|
lidocaine-EPINEPHrine 2%-1:100,000 Inj MDV 20 mL[VDMC]
|
Facility
|
OP
|
$38.32
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10386509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$34.49
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.49
|
| Rate for Payer: Aetna of IA Medicare |
$21.84
|
| Rate for Payer: Amerigroup Medicaid |
$22.10
|
| Rate for Payer: Amerigroup Medicare |
$17.42
|
| Rate for Payer: Cash Price |
$30.66
|
| Rate for Payer: Cash Price |
$30.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.74
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.89
|
| Rate for Payer: Medical Associates Commercial |
$28.74
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.25
|
| Rate for Payer: Midlands Choice Commercial |
$26.83
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.83
|
| Rate for Payer: United Healthcare Commercial |
$34.49
|
| Rate for Payer: United Healthcare Managed Medicare |
$22.61
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
lidocaine-EPINEPHrine 2%-1:200,000- PF Inj 10 mL SDV [VDMC]
|
Facility
|
IP
|
$31.41
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10386643
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$28.27 |
| Rate for Payer: Aetna of IA Commercial |
$28.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.27
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.56
|
| Rate for Payer: Medical Associates Commercial |
$23.56
|
| Rate for Payer: Midlands Choice Commercial |
$21.99
|
| Rate for Payer: United Healthcare Commercial |
$28.27
|
|
|
lidocaine-EPINEPHrine 2%-1:200,000- PF Inj 10 mL SDV [VDMC]
|
Facility
|
OP
|
$31.41
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10386643
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.27
|
| Rate for Payer: Aetna of IA Medicare |
$17.90
|
| Rate for Payer: Amerigroup Medicaid |
$18.12
|
| Rate for Payer: Amerigroup Medicare |
$14.27
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.56
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.13
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.94
|
| Rate for Payer: Medical Associates Commercial |
$23.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.13
|
| Rate for Payer: Midlands Choice Commercial |
$21.99
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.25
|
| Rate for Payer: United Healthcare Commercial |
$28.27
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.53
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
lidocaine in D5W 2000 mg sol 4 mg/ml 500ml [VDMC]
|
Facility
|
IP
|
$63.36
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
10432832
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$44.35 |
| Max. Negotiated Rate |
$57.02 |
| Rate for Payer: Aetna of IA Commercial |
$57.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.02
|
| Rate for Payer: Cash Price |
$50.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.52
|
| Rate for Payer: Medical Associates Commercial |
$47.52
|
| Rate for Payer: Midlands Choice Commercial |
$44.35
|
| Rate for Payer: United Healthcare Commercial |
$57.02
|
|
|
lidocaine in D5W 2000 mg sol 4 mg/ml 500ml [VDMC]
|
Facility
|
OP
|
$63.36
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
10432832
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.51 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$57.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.02
|
| Rate for Payer: Aetna of IA Medicare |
$36.12
|
| Rate for Payer: Amerigroup Medicaid |
$36.55
|
| Rate for Payer: Amerigroup Medicare |
$28.80
|
| Rate for Payer: Cash Price |
$50.69
|
| Rate for Payer: Cash Price |
$50.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.51
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.19
|
| Rate for Payer: Medical Associates Commercial |
$47.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.51
|
| Rate for Payer: Midlands Choice Commercial |
$44.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$32.79
|
| Rate for Payer: United Healthcare Commercial |
$57.02
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.38
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
lidocaine-prilocaine Top 2.5%-2.5% kit [VDMC]
|
Facility
|
OP
|
$35.18
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10429506
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.83 |
| Max. Negotiated Rate |
$31.67 |
| Rate for Payer: Aetna of IA Commercial |
$31.67
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.67
|
| Rate for Payer: Aetna of IA Medicare |
$20.05
|
| Rate for Payer: Amerigroup Medicaid |
$20.29
|
| Rate for Payer: Amerigroup Medicare |
$15.99
|
| Rate for Payer: Cash Price |
$28.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.39
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.83
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.10
|
| Rate for Payer: Medical Associates Commercial |
$26.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.83
|
| Rate for Payer: Midlands Choice Commercial |
$24.63
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.21
|
| Rate for Payer: United Healthcare Commercial |
$31.67
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.76
|
|
|
lidocaine-prilocaine Top 2.5%-2.5% kit [VDMC]
|
Facility
|
IP
|
$35.18
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10429506
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.63 |
| Max. Negotiated Rate |
$31.67 |
| Rate for Payer: Aetna of IA Commercial |
$31.67
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.67
|
| Rate for Payer: Cash Price |
$28.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.39
|
| Rate for Payer: Medical Associates Commercial |
$26.39
|
| Rate for Payer: Midlands Choice Commercial |
$24.63
|
| Rate for Payer: United Healthcare Commercial |
$31.67
|
|
|
lidocaine Top 2% Gel w/Appl 5 ML [VDMC]
|
Facility
|
IP
|
$28.79
|
|
|
Service Code
|
NDC 76329-3012-05
|
| Hospital Charge Code |
10435444
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$25.91 |
| Rate for Payer: Aetna of IA Commercial |
$25.91
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.91
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.59
|
