|
CARDIOLOGY
|
Facility
|
IP
|
$1,338.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
8300852
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$936.60 |
| Max. Negotiated Rate |
$1,204.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,204.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,003.50
|
| Rate for Payer: Medical Associates Commercial |
$1,003.50
|
| Rate for Payer: Midlands Choice Commercial |
$936.60
|
| Rate for Payer: United Healthcare Commercial |
$1,204.20
|
|
|
CARDIOPULMONARY RESUSITATION
|
Facility
|
IP
|
$741.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
5338948
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$518.70 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Aetna of IA Commercial |
$666.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$666.90
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$555.75
|
| Rate for Payer: Medical Associates Commercial |
$555.75
|
| Rate for Payer: Midlands Choice Commercial |
$518.70
|
| Rate for Payer: United Healthcare Commercial |
$666.90
|
|
|
CARDIOPULMONARY RESUSITATION
|
Facility
|
OP
|
$741.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
5338948
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$333.45 |
| Max. Negotiated Rate |
$2,116.51 |
| Rate for Payer: Aetna of IA Commercial |
$666.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$666.90
|
| Rate for Payer: Aetna of IA Medicare |
$422.37
|
| Rate for Payer: Amerigroup Medicaid |
$427.41
|
| Rate for Payer: Amerigroup Medicare |
$336.78
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$555.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$333.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$423.26
|
| Rate for Payer: Medical Associates Commercial |
$555.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$333.45
|
| Rate for Payer: Midlands Choice Commercial |
$518.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$429.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$383.47
|
| Rate for Payer: United Healthcare Commercial |
$666.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$437.19
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,921.39
|
| Rate for Payer: Wellmark IA PPO |
$2,116.51
|
|
|
CARDIOVASCULAR STRESS TEST
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
7983038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$394.10 |
| Max. Negotiated Rate |
$506.70 |
| Rate for Payer: Aetna of IA Commercial |
$506.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$506.70
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$422.25
|
| Rate for Payer: Medical Associates Commercial |
$422.25
|
| Rate for Payer: Midlands Choice Commercial |
$394.10
|
| Rate for Payer: United Healthcare Commercial |
$506.70
|
|
|
CARDIOVASCULAR STRESS TEST
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
7983038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$253.35 |
| Max. Negotiated Rate |
$506.70 |
| Rate for Payer: Aetna of IA Commercial |
$506.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$506.70
|
| Rate for Payer: Aetna of IA Medicare |
$320.91
|
| Rate for Payer: Amerigroup Medicaid |
$324.74
|
| Rate for Payer: Amerigroup Medicare |
$255.88
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$422.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$253.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$321.59
|
| Rate for Payer: Medical Associates Commercial |
$422.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$253.35
|
| Rate for Payer: Midlands Choice Commercial |
$394.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$326.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$291.35
|
| Rate for Payer: United Healthcare Commercial |
$506.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$332.17
|
| Rate for Payer: Wellmark IA HMO WHPI |
$368.68
|
| Rate for Payer: Wellmark IA PPO |
$406.12
|
|
|
CARDIOVERSION, ELECTIVE, ELECTRICAL CONVERSION OF ARRHYTHMIA; EXTERNAL
|
Facility
|
OP
|
$1,497.96
|
|
|
Service Code
|
CPT 92960
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,359.86 |
| Max. Negotiated Rate |
$1,497.96 |
| Rate for Payer: Wellmark IA HMO WHPI |
$1,359.86
|
| Rate for Payer: Wellmark IA PPO |
$1,497.96
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Professional
|
Both
|
$524.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
7982756
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$149.55 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Amerigroup Medicaid |
$151.02
|
| Rate for Payer: Cash Price |
$419.20
|
| Rate for Payer: Cash Price |
$419.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$149.55
|
| Rate for Payer: Medical Associates Commercial |
$393.00
|
| Rate for Payer: Midlands Choice Commercial |
$366.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$150.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$393.00
|
| Rate for Payer: United Healthcare Commercial |
$190.09
|
| Rate for Payer: Wellmark IA HMO WHPI |
$294.20
|
| Rate for Payer: Wellmark IA PPO |
$346.10
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
4866863
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$428.40 |
| Max. Negotiated Rate |
$1,497.96 |
| Rate for Payer: Aetna of IA Commercial |
$856.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$856.80
|
| Rate for Payer: Aetna of IA Medicare |
$542.64
|
| Rate for Payer: Amerigroup Medicaid |
$549.11
|
| Rate for Payer: Amerigroup Medicare |
$432.68
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$714.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$428.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$543.78
|
| Rate for Payer: Medical Associates Commercial |
$714.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$428.40
|
| Rate for Payer: Midlands Choice Commercial |
$666.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$551.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$492.66
|
| Rate for Payer: United Healthcare Commercial |
$856.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$561.68
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,359.86
|
| Rate for Payer: Wellmark IA PPO |
$1,497.96
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
4866863
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$666.40 |
| Max. Negotiated Rate |
$856.80 |
| Rate for Payer: Aetna of IA Commercial |
$856.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$856.80
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$714.00
|
| Rate for Payer: Medical Associates Commercial |
$714.00
|
| Rate for Payer: Midlands Choice Commercial |
$666.40
|
| Rate for Payer: United Healthcare Commercial |
$856.80
|
|
|
CARD REHAB PHASE II;W.MONITOR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
8654179
