|
carBAMazepine 100 mg ER Tab [VDMC]
|
Facility
|
OP
|
$1.93
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373786
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Aetna of IA Commercial |
$1.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.74
|
| Rate for Payer: Aetna of IA Medicare |
$1.10
|
| Rate for Payer: Amerigroup Medicaid |
$1.11
|
| Rate for Payer: Amerigroup Medicare |
$0.88
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.45
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.87
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.10
|
| Rate for Payer: Medical Associates Commercial |
$1.45
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.87
|
| Rate for Payer: Midlands Choice Commercial |
$1.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$1.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.14
|
|
|
carBAMazepine 100 mg ER Tab [VDMC]
|
Facility
|
IP
|
$1.93
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373786
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Aetna of IA Commercial |
$1.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.74
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.45
|
| Rate for Payer: Medical Associates Commercial |
$1.45
|
| Rate for Payer: Midlands Choice Commercial |
$1.35
|
| Rate for Payer: United Healthcare Commercial |
$1.74
|
|
|
carBAMazepine 200 mg ER Tab [VDMC]
|
Facility
|
OP
|
$11.68
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373855
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna of IA Commercial |
$10.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.51
|
| Rate for Payer: Aetna of IA Medicare |
$6.66
|
| Rate for Payer: Amerigroup Medicaid |
$6.74
|
| Rate for Payer: Amerigroup Medicare |
$5.31
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.76
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.26
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.67
|
| Rate for Payer: Medical Associates Commercial |
$8.76
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.26
|
| Rate for Payer: Midlands Choice Commercial |
$8.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$6.05
|
| Rate for Payer: United Healthcare Commercial |
$10.51
|
| Rate for Payer: United Healthcare Managed Medicare |
$6.89
|
|
|
carBAMazepine 200 mg ER Tab [VDMC]
|
Facility
|
IP
|
$11.68
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373855
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna of IA Commercial |
$10.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.51
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.76
|
| Rate for Payer: Medical Associates Commercial |
$8.76
|
| Rate for Payer: Midlands Choice Commercial |
$8.18
|
| Rate for Payer: United Healthcare Commercial |
$10.51
|
|
|
carBAMazepine 200 mg Tab [VDMC]
|
Facility
|
IP
|
$3.50
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373926
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Aetna of IA Commercial |
$3.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.15
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.63
|
| Rate for Payer: Medical Associates Commercial |
$2.63
|
| Rate for Payer: Midlands Choice Commercial |
$2.45
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
|
|
carBAMazepine 200 mg Tab [VDMC]
|
Facility
|
OP
|
$3.50
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373926
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Aetna of IA Commercial |
$3.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.15
|
| Rate for Payer: Aetna of IA Medicare |
$2.00
|
| Rate for Payer: Amerigroup Medicaid |
$2.02
|
| Rate for Payer: Amerigroup Medicare |
$1.59
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.63
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.00
|
| Rate for Payer: Medical Associates Commercial |
$2.63
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.58
|
| Rate for Payer: Midlands Choice Commercial |
$2.45
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.81
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.07
|
|
|
Carbamazepine Level DMCL
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
8037508
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Aetna of IA Medicare |
$56.43
|
| Rate for Payer: Amerigroup Medicaid |
$57.10
|
| Rate for Payer: Amerigroup Medicare |
$45.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$44.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.55
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.55
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.23
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.41
|
| Rate for Payer: Wellmark IA HMO WHPI |
$65.23
|
| Rate for Payer: Wellmark IA PPO |
$71.85
|
|
|
Carbamazepine Level DMCL
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
8037508
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
|
|
carbamide peroxide Otic 6.5% Sol [VDMC]
|
Facility
|
OP
|
$19.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433737
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna of IA Commercial |
$17.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.68
|
| Rate for Payer: Aetna of IA Medicare |
$11.19
|
| Rate for Payer: Amerigroup Medicaid |
$11.33
|
| Rate for Payer: Amerigroup Medicare |
$8.93
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.84
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.22
|
| Rate for Payer: Medical Associates Commercial |
$14.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.84
|
| Rate for Payer: Midlands Choice Commercial |
$13.75
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$10.16
|
| Rate for Payer: United Healthcare Commercial |
$17.68
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.59
|
|
|
carbamide peroxide Otic 6.5% Sol [VDMC]
|
Facility
|
IP
|
$19.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433737
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna of IA Commercial |
$17.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.68
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.73
|
| Rate for Payer: Medical Associates Commercial |
$14.73
|
| Rate for Payer: Midlands Choice Commercial |
$13.75
|
| Rate for Payer: United Healthcare Commercial |
$17.68
|
|
|
carbidopa/entacapone/levodopa 25 mg-200 mg-100 mg Tab [VDMC]
|
Facility
|
OP
|
$3.76
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10374064
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna of IA Commercial |
$3.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.38
|
| Rate for Payer: Aetna of IA Medicare |
$2.14
|
| Rate for Payer: Amerigroup Medicaid |
$2.17
|
| Rate for Payer: Amerigroup Medicare |
$1.71
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.69
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.15
|
| Rate for Payer: Medical Associates Commercial |
$2.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.69
|
| Rate for Payer: Midlands Choice Commercial |
$2.63
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.95
|
| Rate for Payer: United Healthcare Commercial |
$3.38
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.22
|
|
|
carbidopa/entacapone/levodopa 25 mg-200 mg-100 mg Tab [VDMC]
|
Facility
|
IP
|
$3.76
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10374064
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna of IA Commercial |
$3.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.38
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.82
|
| Rate for Payer: Medical Associates Commercial |
$2.82
|
| Rate for Payer: Midlands Choice Commercial |
$2.63
|
| Rate for Payer: United Healthcare Commercial |
$3.38
|
|
|
carbidopa-levodopa 10 mg-100 mg Tab [VDMC]
|
Facility
|
IP
|
$1.58
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10374133
