|
CMPLX RPR F/C/C/M/N/AX/G/H/F
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
4863430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of IA Commercial |
$342.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$342.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$285.00
|
| Rate for Payer: Medical Associates Commercial |
$285.00
|
| Rate for Payer: Midlands Choice Commercial |
$266.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
|
|
CMPLX RPR F/C/C/M/N/AX/G/H/F
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
4863431
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$260.55 |
| Max. Negotiated Rate |
$903.62 |
| Rate for Payer: Aetna of IA Commercial |
$521.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$521.10
|
| Rate for Payer: Aetna of IA Medicare |
$330.03
|
| Rate for Payer: Amerigroup Medicaid |
$333.97
|
| Rate for Payer: Amerigroup Medicare |
$263.16
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$434.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$260.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$330.72
|
| Rate for Payer: Medical Associates Commercial |
$434.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$260.55
|
| Rate for Payer: Midlands Choice Commercial |
$405.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$335.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$299.63
|
| Rate for Payer: United Healthcare Commercial |
$521.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$341.61
|
| Rate for Payer: Wellmark IA HMO WHPI |
$820.31
|
| Rate for Payer: Wellmark IA PPO |
$903.62
|
|
|
CMPLX RPR F/C/C/M/N/AX/G/H/F
|
Professional
|
Both
|
$1,277.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
7982820
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$375.53 |
| Max. Negotiated Rate |
$1,009.60 |
| Rate for Payer: Amerigroup Medicaid |
$379.22
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$375.53
|
| Rate for Payer: Medical Associates Commercial |
$957.75
|
| Rate for Payer: Midlands Choice Commercial |
$893.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$377.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$957.75
|
| Rate for Payer: United Healthcare Commercial |
$723.20
|
| Rate for Payer: Wellmark IA HMO WHPI |
$858.10
|
| Rate for Payer: Wellmark IA PPO |
$1,009.60
|
|
|
CMPLX RPR S/A/L 2.6-7.5 CM
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
4863424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$903.62 |
| Rate for Payer: Aetna of IA Commercial |
$472.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$472.50
|
| Rate for Payer: Aetna of IA Medicare |
$299.25
|
| Rate for Payer: Amerigroup Medicaid |
$302.82
|
| Rate for Payer: Amerigroup Medicare |
$238.61
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$393.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$236.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$299.88
|
| Rate for Payer: Medical Associates Commercial |
$393.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$236.25
|
| Rate for Payer: Midlands Choice Commercial |
$367.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$304.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$271.69
|
| Rate for Payer: United Healthcare Commercial |
$472.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$309.75
|
| Rate for Payer: Wellmark IA HMO WHPI |
$820.31
|
| Rate for Payer: Wellmark IA PPO |
$903.62
|
|
|
CMPLX RPR S/A/L 2.6-7.5 CM
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
4863424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna of IA Commercial |
$472.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$472.50
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$393.75
|
| Rate for Payer: Medical Associates Commercial |
$393.75
|
| Rate for Payer: Midlands Choice Commercial |
$367.50
|
| Rate for Payer: United Healthcare Commercial |
$472.50
|
|
|
CMPLX RPR S/A/L 2.6-7.5 CM
|
Professional
|
Both
|
$1,415.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
7982821
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$270.08 |
| Max. Negotiated Rate |
$1,061.25 |
| Rate for Payer: Amerigroup Medicaid |
$272.72
|
| Rate for Payer: Cash Price |
$1,132.00
|
| Rate for Payer: Cash Price |
$1,132.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$270.08
|
| Rate for Payer: Medical Associates Commercial |
$1,061.25
|
| Rate for Payer: Midlands Choice Commercial |
$990.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$271.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,061.25
|
| Rate for Payer: United Healthcare Commercial |
$650.54
|
| Rate for Payer: Wellmark IA HMO WHPI |
$775.50
|
| Rate for Payer: Wellmark IA PPO |
$912.30
|
|
|
CMPLX RPR S/A/L ADDL 5 CM/>
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
4863426
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.35 |
| Max. Negotiated Rate |
$903.62 |
| Rate for Payer: Aetna of IA Commercial |
$218.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$218.70
