|
EMERGENCY INTUBATION
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
8059060
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$142.44 |
| Max. Negotiated Rate |
$1,815.48 |
| Rate for Payer: Aetna of IA Commercial |
$256.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$256.50
|
| Rate for Payer: Aetna of IA Medicare |
$162.45
|
| Rate for Payer: Amerigroup Medicaid |
$143.84
|
| Rate for Payer: Amerigroup Medicare |
$143.92
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$213.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$142.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$142.44
|
| Rate for Payer: Medical Associates Commercial |
$213.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$142.50
|
| Rate for Payer: Midlands Choice Commercial |
$199.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$144.64
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$144.55
|
| Rate for Payer: Oscar Health of IA Commercial |
$213.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$213.75
|
| Rate for Payer: United Healthcare Commercial |
$256.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$168.15
|
| Rate for Payer: Wellmark IA HMO |
$1,650.44
|
| Rate for Payer: Wellmark IA PPO |
$1,815.48
|
|
|
emollients, topical - Cre [VDMC]
|
Facility
|
OP
|
$27.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222638
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$24.77 |
| Rate for Payer: Aetna of IA Commercial |
$24.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.77
|
| Rate for Payer: Aetna of IA Medicare |
$15.69
|
| Rate for Payer: Amerigroup Medicaid |
$13.89
|
| Rate for Payer: Amerigroup Medicare |
$13.90
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.75
|
| Rate for Payer: Medical Associates Commercial |
$20.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.76
|
| Rate for Payer: Midlands Choice Commercial |
$19.26
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.97
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$13.96
|
| Rate for Payer: Oscar Health of IA Commercial |
$20.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.64
|
| Rate for Payer: United Healthcare Commercial |
$24.77
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.24
|
|
|
emollients, topical - Cre [VDMC]
|
Facility
|
IP
|
$27.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222638
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$24.77 |
| Rate for Payer: Aetna of IA Commercial |
$24.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.77
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.64
|
| Rate for Payer: Medical Associates Commercial |
$20.64
|
| Rate for Payer: Midlands Choice Commercial |
$19.26
|
| Rate for Payer: United Healthcare Commercial |
$24.77
|
|
|
empagliflozin 10 mg Tab [VDMC]
|
Facility
|
IP
|
$60.58
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
16938348
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$54.52 |
| Rate for Payer: Aetna of IA Commercial |
$54.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.52
|
| Rate for Payer: Cash Price |
$48.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.44
|
| Rate for Payer: Medical Associates Commercial |
$45.44
|
| Rate for Payer: Midlands Choice Commercial |
$42.41
|
| Rate for Payer: United Healthcare Commercial |
$54.52
|
|
|
empagliflozin 10 mg Tab [VDMC]
|
Facility
|
OP
|
$60.58
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
16938348
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$54.52 |
| Rate for Payer: Aetna of IA Commercial |
$54.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.52
|
| Rate for Payer: Aetna of IA Medicare |
$34.53
|
| Rate for Payer: Amerigroup Medicaid |
$30.57
|
| Rate for Payer: Amerigroup Medicare |
$30.59
|
| Rate for Payer: Cash Price |
$48.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.29
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.28
|
| Rate for Payer: Medical Associates Commercial |
$45.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.29
|
| Rate for Payer: Midlands Choice Commercial |
$42.41
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.74
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$30.73
|
| Rate for Payer: Oscar Health of IA Commercial |
$45.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.44
|
| Rate for Payer: United Healthcare Commercial |
$54.52
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.74
|
|
|
empagliflozin 25 mg Tab UD [VDMC]
|
Facility
|
OP
|
$60.58
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23268393
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$54.52 |
| Rate for Payer: Aetna of IA Commercial |
$54.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.52
|
| Rate for Payer: Aetna of IA Medicare |
$34.53
|
| Rate for Payer: Amerigroup Medicaid |
$30.57
|
| Rate for Payer: Amerigroup Medicare |
$30.59
|
| Rate for Payer: Cash Price |
$48.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.29
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.28
|
| Rate for Payer: Medical Associates Commercial |
$45.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.29
|
| Rate for Payer: Midlands Choice Commercial |
$42.41
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.74
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$30.73
|
| Rate for Payer: Oscar Health of IA Commercial |
$45.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.44
|
| Rate for Payer: United Healthcare Commercial |
$54.52
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.74
|
|
|
empagliflozin 25 mg Tab UD [VDMC]
|
Facility
|
IP
|
$60.58
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23268393
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$54.52 |
| Rate for Payer: Aetna of IA Commercial |
$54.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.52
|
| Rate for Payer: Cash Price |
$48.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.44
|
| Rate for Payer: Medical Associates Commercial |
$45.44
|
| Rate for Payer: Midlands Choice Commercial |
$42.41
|
| Rate for Payer: United Healthcare Commercial |
