|
IMPL SYS, BIO-COMP ACHILLES MID-SUBSTANCE
|
Facility
|
OP
|
$1,755.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8784972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$789.75 |
| Max. Negotiated Rate |
$1,579.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,579.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,579.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,000.35
|
| Rate for Payer: Amerigroup Medicaid |
$1,012.28
|
| Rate for Payer: Amerigroup Medicare |
$797.65
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,316.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$789.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,002.46
|
| Rate for Payer: Medical Associates Commercial |
$1,316.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$789.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,228.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,017.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$908.21
|
| Rate for Payer: United Healthcare Commercial |
$1,579.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,035.45
|
|
|
IMPL SYS, BIO-COMP ACHILLES MID-SUBSTANCE
|
Facility
|
IP
|
$1,755.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8784972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.50 |
| Max. Negotiated Rate |
$1,579.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,579.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,579.50
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,316.25
|
| Rate for Payer: Medical Associates Commercial |
$1,316.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,228.50
|
| Rate for Payer: United Healthcare Commercial |
$1,579.50
|
|
|
INCISE EXTERNAL HEMORRHOID
|
Professional
|
Both
|
$588.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
7982770
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$289.36 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Medical Associates Commercial |
$441.00
|
| Rate for Payer: Midlands Choice Commercial |
$411.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$441.00
|
| Rate for Payer: United Healthcare Commercial |
$289.36
|
|
|
INCISE EXTERNAL HEMORRHOID
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
4864972
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.60 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna of IA Commercial |
$475.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$475.20
|
| Rate for Payer: Aetna of IA Medicare |
$300.96
|
| Rate for Payer: Amerigroup Medicaid |
$304.55
|
| Rate for Payer: Amerigroup Medicare |
$239.98
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$396.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$237.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$301.59
|
| Rate for Payer: Medical Associates Commercial |
$396.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$237.60
|
| Rate for Payer: Midlands Choice Commercial |
$369.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$306.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$273.24
|
| Rate for Payer: United Healthcare Commercial |
$475.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$311.52
|
|
|
INCISE EXTERNAL HEMORRHOID
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
4864972
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna of IA Commercial |
$475.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$475.20
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$396.00
|
| Rate for Payer: Medical Associates Commercial |
$396.00
|
| Rate for Payer: Midlands Choice Commercial |
$369.60
|
| Rate for Payer: United Healthcare Commercial |
$475.20
|
|
|
INCISION AND DRAINAGE
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
7982860
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$183.09 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Medical Associates Commercial |
$228.00
|
| Rate for Payer: Midlands Choice Commercial |
$212.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$228.00
|
| Rate for Payer: United Healthcare Commercial |
$183.09
|
|
|
INCISION OF ANAL ABSCESS
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
4864971
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$852.30 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,704.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,704.60
|
| Rate for Payer: Aetna of IA Medicare |
$1,079.58
|
| Rate for Payer: Amerigroup Medicaid |
$1,092.46
|
| Rate for Payer: Amerigroup Medicare |
$860.82
|
| Rate for Payer: Cash Price |
$1,515.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,420.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$852.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,081.85
|
| Rate for Payer: Medical Associates Commercial |
$1,420.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$852.30
|
| Rate for Payer: Midlands Choice Commercial |
$1,325.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,097.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$980.14
|
| Rate for Payer: United Healthcare Commercial |
$1,704.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,117.46
|
|
|
INCISION OF ANAL ABSCESS
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
4864971
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,325.80 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,704.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,704.60
|
| Rate for Payer: Cash Price |
$1,515.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,420.50
|
| Rate for Payer: Medical Associates Commercial |
$1,420.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,325.80
|
| Rate for Payer: United Healthcare Commercial |
$1,704.60
|
|
|
INCISION OF BREAST LESION
|
Facility
|
OP
|
$2,068.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
7982928
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$930.60 |
| Max. Negotiated Rate |
$1,861.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,861.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,861.20
|
| Rate for Payer: Aetna of IA Medicare |
$1,178.76
|
| Rate for Payer: Amerigroup Medicaid |
$1,192.82
|
