|
CNBT EACH ADDITIONAL HOUR
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
6345015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
|
|
CNBT EACH ADDITIONAL HOUR
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
6345015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$282.35 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Aetna of IA Medicare |
$148.20
|
| Rate for Payer: Amerigroup Medicaid |
$131.22
|
| Rate for Payer: Amerigroup Medicare |
$131.30
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$130.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$129.95
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$130.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$131.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$195.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.40
|
| Rate for Payer: Wellmark IA HMO |
$256.68
|
| Rate for Payer: Wellmark IA PPO |
$282.35
|
|
|
CNBT INITIAL 1ST HOUR
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
6594783
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$282.35 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Aetna of IA Medicare |
$148.20
|
| Rate for Payer: Amerigroup Medicaid |
$131.22
|
| Rate for Payer: Amerigroup Medicare |
$131.30
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$130.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$129.95
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$130.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$131.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$195.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.40
|
| Rate for Payer: Wellmark IA HMO |
$256.68
|
| Rate for Payer: Wellmark IA PPO |
$282.35
|
|
|
CNBT INITIAL 1ST HOUR
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
6594783
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
|
|
Coagulation Disorders
|
Facility
IP
|
$9,404.42
|
|
|
Service Code
|
MS-DRG 813
|
| Hospital Charge Code |
555
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,404.42 |
| Rate for Payer: Amerigroup Medicaid |
$9,358.99
|
| 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 |
$9,268.13
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,404.42
|
|
|
CoEnzyme Q-10 100 mg Cap [VDNC]
|
Facility
IP
|
$1.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Aetna of IA Commercial |
$1.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.37
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.14
|
| Rate for Payer: Medical Associates Commercial |
$1.14
|
| Rate for Payer: Midlands Choice Commercial |
$1.06
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
|
|
CoEnzyme Q-10 100 mg Cap [VDNC]
|
Facility
OP
|
$1.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Aetna of IA Commercial |
$1.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.37
|
| Rate for Payer: Aetna of IA Medicare |
$0.87
|
| Rate for Payer: Amerigroup Medicaid |
$0.77
|
| Rate for Payer: Amerigroup Medicare |
$0.77
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.14
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.76
|
| Rate for Payer: Medical Associates Commercial |
$1.14
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.76
|
| Rate for Payer: Midlands Choice Commercial |
$1.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.14
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.90
|
|
|
COG EVAL
|
Facility
IP
|
$346.00
|
|
|
Service Code
|
CPT 96125 GN
|
| Hospital Charge Code |
7106809
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$311.40 |
| Rate for Payer: Aetna of IA Commercial |
$311.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$311.40
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$259.50
|
| Rate for Payer: Medical Associates Commercial |
$259.50
|
| Rate for Payer: Midlands Choice Commercial |
$242.20
|
| Rate for Payer: United Healthcare Commercial |
$311.40
|
|
|
COG EVAL
|
Facility
OP
|
$346.00
|
|
|
Service Code
|
CPT 96125 GN
|
| Hospital Charge Code |
7106809
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$172.93 |
| Max. Negotiated Rate |
$311.40 |
| Rate for Payer: Aetna of IA Commercial |
$311.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$311.40
|
| Rate for Payer: Aetna of IA Medicare |
$197.22
|
| Rate for Payer: Amerigroup Medicaid |
$174.63
|
| Rate for Payer: Amerigroup Medicare |
$174.73
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$259.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$173.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$172.93
|
| Rate for Payer: Medical Associates Commercial |
$259.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$173.00
|
| Rate for Payer: Midlands Choice Commercial |
$242.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$175.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$259.50
|
| Rate for Payer: United Healthcare Commercial |
$311.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$204.14
|
|
|
COGNITIVE DEV 15 MIN
|
Facility
IP
|
$88.00
|
|
|
Service Code
|
CPT 97532 GN
|
| Hospital Charge Code |
1373954
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna of IA Commercial |
$79.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$79.20
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$66.00
|
| Rate for Payer: Medical Associates Commercial |
$66.00
|
