|
PARING OF CORN/CALLUS 2-4
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
7438806
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna of IA Commercial |
$129.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$129.60
|
| Rate for Payer: Aetna of IA Medicare |
$82.08
|
| Rate for Payer: Amerigroup Medicaid |
$83.06
|
| Rate for Payer: Amerigroup Medicare |
$65.45
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$82.25
|
| Rate for Payer: Medical Associates Commercial |
$108.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.80
|
| Rate for Payer: Midlands Choice Commercial |
$100.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$83.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.52
|
| Rate for Payer: United Healthcare Commercial |
$129.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.96
|
|
|
PARoxetine 12.5 mg ER Tab [VDMC]
|
Facility
|
OP
|
$3.27
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10411863
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Aetna of IA Commercial |
$2.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.95
|
| Rate for Payer: Aetna of IA Medicare |
$1.87
|
| Rate for Payer: Amerigroup Medicaid |
$1.89
|
| Rate for Payer: Amerigroup Medicare |
$1.49
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.45
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.47
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.87
|
| Rate for Payer: Medical Associates Commercial |
$2.45
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.47
|
| Rate for Payer: Midlands Choice Commercial |
$2.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.69
|
| Rate for Payer: United Healthcare Commercial |
$2.95
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.93
|
|
|
PARoxetine 12.5 mg ER Tab [VDMC]
|
Facility
|
IP
|
$3.27
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10411863
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Aetna of IA Commercial |
$2.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.95
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.45
|
| Rate for Payer: Medical Associates Commercial |
$2.45
|
| Rate for Payer: Midlands Choice Commercial |
$2.29
|
| Rate for Payer: United Healthcare Commercial |
$2.95
|
|
|
PARoxetine 20 mg Tab [VDMC]
|
Facility
|
OP
|
$1.56
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10411932
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of IA Commercial |
$1.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.40
|
| Rate for Payer: Aetna of IA Medicare |
$0.89
|
| Rate for Payer: Amerigroup Medicaid |
$0.90
|
| Rate for Payer: Amerigroup Medicare |
$0.71
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.17
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.89
|
| Rate for Payer: Medical Associates Commercial |
$1.17
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.70
|
| Rate for Payer: Midlands Choice Commercial |
$1.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.80
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.92
|
|
|
PARoxetine 20 mg Tab [VDMC]
|
Facility
|
IP
|
$1.56
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10411932
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of IA Commercial |
$1.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.40
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.17
|
| Rate for Payer: Medical Associates Commercial |
$1.17
|
| Rate for Payer: Midlands Choice Commercial |
$1.09
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
|
|
PARS SUTURE IMPLANT KIT W/SUTURETAPE
|
Facility
|
IP
|
$2,691.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8783230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,883.70 |
| Max. Negotiated Rate |
$2,421.90 |
| Rate for Payer: Aetna of IA Commercial |
$2,421.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,421.90
|
| Rate for Payer: Cash Price |
$2,152.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,018.25
|
| Rate for Payer: Medical Associates Commercial |
$2,018.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,883.70
|
| Rate for Payer: United Healthcare Commercial |
$2,421.90
|
|
|
PARS SUTURE IMPLANT KIT W/SUTURETAPE
|
Facility
|
OP
|
$2,691.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8783230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.95 |
| Max. Negotiated Rate |
$2,421.90 |
| Rate for Payer: Aetna of IA Commercial |
$2,421.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,421.90
|
| Rate for Payer: Aetna of IA Medicare |
$1,533.87
|
| Rate for Payer: Amerigroup Medicaid |
$1,552.17
|
| Rate for Payer: Amerigroup Medicare |
$1,223.06
|
| Rate for Payer: Cash Price |
$2,152.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,018.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,210.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,537.10
|
| Rate for Payer: Medical Associates Commercial |
$2,018.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,210.95
|
| Rate for Payer: Midlands Choice Commercial |
$1,883.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,559.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,392.59
|
| Rate for Payer: United Healthcare Commercial |
$2,421.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,587.69
|
|
|
PARTIAL REMOVAL OF RADIUS
|
Facility
|
OP
|
$3,062.00
|
|
|
Service Code
|
CPT 25230
|
| Hospital Charge Code |
7982924
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,377.90 |
| Max. Negotiated Rate |
$2,755.80 |
| Rate for Payer: Aetna of IA Commercial |
$2,755.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,755.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,745.34
|
| Rate for Payer: Amerigroup Medicaid |
$1,766.16
|
| Rate for Payer: Amerigroup Medicare |
$1,391.68
|
| Rate for Payer: Cash Price |
$2,449.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,296.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,377.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,749.01