| Rate for Payer: Amerigroup Medicare |
$939.91
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,551.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$930.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,181.24
|
| Rate for Payer: Medical Associates Commercial |
$1,551.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$930.60
|
| Rate for Payer: Midlands Choice Commercial |
$1,447.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,198.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,070.19
|
| Rate for Payer: United Healthcare Commercial |
$1,861.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,220.12
|
|
|
INCISION OF BREAST LESION
|
Facility
|
IP
|
$2,068.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
7982928
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,447.60 |
| Max. Negotiated Rate |
$1,861.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,861.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,861.20
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,551.00
|
| Rate for Payer: Medical Associates Commercial |
$1,551.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,447.60
|
| Rate for Payer: United Healthcare Commercial |
$1,861.20
|
|
|
INCISION OF RECTAL ABSCESS
|
Facility
|
IP
|
$2,317.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
4864970
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,621.90 |
| Max. Negotiated Rate |
$2,085.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,085.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,085.30
|
| Rate for Payer: Cash Price |
$1,853.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,737.75
|
| Rate for Payer: Medical Associates Commercial |
$1,737.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,621.90
|
| Rate for Payer: United Healthcare Commercial |
$2,085.30
|
|
|
INCISION OF RECTAL ABSCESS
|
Professional
|
Both
|
$1,788.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
7982771
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$821.15 |
| Max. Negotiated Rate |
$1,341.00 |
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Medical Associates Commercial |
$1,341.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,251.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,341.00
|
| Rate for Payer: United Healthcare Commercial |
$821.15
|
|
|
INCISION OF RECTAL ABSCESS
|
Facility
|
OP
|
$2,317.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
4864970
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,042.65 |
| Max. Negotiated Rate |
$2,085.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,085.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,085.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,320.69
|
| Rate for Payer: Amerigroup Medicaid |
$1,336.45
|
| Rate for Payer: Amerigroup Medicare |
$1,053.08
|
| Rate for Payer: Cash Price |
$1,853.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,737.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,042.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,323.47
|
| Rate for Payer: Medical Associates Commercial |
$1,737.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,042.65
|
| Rate for Payer: Midlands Choice Commercial |
$1,621.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,342.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,199.05
|
| Rate for Payer: United Healthcare Commercial |
$2,085.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,367.03
|
|
|
INCISION OF TONGUE FOLD
|
Facility
|
OP
|
$1,663.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
7982938
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$748.35 |
| Max. Negotiated Rate |
$1,496.70 |
| Rate for Payer: Aetna of IA Commercial |
$1,496.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,496.70
|
| Rate for Payer: Aetna of IA Medicare |
$947.91
|
| Rate for Payer: Amerigroup Medicaid |
$959.22
|
| Rate for Payer: Amerigroup Medicare |
$755.83
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,247.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$748.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$949.91
|
| Rate for Payer: Medical Associates Commercial |
$1,247.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$748.35
|
| Rate for Payer: Midlands Choice Commercial |
$1,164.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$963.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$860.60
|
| Rate for Payer: United Healthcare Commercial |
$1,496.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$981.17
|
|
|
INCISION OF TONGUE FOLD
|
Facility
|
IP
|
$1,663.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
7982938
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,164.10 |
| Max. Negotiated Rate |
$1,496.70 |
| Rate for Payer: Aetna of IA Commercial |
$1,496.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,496.70
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,247.25
|
| Rate for Payer: Medical Associates Commercial |
$1,247.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,164.10
|
| Rate for Payer: United Healthcare Commercial |
$1,496.70
|
|
|
inclisiran 284 mg/1.5 mL Sol [VDMC]
|
Facility
|
OP
|
$6,999.48
|
|
|
Service Code
|
HCPCS J1306
|
| Hospital Charge Code |
28747277
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3,149.77 |
| Max. Negotiated Rate |
$6,299.53 |
| Rate for Payer: Aetna of IA Commercial |
$6,299.53
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,299.53
|
| Rate for Payer: Aetna of IA Medicare |
$3,989.70
|
| Rate for Payer: Amerigroup Medicaid |
$4,037.30
|
| Rate for Payer: Amerigroup Medicare |
$3,181.26
|
| Rate for Payer: Cash Price |
$5,599.58
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,249.61
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,149.77
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,998.10
|
| Rate for Payer: Medical Associates Commercial |
$5,249.61
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,149.77
|
| Rate for Payer: Midlands Choice Commercial |
$4,899.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,056.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,622.23
|