| Rate for Payer: Midlands Choice Commercial |
$61.60
|
| Rate for Payer: United Healthcare Commercial |
$79.20
|
|
|
COGNITIVE DEV 15 MIN
|
Facility
OP
|
$88.00
|
|
|
Service Code
|
CPT 97532 GN
|
| Hospital Charge Code |
1373954
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$43.98 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna of IA Commercial |
$79.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$79.20
|
| Rate for Payer: Aetna of IA Medicare |
$50.16
|
| Rate for Payer: Amerigroup Medicaid |
$44.41
|
| Rate for Payer: Amerigroup Medicare |
$44.44
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$66.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$44.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.98
|
| Rate for Payer: Medical Associates Commercial |
$66.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.00
|
| Rate for Payer: Midlands Choice Commercial |
$61.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$79.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$51.92
|
|
|
COGNITIVE TRAINING/PER 15 MIN
|
Facility
OP
|
$86.00
|
|
|
Service Code
|
CPT 97532 GO
|
| Hospital Charge Code |
1373452
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of IA Commercial |
$77.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.40
|
| Rate for Payer: Aetna of IA Medicare |
$49.02
|
| Rate for Payer: Amerigroup Medicaid |
$43.40
|
| Rate for Payer: Amerigroup Medicare |
$43.43
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$43.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.98
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$43.00
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.50
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.74
|
|
|
COGNITIVE TRAINING/PER 15 MIN
|
Facility
IP
|
$86.00
|
|
|
Service Code
|
CPT 97532 GO
|
| Hospital Charge Code |
1373452
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of IA Commercial |
$77.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.40
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.50
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
|
|
colchicine 0.6 mg Tab
|
Facility
IP
|
$1.71
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700540
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of IA Commercial |
$1.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.54
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.28
|
| Rate for Payer: Medical Associates Commercial |
$1.28
|
| Rate for Payer: Midlands Choice Commercial |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
|
|
colchicine 0.6 mg Tab
|
Facility
OP
|
$1.71
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700540
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of IA Commercial |
$1.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.54
|
| Rate for Payer: Aetna of IA Medicare |
$0.97
|
| Rate for Payer: Amerigroup Medicaid |
$0.86
|
| Rate for Payer: Amerigroup Medicare |
$0.86
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.85
|
| Rate for Payer: Medical Associates Commercial |
$1.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.86
|
| Rate for Payer: Midlands Choice Commercial |
$1.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.28
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.01
|
|
|
colesevelam 3.75 g Pow
|
Facility
OP
|
$36.89
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700360
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$33.20 |
| Rate for Payer: Aetna of IA Commercial |
$33.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.20
|
| Rate for Payer: Aetna of IA Medicare |
$21.03
|
| Rate for Payer: Amerigroup Medicaid |
$18.62
|
| Rate for Payer: Amerigroup Medicare |
$18.63
|
| Rate for Payer: Cash Price |
$29.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.67
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.44
|
| Rate for Payer: Medical Associates Commercial |
$27.67
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.44
|
| Rate for Payer: Midlands Choice Commercial |
$25.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.67
|
| Rate for Payer: United Healthcare Commercial |
$33.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.77
|
|
|
colesevelam 3.75 g Pow
|
Facility
IP
|
$36.89
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700360
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.82 |
| Max. Negotiated Rate |
$33.20 |
| Rate for Payer: Aetna of IA Commercial |
$33.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.20
|
| Rate for Payer: Cash Price |
$29.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.67
|
| Rate for Payer: Medical Associates Commercial |
$27.67
|
| Rate for Payer: Midlands Choice Commercial |
$25.82
|
| Rate for Payer: United Healthcare Commercial |
$33.20
|
|
|
colesevelam 625 mg Tab
|
Facility
IP
|
$2.67
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43765597
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Aetna of IA Commercial |
$2.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.40
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.00
|
| Rate for Payer: Medical Associates Commercial |
$2.00
|
| Rate for Payer: Midlands Choice Commercial |
$1.87
|
| Rate for Payer: United Healthcare Commercial |
$2.40
|
|
|
colesevelam 625 mg Tab
|
Facility
OP
|
$2.67