| Rate for Payer: Medical Associates Commercial |
$21.59
|
| Rate for Payer: Midlands Choice Commercial |
$20.15
|
| Rate for Payer: United Healthcare Commercial |
$25.91
|
|
|
lidocaine Top 2% Gel w/Appl 5 ML [VDMC]
|
Facility
|
OP
|
$28.79
|
|
|
Service Code
|
NDC 76329-3012-05
|
| Hospital Charge Code |
10435444
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$25.91 |
| Rate for Payer: Aetna of IA Commercial |
$25.91
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.91
|
| Rate for Payer: Aetna of IA Medicare |
$16.41
|
| Rate for Payer: Amerigroup Medicaid |
$16.61
|
| Rate for Payer: Amerigroup Medicare |
$13.09
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.59
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.45
|
| Rate for Payer: Medical Associates Commercial |
$21.59
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.96
|
| Rate for Payer: Midlands Choice Commercial |
$20.15
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.90
|
| Rate for Payer: United Healthcare Commercial |
$25.91
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.99
|
|
|
lidocaine topical 2% Viscous Sol [VDMC]
|
Facility
|
OP
|
$22.37
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222149
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$20.13 |
| Rate for Payer: Aetna of IA Commercial |
$20.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.13
|
| Rate for Payer: Aetna of IA Medicare |
$12.75
|
| Rate for Payer: Amerigroup Medicaid |
$12.90
|
| Rate for Payer: Amerigroup Medicare |
$10.17
|
| Rate for Payer: Cash Price |
$17.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.77
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.78
|
| Rate for Payer: Medical Associates Commercial |
$16.77
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.06
|
| Rate for Payer: Midlands Choice Commercial |
$15.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.57
|
| Rate for Payer: United Healthcare Commercial |
$20.13
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.20
|
|
|
lidocaine topical 2% Viscous Sol [VDMC]
|
Facility
|
IP
|
$22.37
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222149
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$20.13 |
| Rate for Payer: Aetna of IA Commercial |
$20.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.13
|
| Rate for Payer: Cash Price |
$17.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.77
|
| Rate for Payer: Medical Associates Commercial |
$16.77
|
| Rate for Payer: Midlands Choice Commercial |
$15.66
|
| Rate for Payer: United Healthcare Commercial |
$20.13
|
|
|
lidocaine Topical 4% Sol 50ml[VDMC]
|
Facility
|
OP
|
$15.40
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10435511
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$13.86 |
| Rate for Payer: Aetna of IA Commercial |
$13.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.86
|
| Rate for Payer: Aetna of IA Medicare |
$8.78
|
| Rate for Payer: Amerigroup Medicaid |
$8.88
|
| Rate for Payer: Amerigroup Medicare |
$7.00
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.55
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.93
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.79
|
| Rate for Payer: Medical Associates Commercial |
$11.55
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.93
|
| Rate for Payer: Midlands Choice Commercial |
$10.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.97
|
| Rate for Payer: United Healthcare Commercial |
$13.86
|
| Rate for Payer: United Healthcare Managed Medicare |
$9.08
|
|
|
lidocaine Topical 4% Sol 50ml[VDMC]
|
Facility
|
IP
|
$15.40
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10435511
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$13.86 |
| Rate for Payer: Aetna of IA Commercial |
$13.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.86
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.55
|
| Rate for Payer: Medical Associates Commercial |
$11.55
|
| Rate for Payer: Midlands Choice Commercial |
$10.78
|
| Rate for Payer: United Healthcare Commercial |
$13.86
|
|
|
lidocaine Top Patch 5% film [VDMC]
|
Facility
|
OP
|
$15.29
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10435576
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$13.76 |
| Rate for Payer: Aetna of IA Commercial |
$13.76
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.76
|
| Rate for Payer: Aetna of IA Medicare |
$8.72
|
| Rate for Payer: Amerigroup Medicaid |
$8.82
|
| Rate for Payer: Amerigroup Medicare |
$6.95
|
| Rate for Payer: Cash Price |
$12.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.47
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.74
|
| Rate for Payer: Medical Associates Commercial |
$11.47
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.88
|
| Rate for Payer: Midlands Choice Commercial |
$10.71
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.91
|
| Rate for Payer: United Healthcare Commercial |
$13.76
|
| Rate for Payer: United Healthcare Managed Medicare |
$9.02
|
|
|
lidocaine Top Patch 5% film [VDMC]
|
Facility
|
IP
|
$15.29
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10435576
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$13.76 |
| Rate for Payer: Aetna of IA Commercial |
$13.76
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.76
|
| Rate for Payer: Cash Price |
$12.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.47
|
| Rate for Payer: Medical Associates Commercial |
$11.47
|
| Rate for Payer: Midlands Choice Commercial |
$10.71
|
| Rate for Payer: United Healthcare Commercial |
$13.76
|
|
|
LIGATION OF HEMORRHOID(S)
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
4864973
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$366.75 |
| Max. Negotiated Rate |
$4,161.95 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Aetna of IA Medicare |
$464.55
|
| Rate for Payer: Amerigroup Medicaid |
$470.09
|
| Rate for Payer: Amerigroup Medicare |
$370.42
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$366.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$465.53
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$366.75
