|
dapsone 25 mg Tab [VDMC]
|
Facility
|
OP
|
$8.09
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10380882
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Aetna of IA Commercial |
$7.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7.28
|
| Rate for Payer: Aetna of IA Medicare |
$4.61
|
| Rate for Payer: Amerigroup Medicaid |
$4.67
|
| Rate for Payer: Amerigroup Medicare |
$3.68
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6.07
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4.62
|
| Rate for Payer: Medical Associates Commercial |
$6.07
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.64
|
| Rate for Payer: Midlands Choice Commercial |
$5.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$4.19
|
| Rate for Payer: United Healthcare Commercial |
$7.28
|
| Rate for Payer: United Healthcare Managed Medicare |
$4.77
|
|
|
DAPTOmycin 350 mg SDV Inj [VDMC]
|
Facility
|
OP
|
$66.32
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
29259142
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$59.69 |
| Rate for Payer: Aetna of IA Commercial |
$59.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.69
|
| Rate for Payer: Aetna of IA Medicare |
$37.80
|
| Rate for Payer: Amerigroup Medicaid |
$38.25
|
| Rate for Payer: Amerigroup Medicare |
$30.14
|
| Rate for Payer: Cash Price |
$53.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.74
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.84
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.88
|
| Rate for Payer: Medical Associates Commercial |
$49.74
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.84
|
| Rate for Payer: Midlands Choice Commercial |
$46.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.32
|
| Rate for Payer: United Healthcare Commercial |
$59.69
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.13
|
|
|
DAPTOmycin 350 mg SDV Inj [VDMC]
|
Facility
|
IP
|
$66.32
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
29259142
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$46.42 |
| Max. Negotiated Rate |
$59.69 |
| Rate for Payer: Aetna of IA Commercial |
$59.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.69
|
| Rate for Payer: Cash Price |
$53.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.74
|
| Rate for Payer: Medical Associates Commercial |
$49.74
|
| Rate for Payer: Midlands Choice Commercial |
$46.42
|
| Rate for Payer: United Healthcare Commercial |
$59.69
|
|
|
DAPTOmycin 500 mg SDV IV Inj [VDMC]
|
Facility
|
IP
|
$77.12
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
10380951
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.98 |
| Max. Negotiated Rate |
$69.41 |
| Rate for Payer: Aetna of IA Commercial |
$69.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.41
|
| Rate for Payer: Cash Price |
$61.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.84
|
| Rate for Payer: Medical Associates Commercial |
$57.84
|
| Rate for Payer: Midlands Choice Commercial |
$53.98
|
| Rate for Payer: United Healthcare Commercial |
$69.41
|
|
|
DAPTOmycin 500 mg SDV IV Inj [VDMC]
|
Facility
|
OP
|
$77.12
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
10380951
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$69.41 |
| Rate for Payer: Aetna of IA Commercial |
$69.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.41
|
| Rate for Payer: Aetna of IA Medicare |
$43.96
|
| Rate for Payer: Amerigroup Medicaid |
$44.48
|
| Rate for Payer: Amerigroup Medicare |
$35.05
|
| Rate for Payer: Cash Price |
$61.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.84
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$44.05
|
| Rate for Payer: Medical Associates Commercial |
$57.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.70
|
| Rate for Payer: Midlands Choice Commercial |
$53.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.91
|
| Rate for Payer: United Healthcare Commercial |
$69.41
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.50
|
|
|
daratumumab-hyaluronidase 1800 mg-30,000 units/15 mL Sol SDV [VDMC]
|
Facility
|
IP
|
$21,138.02
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
22278141
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14,796.61 |
| Max. Negotiated Rate |
$19,024.22 |
| Rate for Payer: Aetna of IA Commercial |
$19,024.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19,024.22
|
| Rate for Payer: Cash Price |
$16,910.42
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15,853.51
|
| Rate for Payer: Medical Associates Commercial |
$15,853.51
|
| Rate for Payer: Midlands Choice Commercial |
$14,796.61
|
| Rate for Payer: United Healthcare Commercial |
$19,024.22
|
|
|
daratumumab-hyaluronidase 1800 mg-30,000 units/15 mL Sol SDV [VDMC]
|
Facility
|
OP
|
$21,138.02
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
22278141
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9,512.11 |
| Max. Negotiated Rate |
$19,024.22 |
| Rate for Payer: Aetna of IA Commercial |
$19,024.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19,024.22
|
| Rate for Payer: Aetna of IA Medicare |
$12,048.67
|
| Rate for Payer: Amerigroup Medicaid |
$12,192.41
|
| Rate for Payer: Amerigroup Medicare |
$9,607.23
|
| Rate for Payer: Cash Price |
$16,910.42
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15,853.51
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9,512.11
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12,074.04
|
| Rate for Payer: Medical Associates Commercial |
$15,853.51
|
| Rate for Payer: Medical Associates Managed Medicare |
$9,512.11
|
| Rate for Payer: Midlands Choice Commercial |
$14,796.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,251.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$10,938.93
|
| Rate for Payer: United Healthcare Commercial |
$19,024.22
|
| Rate for Payer: United Healthcare Managed Medicare |
$12,471.43
|
|
|
darbepoetin alfa 100 mcg/0.5ml PFS [VDMC]
|
Facility
|
IP
|
$1,592.33
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
19999298
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,114.63 |
| Max. Negotiated Rate |