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43765597
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Aetna of IA Commercial |
$2.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.40
|
| Rate for Payer: Aetna of IA Medicare |
$1.52
|
| Rate for Payer: Amerigroup Medicaid |
$1.35
|
| Rate for Payer: Amerigroup Medicare |
$1.35
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.33
|
| Rate for Payer: Medical Associates Commercial |
$2.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.34
|
| Rate for Payer: Midlands Choice Commercial |
$1.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.00
|
| Rate for Payer: United Healthcare Commercial |
$2.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.58
|
|
|
Colestipol HCL 1 g Tab
|
Facility
IP
|
$3.67
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705948
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna of IA Commercial |
$3.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.30
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.75
|
| Rate for Payer: Medical Associates Commercial |
$2.75
|
| Rate for Payer: Midlands Choice Commercial |
$2.57
|
| Rate for Payer: United Healthcare Commercial |
$3.30
|
|
|
Colestipol HCL 1 g Tab
|
Facility
OP
|
$3.67
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705948
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna of IA Commercial |
$3.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.30
|
| Rate for Payer: Aetna of IA Medicare |
$2.09
|
| Rate for Payer: Amerigroup Medicaid |
$1.85
|
| Rate for Payer: Amerigroup Medicare |
$1.85
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.84
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.83
|
| Rate for Payer: Medical Associates Commercial |
$2.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.84
|
| Rate for Payer: Midlands Choice Commercial |
$2.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.75
|
| Rate for Payer: United Healthcare Commercial |
$3.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.17
|
|
|
COLLAGENASE 30 GRAM
|
Facility
IP
|
$581.00
|
|
| Hospital Charge Code |
8013715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$406.70 |
| Max. Negotiated Rate |
$522.90 |
| Rate for Payer: Aetna of IA Commercial |
$522.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$522.90
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$435.75
|
| Rate for Payer: Medical Associates Commercial |
$435.75
|
| Rate for Payer: Midlands Choice Commercial |
$406.70
|
| Rate for Payer: United Healthcare Commercial |
$522.90
|
|
|
COLLAGENASE 30 GRAM
|
Facility
OP
|
$581.00
|
|
| Hospital Charge Code |
8013715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$290.38 |
| Max. Negotiated Rate |
$522.90 |
| Rate for Payer: Aetna of IA Commercial |
$522.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$522.90
|
| Rate for Payer: Aetna of IA Medicare |
$331.17
|
| Rate for Payer: Amerigroup Medicaid |
$293.23
|
| Rate for Payer: Amerigroup Medicare |
$293.40
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$435.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$290.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$290.38
|
| Rate for Payer: Medical Associates Commercial |
$435.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$290.50
|
| Rate for Payer: Midlands Choice Commercial |
$406.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$294.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$435.75
|
| Rate for Payer: United Healthcare Commercial |
$522.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$342.79
|
|
|
collagenase Top 250 units/g Oint
|
Facility
IP
|
$1,018.92
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700152
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$713.24 |
| Max. Negotiated Rate |
$917.03 |
| Rate for Payer: Aetna of IA Commercial |
$917.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$917.03
|
| Rate for Payer: Cash Price |
$815.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$764.19
|
| Rate for Payer: Medical Associates Commercial |
$764.19
|
| Rate for Payer: Midlands Choice Commercial |
$713.24
|
| Rate for Payer: United Healthcare Commercial |
$917.03
|
|
|
collagenase Top 250 units/g Oint
|
Facility
OP
|
$1,018.92
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700152
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$509.26 |
| Max. Negotiated Rate |
$917.03 |
| Rate for Payer: Aetna of IA Commercial |
$917.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$917.03
|
| Rate for Payer: Aetna of IA Medicare |
$580.78
|
| Rate for Payer: Amerigroup Medicaid |
$514.25
|
| Rate for Payer: Amerigroup Medicare |
$514.55
|
| Rate for Payer: Cash Price |
$815.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$764.19
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$509.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$509.26
|
| Rate for Payer: Medical Associates Commercial |
$764.19
|
| Rate for Payer: Medical Associates Managed Medicare |
$509.46
|
| Rate for Payer: Midlands Choice Commercial |
$713.24
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$517.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$764.19
|
| Rate for Payer: United Healthcare Commercial |
$917.03
|
| Rate for Payer: United Healthcare Managed Medicare |
$601.16
|
|
