|
mepivacaine 2% 20 ml SDV PF Inj Sol [VDMC]
|
Facility
|
IP
|
$59.88
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
28919314
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$41.91 |
| Max. Negotiated Rate |
$53.89 |
| Rate for Payer: Aetna of IA Commercial |
$53.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.89
|
| Rate for Payer: Cash Price |
$47.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.91
|
| Rate for Payer: Medical Associates Commercial |
$44.91
|
| Rate for Payer: Midlands Choice Commercial |
$41.91
|
| Rate for Payer: United Healthcare Commercial |
$53.89
|
|
|
mepolizumab 100 mg/mL Syringe PFS [VDMC]
|
Facility
|
OP
|
$7,477.66
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
23618580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3,364.95 |
| Max. Negotiated Rate |
$6,729.89 |
| Rate for Payer: Aetna of IA Commercial |
$6,729.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,729.89
|
| Rate for Payer: Aetna of IA Medicare |
$4,262.27
|
| Rate for Payer: Amerigroup Medicaid |
$4,313.11
|
| Rate for Payer: Amerigroup Medicare |
$3,398.60
|
| Rate for Payer: Cash Price |
$5,982.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,608.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,364.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,271.24
|
| Rate for Payer: Medical Associates Commercial |
$5,608.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,364.95
|
| Rate for Payer: Midlands Choice Commercial |
$5,234.36
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,334.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,869.69
|
| Rate for Payer: United Healthcare Commercial |
$6,729.89
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,411.82
|
|
|
mepolizumab 100 mg/mL Syringe PFS [VDMC]
|
Facility
|
IP
|
$7,477.66
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
23618580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5,234.36 |
| Max. Negotiated Rate |
$6,729.89 |
| Rate for Payer: Aetna of IA Commercial |
$6,729.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,729.89
|
| Rate for Payer: Cash Price |
$5,982.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,608.24
|
| Rate for Payer: Medical Associates Commercial |
$5,608.24
|
| Rate for Payer: Midlands Choice Commercial |
$5,234.36
|
| Rate for Payer: United Healthcare Commercial |
$6,729.89
|
|
|
meropenem 500 mg IV Inj SDV [VDMC]
|
Facility
|
IP
|
$27.96
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
10403376
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.57 |
| Max. Negotiated Rate |
$25.17 |
| Rate for Payer: Aetna of IA Commercial |
$25.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.17
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.97
|
| Rate for Payer: Medical Associates Commercial |
$20.97
|
| Rate for Payer: Midlands Choice Commercial |
$19.57
|
| Rate for Payer: United Healthcare Commercial |
$25.17
|
|
|
meropenem 500 mg IV Inj SDV [VDMC]
|
Facility
|
OP
|
$27.96
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
10403376
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$25.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.17
|
| Rate for Payer: Aetna of IA Medicare |
$15.94
|
| Rate for Payer: Amerigroup Medicaid |
$16.13
|
| Rate for Payer: Amerigroup Medicare |
$12.71
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.97
|
| Rate for Payer: Medical Associates Commercial |
$20.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.58
|
| Rate for Payer: Midlands Choice Commercial |
$19.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.47
|
| Rate for Payer: United Healthcare Commercial |
$25.17
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.50
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
mesalamine 250 mg ERCap [VDMC]
|
Facility
|
OP
|
$12.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403514
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Aetna of IA Commercial |
$10.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.90
|
| Rate for Payer: Aetna of IA Medicare |
$6.90
|
| Rate for Payer: Amerigroup Medicaid |
$6.99
|
| Rate for Payer: Amerigroup Medicare |
$5.51
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.08
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.92
|
| Rate for Payer: Medical Associates Commercial |
$9.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.45
|
| Rate for Payer: Midlands Choice Commercial |
$8.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$6.27
|
| Rate for Payer: United Healthcare Commercial |
$10.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.15
|
|
|
mesalamine 250 mg ERCap [VDMC]
|
Facility
|
IP
|
$12.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403514
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Aetna of IA Commercial |
$10.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.90
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.08
|
| Rate for Payer: Medical Associates Commercial |
$9.08
|
| Rate for Payer: Midlands Choice Commercial |
$8.48
|
| Rate for Payer: United Healthcare Commercial |
$10.90
|
|
|
mesalamine 400 mg Cap DR [VDMC]
|
Facility
|
IP
|
$7.18
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403583
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$6.46 |
| Rate for Payer: Aetna of IA Commercial |
$6.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.46
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.39
|
| Rate for Payer: Medical Associates Commercial |
$5.39
|
| Rate for Payer: Midlands Choice Commercial |
$5.03
|
| Rate for Payer: United Healthcare Commercial |
$6.46
|
|
|
mesalamine 400 mg Cap DR [VDMC]
|
Facility
|
OP
|
$7.18
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403583
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$6.46 |
| Rate for Payer: Aetna of IA Commercial |
$6.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.46
|
| Rate for Payer: Aetna of IA Medicare |
$4.09
|
| Rate for Payer: Amerigroup Medicaid |
$4.14
|
| Rate for Payer: Amerigroup Medicare |
$3.26
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.39
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.23
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4.10
|
| Rate for Payer: Medical Associates Commercial |
$5.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.23
|
| Rate for Payer: Midlands Choice Commercial |
$5.03
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.72
|
| Rate for Payer: United Healthcare Commercial |
$6.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$4.24