$1,433.09 |
| Rate for Payer: Aetna of IA Commercial |
$1,433.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,433.09
|
| Rate for Payer: Cash Price |
$1,273.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,194.24
|
| Rate for Payer: Medical Associates Commercial |
$1,194.24
|
| Rate for Payer: Midlands Choice Commercial |
$1,114.63
|
| Rate for Payer: United Healthcare Commercial |
$1,433.09
|
|
|
darbepoetin alfa 100 mcg/0.5ml PFS [VDMC]
|
Facility
|
OP
|
$1,592.33
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
19999298
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$716.55 |
| Max. Negotiated Rate |
$1,433.09 |
| Rate for Payer: Aetna of IA Commercial |
$1,433.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,433.09
|
| Rate for Payer: Aetna of IA Medicare |
$907.63
|
| Rate for Payer: Amerigroup Medicaid |
$918.45
|
| Rate for Payer: Amerigroup Medicare |
$723.71
|
| Rate for Payer: Cash Price |
$1,273.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,194.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$716.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$909.54
|
| Rate for Payer: Medical Associates Commercial |
$1,194.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$716.55
|
| Rate for Payer: Midlands Choice Commercial |
$1,114.63
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$922.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$824.03
|
| Rate for Payer: United Healthcare Commercial |
$1,433.09
|
| Rate for Payer: United Healthcare Managed Medicare |
$939.47
|
|
|
darbepoetin alfa 200 mcg/0.4 mL SDV Inj [VDMC]
|
Facility
|
OP
|
$3,084.66
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
10381018
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,388.10 |
| Max. Negotiated Rate |
$2,776.19 |
| Rate for Payer: Aetna of IA Commercial |
$2,776.19
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,776.19
|
| Rate for Payer: Aetna of IA Medicare |
$1,758.26
|
| Rate for Payer: Amerigroup Medicaid |
$1,779.23
|
| Rate for Payer: Amerigroup Medicare |
$1,401.98
|
| Rate for Payer: Cash Price |
$2,467.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,313.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,388.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,761.96
|
| Rate for Payer: Medical Associates Commercial |
$2,313.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,388.10
|
| Rate for Payer: Midlands Choice Commercial |
$2,159.26
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,787.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,596.31
|
| Rate for Payer: United Healthcare Commercial |
$2,776.19
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,819.95
|
|
|
darbepoetin alfa 200 mcg/0.4 mL SDV Inj [VDMC]
|
Facility
|
IP
|
$3,084.66
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
10381018
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2,159.26 |
| Max. Negotiated Rate |
$2,776.19 |
| Rate for Payer: Aetna of IA Commercial |
$2,776.19
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,776.19
|
| Rate for Payer: Cash Price |
$2,467.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,313.50
|
| Rate for Payer: Medical Associates Commercial |
$2,313.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,159.26
|
| Rate for Payer: United Healthcare Commercial |
$2,776.19
|
|
|
darbepoetin alfa 300 mcg/0.6 mL SDS [VDMC]
|
Facility
|
IP
|
$4,577.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
20945683
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3,203.90 |
| Max. Negotiated Rate |
$4,119.30 |
| Rate for Payer: Aetna of IA Commercial |
$4,119.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,119.30
|
| Rate for Payer: Cash Price |
$3,661.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,432.75
|
| Rate for Payer: Medical Associates Commercial |
$3,432.75
|
| Rate for Payer: Midlands Choice Commercial |
$3,203.90
|
| Rate for Payer: United Healthcare Commercial |
$4,119.30
|
|
|
darbepoetin alfa 300 mcg/0.6 mL SDS [VDMC]
|
Facility
|
OP
|
$4,577.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
20945683
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2,059.65 |
| Max. Negotiated Rate |
$4,119.30 |
| Rate for Payer: Aetna of IA Commercial |
$4,119.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,119.30
|
| Rate for Payer: Aetna of IA Medicare |
$2,608.89
|
| Rate for Payer: Amerigroup Medicaid |
$2,640.01
|
| Rate for Payer: Amerigroup Medicare |
$2,080.25
|
| Rate for Payer: Cash Price |
$3,661.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,432.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,059.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,614.38
|
| Rate for Payer: Medical Associates Commercial |
$3,432.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,059.65
|
| Rate for Payer: Midlands Choice Commercial |
$3,203.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,652.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,368.60
|
| Rate for Payer: United Healthcare Commercial |
$4,119.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,700.43
|
|
|
DAT POLY TUBE
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
7912827
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
|
|
DAT POLY TUBE
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
7912827
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$55.45 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Aetna of IA Medicare |
$33.06
|
| Rate for Payer: Amerigroup Medicaid |
$33.45
|
| Rate for Payer: Amerigroup Medicare |
$26.36
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.13
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.10
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.02
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.22
|
| Rate for Payer: Wellmark IA HMO WHPI |
$50.34
|
| Rate for Payer: Wellmark IA PPO |
$55.45
|
|
|
DBL LOADED 4.75MM BIO-COM SWVLK
|
Facility
|
IP
|
$1,073.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8760621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$751.10 |