|
| Rate for Payer: Aetna of IA Medicare |
$138.51
|
| Rate for Payer: Amerigroup Medicaid |
$140.16
|
| Rate for Payer: Amerigroup Medicare |
$110.44
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$182.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$109.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$138.80
|
| Rate for Payer: Medical Associates Commercial |
$182.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$109.35
|
| Rate for Payer: Midlands Choice Commercial |
$170.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$140.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$125.75
|
| Rate for Payer: United Healthcare Commercial |
$218.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$143.37
|
| Rate for Payer: Wellmark IA HMO WHPI |
$820.31
|
| Rate for Payer: Wellmark IA PPO |
$903.62
|
|
|
CMPLX RPR S/A/L ADDL 5 CM/>
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
4863426
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.10 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Aetna of IA Commercial |
$218.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$218.70
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$182.25
|
| Rate for Payer: Medical Associates Commercial |
$182.25
|
| Rate for Payer: Midlands Choice Commercial |
$170.10
|
| Rate for Payer: United Healthcare Commercial |
$218.70
|
|
|
CMPLX RPR TRUNK 2.6-7.5 CM
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
4863412
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$405.30 |
| Max. Negotiated Rate |
$521.10 |
| Rate for Payer: Aetna of IA Commercial |
$521.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$521.10
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$434.25
|
| Rate for Payer: Medical Associates Commercial |
$434.25
|
| Rate for Payer: Midlands Choice Commercial |
$405.30
|
| Rate for Payer: United Healthcare Commercial |
$521.10
|
|
|
CMPLX RPR TRUNK 2.6-7.5 CM
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
4863412
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$260.55 |
| Max. Negotiated Rate |
$903.62 |
| Rate for Payer: Aetna of IA Commercial |
$521.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$521.10
|
| Rate for Payer: Aetna of IA Medicare |
$330.03
|
| Rate for Payer: Amerigroup Medicaid |
$333.97
|
| Rate for Payer: Amerigroup Medicare |
$263.16
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$434.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$260.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$330.72
|
| Rate for Payer: Medical Associates Commercial |
$434.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$260.55
|
| Rate for Payer: Midlands Choice Commercial |
$405.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$335.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$299.63
|
| Rate for Payer: United Healthcare Commercial |
$521.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$341.61
|
| Rate for Payer: Wellmark IA HMO WHPI |
$820.31
|
| Rate for Payer: Wellmark IA PPO |
$903.62
|
|
|
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 |
$117.00 |
| 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: Aetna of IA Medicare |
$148.20
|
| Rate for Payer: Amerigroup Medicaid |
$149.97
|
| Rate for Payer: Amerigroup Medicare |
$118.17
|
| 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 |
$117.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$148.51
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$117.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$150.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$134.55
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.40
|
| Rate for Payer: Wellmark IA HMO WHPI |
$185.05
|
| Rate for Payer: Wellmark IA PPO |
$203.84
|
|
|
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
|
|
|
CNBT INITIAL 1ST HOUR
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
6594783
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$117.00 |
| 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: Aetna of IA Medicare |
$148.20
|
| Rate for Payer: Amerigroup Medicaid |
$149.97
|
| Rate for Payer: Amerigroup Medicare |
$118.17
|
| 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 |
$117.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$148.51
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$117.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$150.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$134.55
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.40
|
| Rate for Payer: Wellmark IA HMO WHPI |
$185.05
|
| Rate for Payer: Wellmark IA PPO |
$203.84
|
|
|
COAGULATION DISORDERS
|
Facility
|
IP
|
$10,758.71
|
|
|
Service Code
|
MSDRG 813
|
| Min. Negotiated Rate |
$10,602.78 |
| Max. Negotiated Rate |
$10,758.71 |
| Rate for Payer: Amerigroup Medicaid |
$10,706.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10,602.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,758.71
|
|
|
coagulation factor IX 2000 IU/5 mL recombinant [VDMC]
