcare Commercial |
$18.29
|
|