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of IA Commercial |
$1.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.42
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.19
|
| Rate for Payer: Medical Associates Commercial |
$1.19
|
| Rate for Payer: Midlands Choice Commercial |
$1.11
|
| Rate for Payer: United Healthcare Commercial |
$1.42
|
|
|
carbidopa-levodopa 10 mg-100 mg Tab [VDMC]
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10374133
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of IA Commercial |
$1.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.42
|
| Rate for Payer: Aetna of IA Medicare |
$0.90
|
| Rate for Payer: Amerigroup Medicaid |
$0.91
|
| Rate for Payer: Amerigroup Medicare |
$0.72
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.19
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.90
|
| Rate for Payer: Medical Associates Commercial |
$1.19
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.71
|
| Rate for Payer: Midlands Choice Commercial |
$1.11
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.42
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.93
|
|
|
carbidopa-levodopa 25 mg-100 mg ER Tab [VDMC]
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10374202
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna of IA Commercial |
$1.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.81
|
| Rate for Payer: Aetna of IA Medicare |
$1.15
|
| Rate for Payer: Amerigroup Medicaid |
$1.16
|
| Rate for Payer: Amerigroup Medicare |
$0.92
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.51
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.15
|
| Rate for Payer: Medical Associates Commercial |
$1.51
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.91
|
| Rate for Payer: Midlands Choice Commercial |
$1.41
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.81
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.19
|
|
|
carbidopa-levodopa 25 mg-100 mg ER Tab [VDMC]
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10374202
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna of IA Commercial |
$1.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.81
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.51
|
| Rate for Payer: Medical Associates Commercial |
$1.51
|
| Rate for Payer: Midlands Choice Commercial |
$1.41
|
| Rate for Payer: United Healthcare Commercial |
$1.81
|
|
|
carbidopa-levodopa 25 mg-100 mg Tab [VDMC]
|
Facility
|
OP
|
$1.63
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10374273
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of IA Commercial |
$1.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.47
|
| Rate for Payer: Aetna of IA Medicare |
$0.93
|
| Rate for Payer: Amerigroup Medicaid |
$0.94
|
| Rate for Payer: Amerigroup Medicare |
$0.74
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.23
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.74
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.93
|
| Rate for Payer: Medical Associates Commercial |
$1.23
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.74
|
| Rate for Payer: Midlands Choice Commercial |
$1.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.47
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.96
|
|
|
carbidopa-levodopa 25 mg-100 mg Tab [VDMC]
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10374273
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of IA Commercial |
$1.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.47
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.23
|
| Rate for Payer: Medical Associates Commercial |
$1.23
|
| Rate for Payer: Midlands Choice Commercial |
$1.14
|
| Rate for Payer: United Healthcare Commercial |
$1.47
|
|
|
carbidopa-levodopa 25 mg-250 mg Tab [VDMC]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10374344
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna of IA Commercial |
$1.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.62
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.35
|
| Rate for Payer: Medical Associates Commercial |
$1.35
|
| Rate for Payer: Midlands Choice Commercial |
$1.26
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
carbidopa-levodopa 25 mg-250 mg Tab [VDMC]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10374344
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna of IA Commercial |
$1.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.62
|
| Rate for Payer: Aetna of IA Medicare |
$1.03
|
| Rate for Payer: Amerigroup Medicaid |
$1.04
|
| Rate for Payer: Amerigroup Medicare |
$0.82
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.35
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.81
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.03
|
| Rate for Payer: Medical Associates Commercial |
$1.35
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.81
|
| Rate for Payer: Midlands Choice Commercial |
$1.26
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.06
|
|
|
CARBON DIOXIDE LEVEL
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
1628888
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna of IA Commercial |
$39.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.00
|
| Rate for Payer: Medical Associates Commercial |
$33.00
|
| Rate for Payer: Midlands Choice Commercial |
$30.80
|
| Rate for Payer: United Healthcare Commercial |
$39.60
|
|
|
CARBON DIOXIDE LEVEL
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
1628888
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna of IA Commercial |
$39.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.60
|
| Rate for Payer: Aetna of IA Medicare |
$25.08
|
| Rate for Payer: Amerigroup Medicaid |
$25.38
|
| Rate for Payer: Amerigroup Medicare |
$20.00
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$19.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.13
|
| Rate for Payer: Medical Associates Commercial |
$33.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.80
|
| Rate for Payer: Midlands Choice Commercial |
$30.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.77
|
| Rate for Payer: United Healthcare Commercial |
$39.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.96
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
CARBOXYHEMOGLOBIN
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
7928765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of IA Commercial |
$105.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.30
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.75
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
|
|
CARBOXYHEMOGLOBIN
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
7928765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of IA Commercial |
$105.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.30
|
| Rate for Payer: Aetna of IA Medicare |
$66.69
|
| Rate for Payer: Amerigroup Medicaid |
$67.49
|
| Rate for Payer: Amerigroup Medicare |
$53.18
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$66.83
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.65
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$67.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$60.55
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.03
|
| Rate for Payer: Wellmark IA HMO WHPI |
$61.68
|
| Rate for Payer: Wellmark IA PPO |
$67.95
|
|
|
Carboxyhemoglobin Venous
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
8208908
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of IA Commercial |
$105.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.30
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.75
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
|