$54.52
|
|
|
enalaprilat 1.25 mg/mL 1ml SDV [VDMC]
|
Facility
|
OP
|
$35.91
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10385557
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$32.32 |
| Rate for Payer: Aetna of IA Commercial |
$32.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.32
|
| Rate for Payer: Aetna of IA Medicare |
$20.47
|
| Rate for Payer: Amerigroup Medicaid |
$18.12
|
| Rate for Payer: Amerigroup Medicare |
$18.13
|
| Rate for Payer: Cash Price |
$28.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.93
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.95
|
| Rate for Payer: Medical Associates Commercial |
$26.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.96
|
| Rate for Payer: Midlands Choice Commercial |
$25.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.22
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$18.21
|
| Rate for Payer: Oscar Health of IA Commercial |
$26.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.93
|
| Rate for Payer: United Healthcare Commercial |
$32.32
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.19
|
|
|
enalaprilat 1.25 mg/mL 1ml SDV [VDMC]
|
Facility
|
IP
|
$35.91
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10385557
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.14 |
| Max. Negotiated Rate |
$32.32 |
| Rate for Payer: Aetna of IA Commercial |
$32.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.32
|
| Rate for Payer: Cash Price |
$28.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.93
|
| Rate for Payer: Medical Associates Commercial |
$26.93
|
| Rate for Payer: Midlands Choice Commercial |
$25.14
|
| Rate for Payer: United Healthcare Commercial |
$32.32
|
|
|
enalapril maleate 5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.18
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10431638
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Aetna of IA Commercial |
$1.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.06
|
| Rate for Payer: Aetna of IA Medicare |
$0.67
|
| Rate for Payer: Amerigroup Medicaid |
$0.60
|
| Rate for Payer: Amerigroup Medicare |
$0.60
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.89
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.59
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.59
|
| Rate for Payer: Medical Associates Commercial |
$0.89
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.59
|
| Rate for Payer: Midlands Choice Commercial |
$0.83
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.60
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.60
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.89
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.70
|
|
|
enalapril maleate 5 mg Tab [VDMC]
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10431638
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Aetna of IA Commercial |
$1.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.06
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.89
|
| Rate for Payer: Medical Associates Commercial |
$0.89
|
| Rate for Payer: Midlands Choice Commercial |
$0.83
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
|
|
ENDO CLIP CARTRIDGE
|
Facility
|
OP
|
$94.00
|
|
| Hospital Charge Code |
8026309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of IA Commercial |
$84.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$84.60
|
| Rate for Payer: Aetna of IA Medicare |
$53.58
|
| Rate for Payer: Amerigroup Medicaid |
$47.44
|
| Rate for Payer: Amerigroup Medicare |
$47.47
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$70.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$47.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$46.98
|
| Rate for Payer: Medical Associates Commercial |
$70.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.00
|
| Rate for Payer: Midlands Choice Commercial |
$65.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$47.70
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$47.68
|
| Rate for Payer: Oscar Health of IA Commercial |
$70.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$70.50
|
| Rate for Payer: United Healthcare Commercial |
$84.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$55.46
|
|
|
ENDO CLIP CARTRIDGE
|
Facility
|
IP
|
$94.00
|
|
| Hospital Charge Code |
8026309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of IA Commercial |
$84.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$84.60
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$70.50
|
| Rate for Payer: Medical Associates Commercial |
$70.50
|
| Rate for Payer: Midlands Choice Commercial |
$65.80
|
| Rate for Payer: United Healthcare Commercial |
$84.60
|
|
|
Endocrine Disorders With CC
|
Facility
|
IP
|
$6,898.54
|
|
|
Service Code
|
MS-DRG 644
|
| Hospital Charge Code |
430
|
| Min. Negotiated Rate |
$6,798.57 |
| Max. Negotiated Rate |
$6,898.54 |
| Rate for Payer: Amerigroup Medicaid |
$6,865.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,798.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,898.54
|
|
|
Endocrine Disorders With MCC
|
Facility
|
IP
|
$10,931.97
|
|
|
Service Code
|
MS-DRG 643
|
| Hospital Charge Code |
429
|
| Min. Negotiated Rate |
$10,773.54 |
| Max. Negotiated Rate |
$10,931.97 |
| Rate for Payer: Amerigroup Medicaid |
$10,879.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10,773.54
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,931.97
|
|
|
Endocrine Disorders Without CC/MCC
|
Facility
|
IP
|
$5,322.78
|
|
|
Service Code
|
MS-DRG 645
|
| Hospital Charge Code |
431
|
| Min. Negotiated Rate |
$5,245.64 |
| Max. Negotiated Rate |
$5,322.78 |
| Rate for Payer: Amerigroup Medicaid |
$5,297.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5,245.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,322.78
|
|
|
ENDO GIA 30 2.5 (SULU) LOADING UNIT
|
Facility
|
IP
|
$1,141.00
|
|
| Hospital Charge Code |
8047001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,026.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,026.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,026.90