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$472.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$421.76
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$480.85
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,778.26
|
| Rate for Payer: Wellmark IA PPO |
$4,161.95
|
|
|
LIGATION OF HEMORRHOID(S)
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
4864973
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$570.50 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
|
|
Light Chains Quantitative DMCL
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
8037726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of IA Commercial |
$117.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$97.50
|
| Rate for Payer: Medical Associates Commercial |
$97.50
|
| Rate for Payer: Midlands Choice Commercial |
$91.00
|
| Rate for Payer: United Healthcare Commercial |
$117.00
|
|
|
Light Chains Quantitative DMCL
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
8037726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.83 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of IA Commercial |
$117.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.00
|
| Rate for Payer: Aetna of IA Medicare |
$74.10
|
| Rate for Payer: Amerigroup Medicaid |
$74.98
|
| Rate for Payer: Amerigroup Medicare |
$59.08
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$97.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$58.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.26
|
| Rate for Payer: Medical Associates Commercial |
$97.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.50
|
| Rate for Payer: Midlands Choice Commercial |
$91.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$67.28
|
| Rate for Payer: United Healthcare Commercial |
$117.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.70
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$54,738.25
|
|
|
Service Code
|
MSDRG 956
|
| Min. Negotiated Rate |
$53,944.91 |
| Max. Negotiated Rate |
$54,738.25 |
| Rate for Payer: Amerigroup Medicaid |
$54,473.79
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$53,944.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$54,738.25
|
|
|
linaclotide 145 mcg Cap [VDMC]
|
Facility
|
OP
|
$67.31
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10400672
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$60.57 |
| Rate for Payer: Aetna of IA Commercial |
$60.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.57
|
| Rate for Payer: Aetna of IA Medicare |
$38.36
|
| Rate for Payer: Amerigroup Medicaid |
$38.82
|
| Rate for Payer: Amerigroup Medicare |
$30.59
|
| Rate for Payer: Cash Price |
$53.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.48
|
| 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 |
$38.44
|
| Rate for Payer: Medical Associates Commercial |
$50.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.29
|
| Rate for Payer: Midlands Choice Commercial |
$47.11
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.83
|
| Rate for Payer: United Healthcare Commercial |
$60.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.71
|
|
|
linaclotide 145 mcg Cap [VDMC]
|
Facility
|
IP
|
$67.31
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10400672
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.11 |
| Max. Negotiated Rate |
$60.57 |
| Rate for Payer: Aetna of IA Commercial |
$60.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.57
|
| Rate for Payer: Cash Price |
$53.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.48
|
| Rate for Payer: Medical Associates Commercial |
$50.48
|
| Rate for Payer: Midlands Choice Commercial |
$47.11
|
| Rate for Payer: United Healthcare Commercial |
$60.57
|
|
|
linagliptin 5 mg Tab [VDMC]
|
Facility
|
IP
|
$51.23
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10400810
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.86 |
| Max. Negotiated Rate |
$46.11 |
| Rate for Payer: Aetna of IA Commercial |
$46.11
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.11
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.42
|
| Rate for Payer: Medical Associates Commercial |
$38.42
|
| Rate for Payer: Midlands Choice Commercial |
$35.86
|
| Rate for Payer: United Healthcare Commercial |
$46.11
|
|
|
linagliptin 5 mg Tab [VDMC]
|
Facility
|
OP
|
$51.23
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10400810
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.05 |
| Max. Negotiated Rate |
$46.11 |
| Rate for Payer: Aetna of IA Commercial |
$46.11
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.11
|
| Rate for Payer: Aetna of IA Medicare |
$29.20
|
| Rate for Payer: Amerigroup Medicaid |
$29.55
|
| Rate for Payer: Amerigroup Medicare |
$23.28
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.26
|
| Rate for Payer: Medical Associates Commercial |
$38.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.05
|
| Rate for Payer: Midlands Choice Commercial |
$35.86
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.51
|
| Rate for Payer: United Healthcare Commercial |
$46.11
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.23
|
|
|
linezolid 2 mg/mL-D5% 300ml [VDMC]
|
Facility
|
OP
|
$84.92
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
16670233
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.21 |
| Max. Negotiated Rate |
$76.43 |
| Rate for Payer: Aetna of IA Commercial |
$76.43
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.43
|
| Rate for Payer: Aetna of IA Medicare |
$48.40
|
| Rate for Payer: Amerigroup Medicaid |
$48.98
|
| Rate for Payer: Amerigroup Medicare |
$38.60
|
| Rate for Payer: Cash Price |
$67.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.69
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.21
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$48.51
|
| Rate for Payer: Medical Associates Commercial |
$63.69
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.21
|
| Rate for Payer: Midlands Choice Commercial |
$59.44
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.95
|
| Rate for Payer: United Healthcare Commercial |
$76.43
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.10
|
|