| Rate for Payer: United Healthcare Commercial |
$6,299.53
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,129.69
|
|
|
inclisiran 284 mg/1.5 mL Sol [VDMC]
|
Facility
|
IP
|
$6,999.48
|
|
|
Service Code
|
HCPCS J1306
|
| Hospital Charge Code |
28747277
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4,899.64 |
| Max. Negotiated Rate |
$6,299.53 |
| Rate for Payer: Aetna of IA Commercial |
$6,299.53
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,299.53
|
| Rate for Payer: Cash Price |
$5,599.58
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,249.61
|
| Rate for Payer: Medical Associates Commercial |
$5,249.61
|
| Rate for Payer: Midlands Choice Commercial |
$4,899.64
|
| Rate for Payer: United Healthcare Commercial |
$6,299.53
|
|
|
INC/REPL SPINE NSTIM PG/RCVR
|
Professional
|
Both
|
$1,229.00
|
|
|
Service Code
|
CPT 63685
|
| Hospital Charge Code |
8015885
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$542.26 |
| Max. Negotiated Rate |
$921.75 |
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Medical Associates Commercial |
$921.75
|
| Rate for Payer: Midlands Choice Commercial |
$860.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$921.75
|
| Rate for Payer: United Healthcare Commercial |
$542.26
|
|
|
indapamide 2.5 mg Tab [VDMC]
|
Facility
|
IP
|
$1.39
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10396186
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Aetna of IA Commercial |
$1.25
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.25
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.04
|
| Rate for Payer: Medical Associates Commercial |
$1.04
|
| Rate for Payer: Midlands Choice Commercial |
$0.97
|
| Rate for Payer: United Healthcare Commercial |
$1.25
|
|
|
indapamide 2.5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.39
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10396186
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Aetna of IA Commercial |
$1.25
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.25
|
| Rate for Payer: Aetna of IA Medicare |
$0.79
|
| Rate for Payer: Amerigroup Medicaid |
$0.80
|
| Rate for Payer: Amerigroup Medicare |
$0.63
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.79
|
| Rate for Payer: Medical Associates Commercial |
$1.04
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.62
|
| Rate for Payer: Midlands Choice Commercial |
$0.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.72
|
| Rate for Payer: United Healthcare Commercial |
$1.25
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.82
|
|
|
INDIVIDUAL PSYCHOTHERAPHY 60 MIN
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
CPT 90837 AJ|HO
|
| Hospital Charge Code |
4849289
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$218.35 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Medical Associates Commercial |
$272.25
|
| Rate for Payer: Midlands Choice Commercial |
$254.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$272.25
|
| Rate for Payer: United Healthcare Commercial |
$218.35
|
|
|
INDIVIDUAL PSYCHOTHERAPY 45 MIN
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
CPT 90834 AJ|HO
|
| Hospital Charge Code |
4849288
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$145.73 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Medical Associates Commercial |
$272.25
|
| Rate for Payer: Midlands Choice Commercial |
$254.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$272.25
|
| Rate for Payer: United Healthcare Commercial |
$145.73
|
|
|
indocyanine green 25 mg Pow SDV [VDMC]
|
Facility
|
IP
|
$514.76
|
|
|
Service Code
|
HCPCS C9776
|
| Hospital Charge Code |
27084544
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$360.33 |
| Max. Negotiated Rate |
$463.28 |
| Rate for Payer: Aetna of IA Commercial |
$463.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$463.28
|
| Rate for Payer: Cash Price |
$411.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$386.07
|
| Rate for Payer: Medical Associates Commercial |
$386.07
|
| Rate for Payer: Midlands Choice Commercial |
$360.33
|
| Rate for Payer: United Healthcare Commercial |
$463.28
|
|
|
indocyanine green 25 mg Pow SDV [VDMC]
|
Facility
|
OP
|
$514.76
|
|
|
Service Code
|
HCPCS C9776
|
| Hospital Charge Code |
27084544
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$231.64 |
| Max. Negotiated Rate |
$463.28 |
| Rate for Payer: Aetna of IA Commercial |
$463.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$463.28
|
| Rate for Payer: Aetna of IA Medicare |
$293.41
|
| Rate for Payer: Amerigroup Medicaid |
$296.91
|
| Rate for Payer: Amerigroup Medicare |
$233.96
|
| Rate for Payer: Cash Price |
$411.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$386.07
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$231.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$294.03
|
| Rate for Payer: Medical Associates Commercial |
$386.07
|
| Rate for Payer: Medical Associates Managed Medicare |
$231.64
|
| Rate for Payer: Midlands Choice Commercial |
$360.33
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$298.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$266.39
|
| Rate for Payer: United Healthcare Commercial |
$463.28
|
| Rate for Payer: United Healthcare Managed Medicare |
$303.71
|
|
|
indomethacin 25 mg Cap [VDMC]
|
Facility
|
OP
|
$1.25
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10396322
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of IA Commercial |
$1.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.13
|
| Rate for Payer: Aetna of IA Medicare |
$0.71
|
| Rate for Payer: Amerigroup Medicaid |
$0.72
|
| Rate for Payer: Amerigroup Medicare |
$0.57
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.94
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.71
|
| Rate for Payer: Medical Associates Commercial |
$0.94
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.56
|
| Rate for Payer: Midlands Choice Commercial |
$0.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.65
|
| Rate for Payer: United Healthcare Commercial |
$1.13
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.74
|
|