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$855.75
|
| Rate for Payer: Medical Associates Commercial |
$855.75
|
| Rate for Payer: Midlands Choice Commercial |
$798.70
|
| Rate for Payer: United Healthcare Commercial |
$1,026.90
|
|
|
ENDO GIA 30 2.5 (SULU) LOADING UNIT
|
Facility
|
OP
|
$1,141.00
|
|
| Hospital Charge Code |
8047001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.27 |
| Max. Negotiated Rate |
$1,026.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,026.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,026.90
|
| Rate for Payer: Aetna of IA Medicare |
$650.37
|
| Rate for Payer: Amerigroup Medicaid |
$575.86
|
| Rate for Payer: Amerigroup Medicare |
$576.20
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$855.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$570.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$570.27
|
| Rate for Payer: Medical Associates Commercial |
$855.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$570.50
|
| Rate for Payer: Midlands Choice Commercial |
$798.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$579.06
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$578.72
|
| Rate for Payer: Oscar Health of IA Commercial |
$855.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$855.75
|
| Rate for Payer: United Healthcare Commercial |
$1,026.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$673.19
|
|
|
ENDO GIA 30 3.5 LOAD
|
Facility
|
IP
|
$603.00
|
|
| Hospital Charge Code |
8025853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$422.10 |
| Max. Negotiated Rate |
$542.70 |
| Rate for Payer: Aetna of IA Commercial |
$542.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$542.70
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$452.25
|
| Rate for Payer: Medical Associates Commercial |
$452.25
|
| Rate for Payer: Midlands Choice Commercial |
$422.10
|
| Rate for Payer: United Healthcare Commercial |
$542.70
|
|
|
ENDO GIA 30 3.5 LOAD
|
Facility
|
OP
|
$603.00
|
|
| Hospital Charge Code |
8025853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$301.38 |
| Max. Negotiated Rate |
$542.70 |
| Rate for Payer: Aetna of IA Commercial |
$542.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$542.70
|
| Rate for Payer: Aetna of IA Medicare |
$343.71
|
| Rate for Payer: Amerigroup Medicaid |
$304.33
|
| Rate for Payer: Amerigroup Medicare |
$304.52
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$452.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$301.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$301.38
|
| Rate for Payer: Medical Associates Commercial |
$452.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$301.50
|
| Rate for Payer: Midlands Choice Commercial |
$422.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$306.02
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$305.84
|
| Rate for Payer: Oscar Health of IA Commercial |
$452.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$452.25
|
| Rate for Payer: United Healthcare Commercial |
$542.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$355.77
|
|
|
Endomysial IgA Antibody DMCL
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
8037839
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna of IA Commercial |
$103.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$103.50
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$86.25
|
| Rate for Payer: Medical Associates Commercial |
$86.25
|
| Rate for Payer: Midlands Choice Commercial |
$80.50
|
| Rate for Payer: United Healthcare Commercial |
$103.50
|
|
|
Endomysial IgA Antibody DMCL
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
8037839
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna of IA Commercial |
$103.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$103.50
|
| Rate for Payer: Aetna of IA Medicare |
$65.55
|
| Rate for Payer: Amerigroup Medicaid |
$58.04
|
| Rate for Payer: Amerigroup Medicare |
$58.08
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$86.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.48
|
| Rate for Payer: Medical Associates Commercial |
$86.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.50
|
| Rate for Payer: Midlands Choice Commercial |
$80.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$58.36
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$58.33
|
| Rate for Payer: Oscar Health of IA Commercial |
$86.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$86.25
|
| Rate for Payer: United Healthcare Commercial |
$103.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.85
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Endovascular Cardiac Valve Replacement and Supplement Procedures With MCC
|
Facility
|
IP
|
$61,018.05
|
|
|
Service Code
|
MS-DRG 266
|
| Hospital Charge Code |
128
|
| Min. Negotiated Rate |
$60,133.73 |
| Max. Negotiated Rate |
$61,018.05 |
| Rate for Payer: Amerigroup Medicaid |
$60,723.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$60,133.73
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$61,018.05
|
|
|
Endovascular Cardiac Valve Replacement and Supplement Procedures Without MCC
|
Facility
|
IP
|
$51,305.56
|
|
|
Service Code
|
MS-DRG 267
|
| Hospital Charge Code |
129
|
| Min. Negotiated Rate |
$50,562.00 |
| Max. Negotiated Rate |
$51,305.56 |
| Rate for Payer: Amerigroup Medicaid |
$51,057.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$50,562.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$51,305.56
|
|
|
enoxaparin 100 mg/mL 1ml SDV syringe [VDMC]
|
Facility
|
IP
|
$44.50
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
10385695
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.15 |
| Max. Negotiated Rate |
$40.05 |
| Rate for Payer: Aetna of IA Commercial |
$40.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.05
|
| Rate for Payer: Cash Price |
$35.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.38
|
| Rate for Payer: Medical Associates Commercial |
$33.38
|
| Rate for Payer: Midlands Choice Commercial |
$31.15
|
| Rate for Payer: United Healthcare Commercial |
$40.05
|
|