|
|
|
MESH COMPOSITE PARIETEX 10X8
|
Facility
|
IP
|
$1,554.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8047039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.80 |
| Max. Negotiated Rate |
$1,398.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,398.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,398.60
|
| Rate for Payer: Cash Price |
$1,243.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,165.50
|
| Rate for Payer: Medical Associates Commercial |
$1,165.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,087.80
|
| Rate for Payer: United Healthcare Commercial |
$1,398.60
|
|
|
MESH COMPOSITE PARIETEX 10X8
|
Facility
|
OP
|
$1,554.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8047039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.30 |
| Max. Negotiated Rate |
$1,398.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,398.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,398.60
|
| Rate for Payer: Aetna of IA Medicare |
$885.78
|
| Rate for Payer: Amerigroup Medicaid |
$896.35
|
| Rate for Payer: Amerigroup Medicare |
$706.29
|
| Rate for Payer: Cash Price |
$1,243.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,165.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$699.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$887.64
|
| Rate for Payer: Medical Associates Commercial |
$1,165.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$699.30
|
| Rate for Payer: Midlands Choice Commercial |
$1,087.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$900.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$804.20
|
| Rate for Payer: United Healthcare Commercial |
$1,398.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$916.86
|
|
|
MESH COMPOSITE PARIETEX 8X6
|
Facility
|
OP
|
$1,497.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8046389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.65 |
| Max. Negotiated Rate |
$1,347.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,347.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,347.30
|
| Rate for Payer: Aetna of IA Medicare |
$853.29
|
| Rate for Payer: Amerigroup Medicaid |
$863.47
|
| Rate for Payer: Amerigroup Medicare |
$680.39
|
| Rate for Payer: Cash Price |
$1,197.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,122.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$673.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$855.09
|
| Rate for Payer: Medical Associates Commercial |
$1,122.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$673.65
|
| Rate for Payer: Midlands Choice Commercial |
$1,047.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$867.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$774.70
|
| Rate for Payer: United Healthcare Commercial |
$1,347.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$883.23
|
|
|
MESH COMPOSITE PARIETEX 8X6
|
Facility
|
IP
|
$1,497.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8046389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.90 |
| Max. Negotiated Rate |
$1,347.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,347.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,347.30
|
| Rate for Payer: Cash Price |
$1,197.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,122.75
|
| Rate for Payer: Medical Associates Commercial |
$1,122.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,047.90
|
| Rate for Payer: United Healthcare Commercial |
$1,347.30
|
|
|
Mesh Surgical Bard 4x1.8in Groin Pre-Shaped
|
Facility
|
OP
|
$534.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8970697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.73 |
| Max. Negotiated Rate |
$481.46 |
| Rate for Payer: Aetna of IA Commercial |
$481.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$481.46
|
| Rate for Payer: Aetna of IA Medicare |
$304.93
|
| Rate for Payer: Amerigroup Medicaid |
$308.56
|
| Rate for Payer: Amerigroup Medicare |
$243.14
|
| Rate for Payer: Cash Price |
$427.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$401.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$240.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$305.57
|
| Rate for Payer: Medical Associates Commercial |
$401.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$240.73
|
| Rate for Payer: Midlands Choice Commercial |
$374.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$310.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$276.84
|
| Rate for Payer: United Healthcare Commercial |
$481.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$315.63
|
|
|
Mesh Surgical Bard 4x1.8in Groin Pre-Shaped
|
Facility
|
IP
|
$534.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8970697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$374.47 |
| Max. Negotiated Rate |
$481.46 |
| Rate for Payer: Aetna of IA Commercial |
$481.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$481.46
|
| Rate for Payer: Cash Price |
$427.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$401.22
|
| Rate for Payer: Medical Associates Commercial |
$401.22
|
| Rate for Payer: Midlands Choice Commercial |
$374.47
|
| Rate for Payer: United Healthcare Commercial |
$481.46
|
|
|
Mesh Surgical Bard Marlex 5.4x2.4in Pre-Shaped
|
Facility
|
IP
|
$714.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8970699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$500.47 |
| Max. Negotiated Rate |
$643.46 |
| Rate for Payer: Aetna of IA Commercial |
$643.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$643.46
|
| Rate for Payer: Cash Price |
$571.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$536.22
|
| Rate for Payer: Medical Associates Commercial |
$536.22
|
| Rate for Payer: Midlands Choice Commercial |
$500.47
|
| Rate for Payer: United Healthcare Commercial |
$643.46
|
|
|
Mesh Surgical Bard Marlex 5.4x2.4in Pre-Shaped
|
Facility
|
OP
|
$714.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8970699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$321.73 |
| Max. Negotiated Rate |
$643.46 |
| Rate for Payer: Aetna of IA Commercial |
$643.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$643.46
|
| Rate for Payer: Aetna of IA Medicare |
$407.53
|
| Rate for Payer: Amerigroup Medicaid |
$412.39
|
| Rate for Payer: Amerigroup Medicare |
$324.95
|
| Rate for Payer: Cash Price |
$571.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$536.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$321.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$408.39
|