|
| Rate for Payer: Medical Associates Commercial |
$2,296.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,377.90
|
| Rate for Payer: Midlands Choice Commercial |
$2,143.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,774.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,584.59
|
| Rate for Payer: United Healthcare Commercial |
$2,755.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,806.58
|
|
|
PARTIAL REMOVAL OF RADIUS
|
Facility
|
IP
|
$3,062.00
|
|
|
Service Code
|
CPT 25230
|
| Hospital Charge Code |
7982924
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,143.40 |
| Max. Negotiated Rate |
$2,755.80 |
| Rate for Payer: Aetna of IA Commercial |
$2,755.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,755.80
|
| Rate for Payer: Cash Price |
$2,449.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,296.50
|
| Rate for Payer: Medical Associates Commercial |
$2,296.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,143.40
|
| Rate for Payer: United Healthcare Commercial |
$2,755.80
|
|
|
Partial Thromboplastin Time DMCL
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
8037749
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
|
|
Partial Thromboplastin Time DMCL
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
8037749
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Aetna of IA Medicare |
$36.48
|
| Rate for Payer: Amerigroup Medicaid |
$36.92
|
| Rate for Payer: Amerigroup Medicare |
$29.09
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.56
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.80
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.12
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
|
|
Pathology Gyn Request DMCL
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
8037736
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Aetna of IA Medicare |
$62.70
|
| Rate for Payer: Amerigroup Medicaid |
$63.45
|
| Rate for Payer: Amerigroup Medicare |
$49.99
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$62.83
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$63.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.92
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.90
|
|
|
Pathology Gyn Request DMCL
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
8037736
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
|
|
patiromer 16.8 g Pow [VDMC]
|
Facility
|
OP
|
$113.69
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
18292192
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$51.16 |
| Max. Negotiated Rate |
$102.33 |
| Rate for Payer: Aetna of IA Commercial |
$102.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.33
|
| Rate for Payer: Aetna of IA Medicare |
$64.81
|
| Rate for Payer: Amerigroup Medicaid |
$65.58
|
| Rate for Payer: Amerigroup Medicare |
$51.67
|
| Rate for Payer: Cash Price |
$90.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.27
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.94
|
| Rate for Payer: Medical Associates Commercial |
$85.27
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.16
|
| Rate for Payer: Midlands Choice Commercial |
$79.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$65.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$58.84
|
| Rate for Payer: United Healthcare Commercial |
$102.33
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.08
|
|
|
patiromer 16.8 g Pow [VDMC]
|
Facility
|
IP
|
$113.69
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
18292192
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$79.59 |
| Max. Negotiated Rate |
$102.33 |
| Rate for Payer: Aetna of IA Commercial |
$102.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.33
|
| Rate for Payer: Cash Price |
$90.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.27
|
| Rate for Payer: Medical Associates Commercial |
$85.27
|
| Rate for Payer: Midlands Choice Commercial |
$79.59
|
| Rate for Payer: United Healthcare Commercial |
$102.33
|
|
|
patiromer 8.4 g Pow [VDMC]
|
Facility
|
OP
|
$78.57
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27933279
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$70.71 |
| Rate for Payer: Aetna of IA Commercial |
$70.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$70.71
|
| Rate for Payer: Aetna of IA Medicare |
$44.78
|
| Rate for Payer: Amerigroup Medicaid |
$45.32
|
| Rate for Payer: Amerigroup Medicare |
$35.71
|
| Rate for Payer: Cash Price |
$62.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.93
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$44.88
|
| Rate for Payer: Medical Associates Commercial |
$58.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.36
|
| Rate for Payer: Midlands Choice Commercial |
$55.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$45.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$40.66
|
| Rate for Payer: United Healthcare Commercial |
$70.71
|
| Rate for Payer: United Healthcare Managed Medicare |
$46.36
|
|
|
patiromer 8.4 g Pow [VDMC]
|
Facility
|
IP
|
$78.57
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27933279
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$70.71 |
| Rate for Payer: Aetna of IA Commercial |
$70.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$70.71
|
| Rate for Payer: Cash Price |
$62.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.93
|
| Rate for Payer: Medical Associates Commercial |
$58.93
|
| Rate for Payer: Midlands Choice Commercial |
$55.00
|
| Rate for Payer: United Healthcare Commercial |
$70.71
|
|
|
Peds Med Surg
|
Facility
|
IP
|
$1,300.00
|
|
| Hospital Charge Code |
8002759
|
|
Hospital Revenue Code
|
113
|
| Min. Negotiated Rate |
$910.00 |
| Max. Negotiated Rate |
$2,580.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,170.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,170.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,258.00
|
| Rate for Payer: Cash Price |
$1,040.00
|
| Rate for Payer: Cash Price |
