|
cefuroxime 250 mg Tab
|
Facility
OP
|
$1.87
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701868
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Aetna of IA Commercial |
$1.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.68
|
| Rate for Payer: Aetna of IA Medicare |
$1.07
|
| Rate for Payer: Amerigroup Medicaid |
$0.94
|
| Rate for Payer: Amerigroup Medicare |
$0.94
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.40
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.93
|
| Rate for Payer: Medical Associates Commercial |
$1.40
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.94
|
| Rate for Payer: Midlands Choice Commercial |
$1.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.40
|
| Rate for Payer: United Healthcare Commercial |
$1.68
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.10
|
|
|
cefuroxime 250 mg Tab
|
Facility
IP
|
$1.87
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701868
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Aetna of IA Commercial |
$1.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.68
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.40
|
| Rate for Payer: Medical Associates Commercial |
$1.40
|
| Rate for Payer: Midlands Choice Commercial |
$1.31
|
| Rate for Payer: United Healthcare Commercial |
$1.68
|
|
|
cefuroxime 750 mg Inj SDV
|
Facility
OP
|
$29.63
|
|
|
Service Code
|
CPT J0697
|
| Hospital Charge Code |
43790414
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.81 |
| Max. Negotiated Rate |
$26.67 |
| Rate for Payer: Aetna of IA Commercial |
$26.67
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$26.67
|
| Rate for Payer: Aetna of IA Medicare |
$16.89
|
| Rate for Payer: Amerigroup Medicaid |
$14.95
|
| Rate for Payer: Amerigroup Medicare |
$14.96
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.81
|
| Rate for Payer: Medical Associates Commercial |
$22.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.82
|
| Rate for Payer: Midlands Choice Commercial |
$20.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.22
|
| Rate for Payer: United Healthcare Commercial |
$26.67
|
| Rate for Payer: United Healthcare Managed Medicare |
$17.48
|
|
|
cefuroxime 750 mg Inj SDV
|
Facility
IP
|
$29.63
|
|
|
Service Code
|
CPT J0697
|
| Hospital Charge Code |
43790414
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.74 |
| Max. Negotiated Rate |
$26.67 |
| Rate for Payer: Aetna of IA Commercial |
$26.67
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$26.67
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.22
|
| Rate for Payer: Medical Associates Commercial |
$22.22
|
| Rate for Payer: Midlands Choice Commercial |
$20.74
|
| Rate for Payer: United Healthcare Commercial |
$26.67
|
|
|
celecoxib 100 mg Cap
|
Facility
IP
|
$1.55
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of IA Commercial |
$1.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.40
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.16
|
| Rate for Payer: Medical Associates Commercial |
$1.16
|
| Rate for Payer: Midlands Choice Commercial |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
|
|
celecoxib 100 mg Cap
|
Facility
OP
|
$1.55
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of IA Commercial |
$1.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.40
|
| Rate for Payer: Aetna of IA Medicare |
$0.88
|
| Rate for Payer: Amerigroup Medicaid |
$0.78
|
| Rate for Payer: Amerigroup Medicare |
$0.78
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.16
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.77
|
| Rate for Payer: Medical Associates Commercial |
$1.16
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.78
|
| Rate for Payer: Midlands Choice Commercial |
$1.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.16
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.91
|
|
|
Cellulitis With MCC
|
Facility
IP
|
$13,070.73
|
|
|
Service Code
|
MS-DRG 602
|
| Hospital Charge Code |
400
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$13,070.73 |
| Rate for Payer: Amerigroup Medicaid |
$13,007.58
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12,881.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,070.73
|
|
|
Cellulitis Without MCC
|
Facility
IP
|
$6,762.72
|
|
|
Service Code
|
MS-DRG 603
|
| Hospital Charge Code |
401
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,762.72 |
| Rate for Payer: Amerigroup Medicaid |
$6,730.05
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,664.71
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,762.72
|
|
|
CENTRAL LINE DRAW/LAB NO OTHR SVC
|
Facility
IP
|
$31.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
7983016
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
CENTRAL LINE DRAW/LAB NO OTHR SVC
|
Facility
OP
|
$31.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
7983016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$387.38 |
| Rate for Payer: Aetna of IA Commercial |
$27.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.90
|
| Rate for Payer: Aetna of IA Medicare |
$17.67
|
| Rate for Payer: Amerigroup Medicaid |
$15.65
|
| Rate for Payer: Amerigroup Medicare |
$15.66
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.49
|
| Rate for Payer: Medical Associates Commercial |
$23.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.50
|
| Rate for Payer: Midlands Choice Commercial |
$21.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.25
|
| Rate for Payer: United Healthcare Commercial |
$27.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.29
|
| Rate for Payer: Wellmark IA HMO |
$352.16
|
| Rate for Payer: Wellmark IA PPO |
$387.38
|
|
|
CENTRAL LINE DRAW/LAB W/OTHR SVC
|
Facility
IP
|
$31.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
4866808
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
CENTRAL LINE DRAW/LAB W/OTHR SVC
|
Facility
OP
|
$31.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
4866808
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.49 |
| 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: Aetna of IA Medicare |
$17.67
|
| Rate for Payer: Amerigroup Medicaid |
$15.65
|
| Rate for Payer: Amerigroup Medicare |
$15.66
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.49
|
| Rate for Payer: Medical Associates Commercial |
$23.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.50
|
| Rate for Payer: Midlands Choice Commercial |
$21.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.25
|
| Rate for Payer: United Healthcare Commercial |
$27.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.29
|
|
|