| Rate for Payer: Medical Associates Commercial |
$536.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$321.73
|
| Rate for Payer: Midlands Choice Commercial |
$500.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$414.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$369.99
|
| Rate for Payer: United Healthcare Commercial |
$643.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$421.83
|
|
|
MESH VENTRALIGHT ST 11CM
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8773703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$696.50 |
| Max. Negotiated Rate |
$895.50 |
| Rate for Payer: Aetna of IA Commercial |
$895.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$895.50
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$746.25
|
| Rate for Payer: Medical Associates Commercial |
$746.25
|
| Rate for Payer: Midlands Choice Commercial |
$696.50
|
| Rate for Payer: United Healthcare Commercial |
$895.50
|
|
|
MESH VENTRALIGHT ST 11CM
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8773703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.75 |
| Max. Negotiated Rate |
$895.50 |
| Rate for Payer: Aetna of IA Commercial |
$895.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$895.50
|
| Rate for Payer: Aetna of IA Medicare |
$567.15
|
| Rate for Payer: Amerigroup Medicaid |
$573.92
|
| Rate for Payer: Amerigroup Medicare |
$452.23
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$746.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$447.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$568.34
|
| Rate for Payer: Medical Associates Commercial |
$746.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$447.75
|
| Rate for Payer: Midlands Choice Commercial |
$696.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$576.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$514.91
|
| Rate for Payer: United Healthcare Commercial |
$895.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$587.05
|
|
|
MESH VENTRALIGHT ST 6X8
|
Facility
|
OP
|
$1,805.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8711059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$812.25 |
| Max. Negotiated Rate |
$1,624.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,624.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,624.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,028.85
|
| Rate for Payer: Amerigroup Medicaid |
$1,041.12
|
| Rate for Payer: Amerigroup Medicare |
$820.37
|
| Rate for Payer: Cash Price |
$1,444.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,353.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$812.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,031.02
|
| Rate for Payer: Medical Associates Commercial |
$1,353.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$812.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,263.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,046.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$934.09
|
| Rate for Payer: United Healthcare Commercial |
$1,624.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,064.95
|
|
|
MESH VENTRALIGHT ST 6X8
|
Facility
|
IP
|
$1,805.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8711059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,263.50 |
| Max. Negotiated Rate |
$1,624.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,624.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,624.50
|
| Rate for Payer: Cash Price |
$1,444.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,353.75
|
| Rate for Payer: Medical Associates Commercial |
$1,353.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,263.50
|
| Rate for Payer: United Healthcare Commercial |
$1,624.50
|
|
|
Mesna 100 mg/mL 10 ml MDV inj [VDMC]
|
Facility
|
OP
|
$50.92
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
10403652
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$45.83 |
| Rate for Payer: Aetna of IA Commercial |
$45.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.83
|
| Rate for Payer: Aetna of IA Medicare |
$29.02
|
| Rate for Payer: Amerigroup Medicaid |
$29.37
|
| Rate for Payer: Amerigroup Medicare |
$23.14
|
| Rate for Payer: Cash Price |
$40.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.19
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.09
|
| Rate for Payer: Medical Associates Commercial |
$38.19
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.91
|
| Rate for Payer: Midlands Choice Commercial |
$35.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.35
|
| Rate for Payer: United Healthcare Commercial |
$45.83
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.04
|
|
|
Mesna 100 mg/mL 10 ml MDV inj [VDMC]
|
Facility
|
IP
|
$50.92
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
10403652
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.64 |
| Max. Negotiated Rate |
$45.83 |
| Rate for Payer: Aetna of IA Commercial |
$45.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.83
|
| Rate for Payer: Cash Price |
$40.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.19
|
| Rate for Payer: Medical Associates Commercial |
$38.19
|
| Rate for Payer: Midlands Choice Commercial |
$35.64
|
| Rate for Payer: United Healthcare Commercial |
$45.83
|
|
|
Metanephrine Fract Free Plasma DMCL
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
8519262
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$54.67 |
| Rate for Payer: Aetna of IA Commercial |
$53.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.10
|
| Rate for Payer: Aetna of IA Medicare |
$33.63
|
| Rate for Payer: Amerigroup Medicaid |
$34.03
|
| Rate for Payer: Amerigroup Medicare |
$26.82
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.70
|
| Rate for Payer: Medical Associates Commercial |
$44.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.55
|
| Rate for Payer: Midlands Choice Commercial |
$41.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.53
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.81
|
| Rate for Payer: Wellmark IA HMO WHPI |
$49.63
|
| Rate for Payer: Wellmark IA PPO |
$54.67
|
|
|
Metanephrine Fract Free Plasma DMCL
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
8519262
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna of IA Commercial |
$53.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.10
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.25
|
| Rate for Payer: Medical Associates Commercial |
$44.25
|
| Rate for Payer: Midlands Choice Commercial |
$41.30
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
|