| Max. Negotiated Rate |
$965.70 |
| Rate for Payer: Aetna of IA Commercial |
$965.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$965.70
|
| Rate for Payer: Cash Price |
$858.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$804.75
|
| Rate for Payer: Medical Associates Commercial |
$804.75
|
| Rate for Payer: Midlands Choice Commercial |
$751.10
|
| Rate for Payer: United Healthcare Commercial |
$965.70
|
|
|
DBL LOADED 4.75MM BIO-COM SWVLK
|
Facility
|
OP
|
$1,073.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8760621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.85 |
| Max. Negotiated Rate |
$965.70 |
| Rate for Payer: Aetna of IA Commercial |
$965.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$965.70
|
| Rate for Payer: Aetna of IA Medicare |
$611.61
|
| Rate for Payer: Amerigroup Medicaid |
$618.91
|
| Rate for Payer: Amerigroup Medicare |
$487.68
|
| Rate for Payer: Cash Price |
$858.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$804.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$482.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$612.90
|
| Rate for Payer: Medical Associates Commercial |
$804.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$482.85
|
| Rate for Payer: Midlands Choice Commercial |
$751.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$621.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$555.28
|
| Rate for Payer: United Healthcare Commercial |
$965.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$633.07
|
|
|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC
|
Facility
|
IP
|
$10,554.91
|
|
|
Service Code
|
MSDRG 744
|
| Min. Negotiated Rate |
$10,401.93 |
| Max. Negotiated Rate |
$10,554.91 |
| Rate for Payer: Amerigroup Medicaid |
$10,503.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10,401.93
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,554.91
|
|
|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC
|
Facility
|
IP
|
$10,554.91
|
|
|
Service Code
|
MSDRG 745
|
| Min. Negotiated Rate |
$10,401.93 |
| Max. Negotiated Rate |
$10,554.91 |
| Rate for Payer: Amerigroup Medicaid |
$10,503.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10,401.93
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,554.91
|
|
|
DDIMER
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
8057341
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of IA Commercial |
$69.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.30
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.75
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
|
|
DDIMER
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
8057341
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.07 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of IA Commercial |
$69.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.30
|
| Rate for Payer: Aetna of IA Medicare |
$43.89
|
| Rate for Payer: Amerigroup Medicaid |
$44.41
|
| Rate for Payer: Amerigroup Medicare |
$35.00
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.98
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.65
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.85
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.43
|
| Rate for Payer: Wellmark IA HMO WHPI |
$29.07
|
| Rate for Payer: Wellmark IA PPO |
$32.02
|
|
|
DDIMER
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
633718
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.07 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of IA Commercial |
$69.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.30
|
| Rate for Payer: Aetna of IA Medicare |
$43.89
|
| Rate for Payer: Amerigroup Medicaid |
$44.41
|
| Rate for Payer: Amerigroup Medicare |
$35.00
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.98
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.65
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.85
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.43
|
| Rate for Payer: Wellmark IA HMO WHPI |
$29.07
|
| Rate for Payer: Wellmark IA PPO |
$32.02
|
|
|
DDIMER
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
633718
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of IA Commercial |
$69.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.30
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.75
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
|
|
DEB BONE 20 SQ CM/<
|
Facility
|
OP
|
$2,345.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
7983000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$4,090.88 |
| Rate for Payer: Aetna of IA Commercial |
$2,110.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,110.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,336.65
|
| Rate for Payer: Amerigroup Medicaid |
$1,352.60
|
| Rate for Payer: Amerigroup Medicare |
$1,065.80
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,758.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,055.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,339.46
|
| Rate for Payer: Medical Associates Commercial |
$1,758.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,055.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,641.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,359.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,213.54
|
| Rate for Payer: United Healthcare Commercial |
$2,110.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,383.55
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,713.74
|
| Rate for Payer: Wellmark IA PPO |
$4,090.88
|
|
|
DEB BONE 20 SQ CM/<
|
Facility
|
IP
|
$2,345.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
7983000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,641.50 |
| Max. Negotiated Rate |
$2,110.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,110.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,110.50
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,758.75
|
| Rate for Payer: Medical Associates Commercial |
$1,758.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,641.50
|
| Rate for Payer: United Healthcare Commercial |
$2,110.50
|
|
