|
Complete Blood Count w Man Diff DMCL
|
Facility
OP
|
$66.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
8037516
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.86 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna of IA Commercial |
$59.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.40
|
| Rate for Payer: Aetna of IA Medicare |
$37.62
|
| Rate for Payer: Amerigroup Medicaid |
$33.31
|
| Rate for Payer: Amerigroup Medicare |
$33.33
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.99
|
| Rate for Payer: Medical Associates Commercial |
$49.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.00
|
| Rate for Payer: Midlands Choice Commercial |
$46.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$59.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.94
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
|
Complete Blood Count w Man Diff DMCL
|
Facility
IP
|
$66.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
8037516
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna of IA Commercial |
$59.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.50
|
| Rate for Payer: Medical Associates Commercial |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$59.40
|
|
|
Complicated Peptic Ulcer With CC
|
Facility
IP
|
$7,809.95
|
|
|
Service Code
|
MS-DRG 381
|
| Hospital Charge Code |
222
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,809.95 |
| Rate for Payer: Amerigroup Medicaid |
$7,772.23
|
| 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 |
$7,696.77
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,809.95
|
|
|
Complicated Peptic Ulcer With MCC
|
Facility
IP
|
$14,224.26
|
|
|
Service Code
|
MS-DRG 380
|
| Hospital Charge Code |
221
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$14,224.26 |
| Rate for Payer: Amerigroup Medicaid |
$14,155.55
|
| 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 |
$14,018.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14,224.26
|
|
|
Complicated Peptic Ulcer Without CC/MCC
|
Facility
IP
|
$7,078.67
|
|
|
Service Code
|
MS-DRG 382
|
| Hospital Charge Code |
223
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,078.67 |
| Rate for Payer: Amerigroup Medicaid |
$7,044.47
|
| 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 |
$6,976.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,078.67
|
|
|
Complications of Treatment With CC
|
Facility
IP
|
$9,673.13
|
|
|
Service Code
|
MS-DRG 920
|
| Hospital Charge Code |
638
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,673.13 |
| Rate for Payer: Amerigroup Medicaid |
$9,626.40
|
| 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 |
$9,532.94
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,673.13
|
|
|
Complications of Treatment With MCC
|
Facility
IP
|
$12,469.36
|
|
|
Service Code
|
MS-DRG 919
|
| Hospital Charge Code |
637
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$12,469.36 |
| Rate for Payer: Amerigroup Medicaid |
$12,409.12
|
| 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 |
$12,288.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,469.36
|
|
|
Complications of Treatment Without CC/MCC
|
Facility
IP
|
$4,681.06
|
|
|
Service Code
|
MS-DRG 921
|
| Hospital Charge Code |
639
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$4,681.06 |
| Rate for Payer: Amerigroup Medicaid |
$4,658.44
|
| 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 |
$4,613.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,681.06
|
|
|
COMPOSITE CORKSCREW 5.5 SUTURE ANCHOR
|
Facility
OP
|
$549.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.39 |
| Max. Negotiated Rate |
$494.10 |
| Rate for Payer: Aetna of IA Commercial |
$494.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$494.10
|
| Rate for Payer: Aetna of IA Medicare |
$312.93
|
| Rate for Payer: Amerigroup Medicaid |
$277.08
|
| Rate for Payer: Amerigroup Medicare |
$277.24
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$411.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$274.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$274.39
|
| Rate for Payer: Medical Associates Commercial |
$411.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$274.50
|
| Rate for Payer: Midlands Choice Commercial |
$384.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$278.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$411.75
|
| Rate for Payer: United Healthcare Commercial |
$494.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$323.91
|
|
|
COMPOSITE CORKSCREW 5.5 SUTURE ANCHOR
|
Facility
IP
|
$549.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.30 |
| Max. Negotiated Rate |
$494.10 |
| Rate for Payer: Aetna of IA Commercial |
$494.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$494.10
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$411.75
|
| Rate for Payer: Medical Associates Commercial |
$411.75
|
| Rate for Payer: Midlands Choice Commercial |
$384.30
|
| Rate for Payer: United Healthcare Commercial |
$494.10
|
|
|
COMPREHENSIVE METABOLIC PANEL
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
633709
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.08 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| 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 |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
| Rate for Payer: Wellmark IA HMO |
$52.08
|
| Rate for Payer: Wellmark IA PPO |
$57.29
|
|
|
COMPREHENSIVE METABOLIC PANEL
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
633709
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
COMPUTER XM OK
|
Facility
IP
|
$73.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
6306782
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
|
|
COMPUTER XM OK
|
Facility
OP
|
$73.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
6306782
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Aetna of IA Medicare |
$41.61
|
| Rate for Payer: Amerigroup Medicaid |
$36.84
|
| Rate for Payer: Amerigroup Medicare |
$36.86
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.49
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.50
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.75
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.07
|
| Rate for Payer: Wellmark IA HMO |
$97.34
|
| Rate for Payer: Wellmark IA PPO |
$107.07
|
|
|
CONCELLTRATE 100 2.5CC JAR
|
Facility
IP
|
$2,205.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.50 |
| Max. Negotiated Rate |
$1,984.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,984.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,984.50
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,653.75
|
| Rate for Payer: Medical Associates Commercial |
$1,653.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,543.50
|
| Rate for Payer: United Healthcare Commercial |
$1,984.50
|
|
|
CONCELLTRATE 100 2.5CC JAR
|
Facility
OP
|
$2,205.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.06 |