CENTRAL LINE-PHYSICIAN CHARGE
|
Professional
|
$774.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
7982776
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$75.99 |
| Max. Negotiated Rate |
$541.80 |
| Rate for Payer: Aetna of IA Medicare |
$75.99
|
| Rate for Payer: Amerigroup Medicaid |
$78.57
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$91.19
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$77.51
|
| Rate for Payer: Medical Associates Commercial |
$144.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.99
|
| Rate for Payer: Midlands Choice Commercial |
$541.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.98
|
| Rate for Payer: Wellmark IA HMO |
$148.00
|
| Rate for Payer: Wellmark IA PPO |
$174.00
|
|
|
cephalexin 250 mg/5 mL 100ml Oral Liq
|
Facility
IP
|
$54.68
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.28 |
| Max. Negotiated Rate |
$49.21 |
| Rate for Payer: Aetna of IA Commercial |
$49.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.21
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.01
|
| Rate for Payer: Medical Associates Commercial |
$41.01
|
| Rate for Payer: Midlands Choice Commercial |
$38.28
|
| Rate for Payer: United Healthcare Commercial |
$49.21
|
|
|
cephalexin 250 mg/5 mL 100ml Oral Liq
|
Facility
OP
|
$54.68
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.33 |
| Max. Negotiated Rate |
$49.21 |
| Rate for Payer: Aetna of IA Commercial |
$49.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.21
|
| Rate for Payer: Aetna of IA Medicare |
$31.17
|
| Rate for Payer: Amerigroup Medicaid |
$27.60
|
| Rate for Payer: Amerigroup Medicare |
$27.61
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.01
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.33
|
| Rate for Payer: Medical Associates Commercial |
$41.01
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.34
|
| Rate for Payer: Midlands Choice Commercial |
$38.28
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$41.01
|
| Rate for Payer: United Healthcare Commercial |
$49.21
|
| Rate for Payer: United Healthcare Managed Medicare |
$32.26
|
|
|
cephalexin 250 mg Cap
|
Facility
OP
|
$1.26
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702568
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of IA Commercial |
$1.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.13
|
| Rate for Payer: Aetna of IA Medicare |
$0.72
|
| Rate for Payer: Amerigroup Medicaid |
$0.64
|
| Rate for Payer: Amerigroup Medicare |
$0.64
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.63
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.63
|
| Rate for Payer: Medical Associates Commercial |
$0.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.63
|
| Rate for Payer: Midlands Choice Commercial |
$0.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.95
|
| Rate for Payer: United Healthcare Commercial |
$1.13
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.74
|
|
|
cephalexin 250 mg Cap
|
Facility
IP
|
$1.26
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702568
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of IA Commercial |
$1.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.13
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.95
|
| Rate for Payer: Medical Associates Commercial |
$0.95
|
| Rate for Payer: Midlands Choice Commercial |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$1.13
|
|
|
cephalexin 500 mg Cap
|
Facility
OP
|
$1.89
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Aetna of IA Commercial |
$1.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.70
|
| Rate for Payer: Aetna of IA Medicare |
$1.08
|
| Rate for Payer: Amerigroup Medicaid |
$0.95
|
| Rate for Payer: Amerigroup Medicare |
$0.95
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.94
|
| Rate for Payer: Medical Associates Commercial |
$1.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.95
|
| Rate for Payer: Midlands Choice Commercial |
$1.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.42
|
| Rate for Payer: United Healthcare Commercial |
$1.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.12
|
|
|
cephalexin 500 mg Cap
|
Facility
IP
|
$1.89
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Aetna of IA Commercial |
$1.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.70
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.42
|
| Rate for Payer: Medical Associates Commercial |
$1.42
|
| Rate for Payer: Midlands Choice Commercial |
$1.32
|
| Rate for Payer: United Healthcare Commercial |
$1.70
|
|
|
Ceruloplasmin DMCL
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
8037510
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
Ceruloplasmin DMCL
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
8037510
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
CERUMEN REMOVAL
|
Professional
|
$132.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
7982759
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$29.54 |
| Max. Negotiated Rate |
$92.40 |
| Rate for Payer: Aetna of IA Medicare |
$29.54
|
| Rate for Payer: Amerigroup Medicaid |
$30.54
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.13
|
| Rate for Payer: Medical Associates Commercial |
$56.13
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.54
|
| Rate for Payer: Midlands Choice Commercial |
$92.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.31
|
| Rate for Payer: Wellmark IA HMO |
$62.00
|
| Rate for Payer: Wellmark IA PPO |
$73.00
|
|
|
Cervical Spinal Fusion With CC
|
Facility
IP
|
$23,571.60
|
|
|
Service Code
|
MS-DRG 472
|
| Hospital Charge Code |
292
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$23,571.60 |
| Rate for Payer: Amerigroup Medicaid |
$23,457.72
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23,229.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23,571.60
|
|
|
Cervical Spinal Fusion With MCC
|
Facility
IP
|
$40,149.18
|
|
|
Service Code
|
MS-DRG 471
|
| Hospital Charge Code |
291
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$40,149.18 |
| Rate for Payer: Amerigroup Medicaid |
$39,955.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$39,567.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$40,149.18
|
|
|
Cervical Spinal Fusion Without CC/MCC
|
Facility
IP
|
$18,371.85
|
|
|
Service Code
|
MS-DRG 473
|
| Hospital Charge Code |
293
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$18,371.85 |
| Rate for Payer: Amerigroup Medicaid |
$18,283.10
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18,105.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18,371.85
|
|