$1,040.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$975.00
|
| Rate for Payer: Medical Associates Commercial |
$975.00
|
| Rate for Payer: Midlands Choice Commercial |
$910.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,580.60
|
| Rate for Payer: United Healthcare Commercial |
$1,170.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,306.00
|
|
|
peg 3350 electrolytes100-7.5-2.691gm Oral Pwdr for Sol [VDMC]
|
Facility
|
IP
|
$214.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10412200
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$149.97 |
| Max. Negotiated Rate |
$192.82 |
| Rate for Payer: Aetna of IA Commercial |
$192.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$192.82
|
| Rate for Payer: Cash Price |
$171.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$160.68
|
| Rate for Payer: Medical Associates Commercial |
$160.68
|
| Rate for Payer: Midlands Choice Commercial |
$149.97
|
| Rate for Payer: United Healthcare Commercial |
$192.82
|
|
|
peg 3350 electrolytes100-7.5-2.691gm Oral Pwdr for Sol [VDMC]
|
Facility
|
OP
|
$214.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10412200
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$96.41 |
| Max. Negotiated Rate |
$192.82 |
| Rate for Payer: Aetna of IA Commercial |
$192.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$192.82
|
| Rate for Payer: Aetna of IA Medicare |
$122.12
|
| Rate for Payer: Amerigroup Medicaid |
$123.57
|
| Rate for Payer: Amerigroup Medicare |
$97.37
|
| Rate for Payer: Cash Price |
$171.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$160.68
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$96.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$122.37
|
| Rate for Payer: Medical Associates Commercial |
$160.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$96.41
|
| Rate for Payer: Midlands Choice Commercial |
$149.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$124.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$110.87
|
| Rate for Payer: United Healthcare Commercial |
$192.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$126.40
|
|
|
PEG 3350 electrolytes Oral Pwdr for Sol 4000 mL [VDMC]
|
Facility
|
OP
|
$98.68
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10414263
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$44.41 |
| Max. Negotiated Rate |
$88.81 |
| Rate for Payer: Aetna of IA Commercial |
$88.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.81
|
| Rate for Payer: Aetna of IA Medicare |
$56.25
|
| Rate for Payer: Amerigroup Medicaid |
$56.92
|
| Rate for Payer: Amerigroup Medicare |
$44.85
|
| Rate for Payer: Cash Price |
$78.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.01
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$44.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.37
|
| Rate for Payer: Medical Associates Commercial |
$74.01
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.41
|
| Rate for Payer: Midlands Choice Commercial |
$69.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.07
|
| Rate for Payer: United Healthcare Commercial |
$88.81
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.22
|
|
|
PEG 3350 electrolytes Oral Pwdr for Sol 4000 mL [VDMC]
|
Facility
|
IP
|
$98.68
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10414263
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$69.08 |
| Max. Negotiated Rate |
$88.81 |
| Rate for Payer: Aetna of IA Commercial |
$88.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.81
|
| Rate for Payer: Cash Price |
$78.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.01
|
| Rate for Payer: Medical Associates Commercial |
$74.01
|
| Rate for Payer: Midlands Choice Commercial |
$69.08
|
| Rate for Payer: United Healthcare Commercial |
$88.81
|
|
|
peg 400-propylene glycol drops [VDMC]
|
Facility
|
IP
|
$56.44
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10409939
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.51 |
| Max. Negotiated Rate |
$50.80 |
| Rate for Payer: Aetna of IA Commercial |
$50.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.80
|
| Rate for Payer: Cash Price |
$45.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.33
|
| Rate for Payer: Medical Associates Commercial |
$42.33
|
| Rate for Payer: Midlands Choice Commercial |
$39.51
|
| Rate for Payer: United Healthcare Commercial |
$50.80
|
|
|
peg 400-propylene glycol drops [VDMC]
|
Facility
|
OP
|
$56.44
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10409939
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$50.80 |
| Rate for Payer: Aetna of IA Commercial |
$50.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.80
|
| Rate for Payer: Aetna of IA Medicare |
$32.17
|
| Rate for Payer: Amerigroup Medicaid |
$32.55
|
| Rate for Payer: Amerigroup Medicare |
$25.65
|
| Rate for Payer: Cash Price |
$45.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.33
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.24
|
| Rate for Payer: Medical Associates Commercial |
$42.33
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.40
|
| Rate for Payer: Midlands Choice Commercial |
$39.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$29.21
|
| Rate for Payer: United Healthcare Commercial |
$50.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.30
|
|
|
pegfilgrastim 6 mg/0.6 mL SubQ SDV Inj [VDMC]
|
Facility
|
IP
|
$8,399.00
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
10412131
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5,879.30 |
| Max. Negotiated Rate |
$7,559.10 |
| Rate for Payer: Aetna of IA Commercial |
$7,559.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,559.10
|
| Rate for Payer: Cash Price |
$6,719.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,299.25
|
| Rate for Payer: Medical Associates Commercial |
$6,299.25
|
| Rate for Payer: Midlands Choice Commercial |
$5,879.30
|
| Rate for Payer: United Healthcare Commercial |
$7,559.10
|
|