| Max. Negotiated Rate |
$1,984.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,984.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,984.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,256.85
|
| Rate for Payer: Amerigroup Medicaid |
$1,112.86
|
| Rate for Payer: Amerigroup Medicare |
$1,113.52
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,653.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,102.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,102.06
|
| Rate for Payer: Medical Associates Commercial |
$1,653.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,102.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,543.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,119.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,653.75
|
| Rate for Payer: United Healthcare Commercial |
$1,984.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,300.95
|
|
|
CONCELLTRATE 100 5.0CC JAR
|
Facility
IP
|
$3,069.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,148.30 |
| Max. Negotiated Rate |
$2,762.10 |
| Rate for Payer: Aetna of IA Commercial |
$2,762.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,762.10
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,301.75
|
| Rate for Payer: Medical Associates Commercial |
$2,301.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,148.30
|
| Rate for Payer: United Healthcare Commercial |
$2,762.10
|
|
|
CONCELLTRATE 100 5.0CC JAR
|
Facility
OP
|
$3,069.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,533.89 |
| Max. Negotiated Rate |
$2,762.10 |
| Rate for Payer: Aetna of IA Commercial |
$2,762.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,762.10
|
| Rate for Payer: Aetna of IA Medicare |
$1,749.33
|
| Rate for Payer: Amerigroup Medicaid |
$1,548.92
|
| Rate for Payer: Amerigroup Medicare |
$1,549.84
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,301.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,534.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,533.89
|
| Rate for Payer: Medical Associates Commercial |
$2,301.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,534.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,148.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,557.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,301.75
|
| Rate for Payer: United Healthcare Commercial |
$2,762.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,810.71
|
|
|
Concussion With CC
|
Facility
IP
|
$8,835.54
|
|
|
Service Code
|
MS-DRG 089
|
| Hospital Charge Code |
769
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,835.54 |
| Rate for Payer: Amerigroup Medicaid |
$8,792.85
|
| 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 |
$8,707.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,835.54
|
|
|
Concussion With MCC
|
Facility
IP
|
$14,366.97
|
|
|
Service Code
|
MS-DRG 088
|
| Hospital Charge Code |
768
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$14,366.97 |
| Rate for Payer: Amerigroup Medicaid |
$14,297.56
|
| 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 |
$14,158.75
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14,366.97
|
|
|
Concussion Without CC/MCC
|
Facility
IP
|
$5,034.40
|
|
|
Service Code
|
MS-DRG 090
|
| Hospital Charge Code |
770
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,034.40 |
| Rate for Payer: Amerigroup Medicaid |
$5,010.07
|
| 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 |
$4,961.43
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,034.40
|
|
|
conivaptan 20 mg/100 mL-D5% Sol SDV
|
Facility
OP
|
$2,252.16
|
|
|
Service Code
|
CPT C9488
|
| Hospital Charge Code |
43784515
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,125.63 |
| Max. Negotiated Rate |
$2,026.94 |
| Rate for Payer: Aetna of IA Commercial |
$2,026.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,026.94
|
| Rate for Payer: Aetna of IA Medicare |
$1,283.73
|
| Rate for Payer: Amerigroup Medicaid |
$1,136.67
|
| Rate for Payer: Amerigroup Medicare |
$1,137.34
|
| Rate for Payer: Cash Price |
$1,801.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,689.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,126.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,125.63
|
| Rate for Payer: Medical Associates Commercial |
$1,689.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,126.08
|
| Rate for Payer: Midlands Choice Commercial |
$1,576.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,142.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,689.12
|
| Rate for Payer: United Healthcare Commercial |
$2,026.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,328.77
|
|
|
conivaptan 20 mg/100 mL-D5% Sol SDV
|
Facility
IP
|
$2,252.16
|
|
|
Service Code
|
CPT C9488
|
| Hospital Charge Code |
43784515
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,576.51 |
| Max. Negotiated Rate |
$2,026.94 |
| Rate for Payer: Aetna of IA Commercial |
$2,026.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,026.94
|
| Rate for Payer: Cash Price |
$1,801.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,689.12
|
| Rate for Payer: Medical Associates Commercial |
$1,689.12
|
| Rate for Payer: Midlands Choice Commercial |
$1,576.51
|
| Rate for Payer: United Healthcare Commercial |
$2,026.94
|
|
|
conjugated estrogens topical 0.625 mg/g Cre
|
Facility
IP
|
$1,531.04
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,071.73 |
| Max. Negotiated Rate |
$1,377.94 |
| Rate for Payer: Aetna of IA Commercial |
$1,377.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,377.94
|
| Rate for Payer: Cash Price |
$1,224.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,148.28
|
| Rate for Payer: Medical Associates Commercial |
$1,148.28
|
| Rate for Payer: Midlands Choice Commercial |
$1,071.73
|
| Rate for Payer: United Healthcare Commercial |
$1,377.94
|
|
|
conjugated estrogens topical 0.625 mg/g Cre
|
Facility
OP
|
$1,531.04
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$765.21 |
| Max. Negotiated Rate |
$1,377.94 |
| Rate for Payer: Aetna of IA Commercial |
$1,377.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,377.94
|
| Rate for Payer: Aetna of IA Medicare |
$872.69
|
| Rate for Payer: Amerigroup Medicaid |
$772.72
|
| Rate for Payer: Amerigroup Medicare |
$773.18
|
| Rate for Payer: Cash Price |
$1,224.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,148.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$765.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$765.21
|
| Rate for Payer: Medical Associates Commercial |
$1,148.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$765.52
|
| Rate for Payer: Midlands Choice Commercial |
$1,071.73
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$777.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,148.28
|
| Rate for Payer: United Healthcare Commercial |
$1,377.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$903.31
|
|