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$361.60 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$126.90
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.66
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.85
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
| Rate for Payer: Wellmark IA HMO WHPI |
$328.27
|
| Rate for Payer: Wellmark IA PPO |
$361.60
|
|
|
CARD REHAB PHASE II;W.MONITOR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
8654179
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 93798 KX
|
| Hospital Charge Code |
7722942
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$361.60 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$126.90
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.66
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.85
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
| Rate for Payer: Wellmark IA HMO WHPI |
$328.27
|
| Rate for Payer: Wellmark IA PPO |
$361.60
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 93798 KX
|
| Hospital Charge Code |
8654178
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
6380786
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
6380787
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$361.60 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$126.90
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.66
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.85
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
| Rate for Payer: Wellmark IA HMO WHPI |
$328.27
|
| Rate for Payer: Wellmark IA PPO |
$361.60
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
6380786
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$361.60 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$126.90
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.66
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.85
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
| Rate for Payer: Wellmark IA HMO WHPI |
$328.27
|
| Rate for Payer: Wellmark IA PPO |
$361.60
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
6380787
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 93798 KX
|
| Hospital Charge Code |
7722942
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 93798 KX
|
| Hospital Charge Code |
7722943
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$361.60 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$126.90
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.66
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.85
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
| Rate for Payer: Wellmark IA HMO WHPI |
$328.27
|
| Rate for Payer: Wellmark IA PPO |
$361.60
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 93798 KX
|
| Hospital Charge Code |
7722943
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 93798 KX
|
| Hospital Charge Code |
8654178
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$361.60 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$126.90
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.66
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.85
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
| Rate for Payer: Wellmark IA HMO WHPI |
$328.27
|
| Rate for Payer: Wellmark IA PPO |
$361.60
|
|
|
carfilzomib 10 mg Pow SDV [VDMC]
|
Facility
|
OP
|
$2,408.12
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
22278206
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,083.65 |
| Max. Negotiated Rate |
$2,167.31 |
| Rate for Payer: Aetna of IA Commercial |
$2,167.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,167.31
|
| Rate for Payer: Aetna of IA Medicare |
$1,372.63
|
| Rate for Payer: Amerigroup Medicaid |
$1,389.00
|
| Rate for Payer: Amerigroup Medicare |
$1,094.49
|
| Rate for Payer: Cash Price |
$1,926.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,806.09
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,083.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,375.52
|
| Rate for Payer: Medical Associates Commercial |
$1,806.09
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,083.65
|
| Rate for Payer: Midlands Choice Commercial |
$1,685.68
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,395.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,246.20
|
| Rate for Payer: United Healthcare Commercial |
$2,167.31
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,420.79
|
|
|
carfilzomib 10 mg Pow SDV [VDMC]
|
Facility
|
IP
|
$2,408.12
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
22278206
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,685.68 |
| Max. Negotiated Rate |
$2,167.31 |
| Rate for Payer: Aetna of IA Commercial |
$2,167.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,167.31
|
| Rate for Payer: Cash Price |
$1,926.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,806.09
|
| Rate for Payer: Medical Associates Commercial |
$1,806.09
|
| Rate for Payer: Midlands Choice Commercial |
$1,685.68
|
| Rate for Payer: United Healthcare Commercial |
$2,167.31
|
|
|
carfilzomib 30 mg Pow SDV [VDMC]
|
Facility
|
IP
|
$2,679.12
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
22278329
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,875.38 |
| Max. Negotiated Rate |
$2,411.21 |
| Rate for Payer: Aetna of IA Commercial |
$2,411.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,411.21
|
| Rate for Payer: Cash Price |
$2,143.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,009.34
|
| Rate for Payer: Medical Associates Commercial |
$2,009.34
|
| Rate for Payer: Midlands Choice Commercial |
$1,875.38
|
| Rate for Payer: United Healthcare Commercial |
$2,411.21
|
|
|
carfilzomib 30 mg Pow SDV [VDMC]
|
Facility
|
OP
|
$2,679.12
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
22278329
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,205.60 |
| Max. Negotiated Rate |
$2,411.21 |
| Rate for Payer: Aetna of IA Commercial |
$2,411.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,411.21
|
| Rate for Payer: Aetna of IA Medicare |
$1,527.10
|
| Rate for Payer: Amerigroup Medicaid |
$1,545.32
|
| Rate for Payer: Amerigroup Medicare |
$1,217.66
|
| Rate for Payer: Cash Price |
$2,143.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,009.34
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,205.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,530.31
|
| Rate for Payer: Medical Associates Commercial |
$2,009.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,205.60
|
| Rate for Payer: Midlands Choice Commercial |
$1,875.38
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,552.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,386.44
|
| Rate for Payer: United Healthcare Commercial |
$2,411.21
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,580.68
|
|