|
Facility
|
OP
|
$4,445.20
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
28525009
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2,000.34 |
| Max. Negotiated Rate |
$4,000.68 |
| Rate for Payer: Aetna of IA Commercial |
$4,000.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,000.68
|
| Rate for Payer: Aetna of IA Medicare |
$2,533.76
|
| Rate for Payer: Amerigroup Medicaid |
$2,563.99
|
| Rate for Payer: Amerigroup Medicare |
$2,020.34
|
| Rate for Payer: Cash Price |
$3,556.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,333.90
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,000.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,539.10
|
| Rate for Payer: Medical Associates Commercial |
$3,333.90
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,000.34
|
| Rate for Payer: Midlands Choice Commercial |
$3,111.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,576.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,300.39
|
| Rate for Payer: United Healthcare Commercial |
$4,000.68
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,622.67
|
|
|
coagulation factor IX 2000 IU/5 mL recombinant [VDMC]
|
Facility
|
IP
|
$4,445.20
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
28525009
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3,111.64 |
| Max. Negotiated Rate |
$4,000.68 |
| Rate for Payer: Aetna of IA Commercial |
$4,000.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,000.68
|
| Rate for Payer: Cash Price |
$3,556.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,333.90
|
| Rate for Payer: Medical Associates Commercial |
$3,333.90
|
| Rate for Payer: Midlands Choice Commercial |
$3,111.64
|
| Rate for Payer: United Healthcare Commercial |
$4,000.68
|
|
|
CoEnzyme Q-10 100 mg Cap
|
Facility
|
OP
|
$1.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
19626908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| 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 |
$0.88
|
| Rate for Payer: Amerigroup Medicare |
$0.69
|
| 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 |
$0.68
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.87
|
| Rate for Payer: Medical Associates Commercial |
$1.14
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.68
|
| Rate for Payer: Midlands Choice Commercial |
$1.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.90
|
|
|
CoEnzyme Q-10 100 mg Cap
|
Facility
|
IP
|
$1.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
19626908
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
|
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 |
$155.70 |
| Max. Negotiated Rate |
$503.75 |
| 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 |
$199.57
|
| Rate for Payer: Amerigroup Medicare |
$157.26
|
| Rate for Payer: Cash Price |
$276.80
|
| 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 |
$155.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$197.64
|
| Rate for Payer: Medical Associates Commercial |
$259.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$155.70
|
| Rate for Payer: Midlands Choice Commercial |
$242.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$200.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$179.06
|
| Rate for Payer: United Healthcare Commercial |
$311.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$204.14
|
| Rate for Payer: Wellmark IA HMO WHPI |
$457.31
|
| Rate for Payer: Wellmark IA PPO |
$503.75
|
|
|
COGNITIVE DEV 15 MIN
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 97532 GN
|
| Hospital Charge Code |
1373954
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$39.60 |
| 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: Aetna of IA Medicare |
$50.16
|
| Rate for Payer: Amerigroup Medicaid |
$50.76
|
| Rate for Payer: Amerigroup Medicare |
$40.00
|
| 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 |
$39.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$50.27
|
| Rate for Payer: Medical Associates Commercial |
$66.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$39.60
|
| Rate for Payer: Midlands Choice Commercial |
$61.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$51.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.54
|
| Rate for Payer: United Healthcare Commercial |
$79.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$51.92
|
|
|
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 TRAINING/PER 15 MIN
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 97532 GO
|
| Hospital Charge Code |
1373452
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.70 |
| 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 |
$49.60
|
| Rate for Payer: Amerigroup Medicare |
$39.09
|
| 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 |
$38.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.12
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.70
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.50
|
| 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
|
|
