|
PHOSPHOLIPID NEUTRALIZATION, PLATELET
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
8093942
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
|
|
PHOSPHOLIPID NEUTRALIZATION, PLATELET
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
8093942
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$62.06 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Aetna of IA Medicare |
$33.06
|
| Rate for Payer: Amerigroup Medicaid |
$29.27
|
| Rate for Payer: Amerigroup Medicare |
$29.29
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.99
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.00
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.44
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$29.42
|
| Rate for Payer: Oscar Health of IA Commercial |
$43.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.22
|
| Rate for Payer: Wellmark IA HMO |
$56.42
|
| Rate for Payer: Wellmark IA PPO |
$62.06
|
|
|
PHOSPHOROUS
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
633803
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna of IA Commercial |
$40.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.50
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.75
|
| Rate for Payer: Medical Associates Commercial |
$33.75
|
| Rate for Payer: Midlands Choice Commercial |
$31.50
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
|
|
PHOSPHOROUS
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
633803
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna of IA Commercial |
$40.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.50
|
| Rate for Payer: Aetna of IA Medicare |
$25.65
|
| Rate for Payer: Amerigroup Medicaid |
$22.71
|
| Rate for Payer: Amerigroup Medicare |
$22.72
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.49
|
| Rate for Payer: Medical Associates Commercial |
$33.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.50
|
| Rate for Payer: Midlands Choice Commercial |
$31.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.84
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$22.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$33.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.75
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.55
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
physostiGMine 1 mg/ml 2ml Inj Sol [VDMC]
|
Facility
|
IP
|
$309.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10413370
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$216.72 |
| Max. Negotiated Rate |
$278.64 |
| Rate for Payer: Aetna of IA Commercial |
$278.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$278.64
|
| Rate for Payer: Cash Price |
$247.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$232.20
|
| Rate for Payer: Medical Associates Commercial |
$232.20
|
| Rate for Payer: Midlands Choice Commercial |
$216.72
|
| Rate for Payer: United Healthcare Commercial |
$278.64
|
|
|
physostiGMine 1 mg/ml 2ml Inj Sol [VDMC]
|
Facility
|
OP
|
$309.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10413370
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$154.74 |
| Max. Negotiated Rate |
$278.64 |
| Rate for Payer: Aetna of IA Commercial |
$278.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$278.64
|
| Rate for Payer: Aetna of IA Medicare |
$176.47
|
| Rate for Payer: Amerigroup Medicaid |
$156.26
|
| Rate for Payer: Amerigroup Medicare |
$156.35
|
| Rate for Payer: Cash Price |
$247.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$232.20
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$154.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$154.74
|
| Rate for Payer: Medical Associates Commercial |
$232.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$154.80
|
| Rate for Payer: Midlands Choice Commercial |
$216.72
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$157.12
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$157.03
|
| Rate for Payer: Oscar Health of IA Commercial |
$232.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$232.20
|
| Rate for Payer: United Healthcare Commercial |
$278.64
|
| Rate for Payer: United Healthcare Managed Medicare |
$182.66
|
|
|
phytonadione 10 mg/mL 1 ml SDV Inj Sol [VDMC]
|
Facility
|
IP
|
$133.77
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
10413508
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$93.64 |
| Max. Negotiated Rate |
$120.39 |
| Rate for Payer: Aetna of IA Commercial |
$120.39
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.39
|
| Rate for Payer: Cash Price |
$107.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.33
|
| Rate for Payer: Medical Associates Commercial |
$100.33
|
| Rate for Payer: Midlands Choice Commercial |
$93.64
|
| Rate for Payer: United Healthcare Commercial |
$120.39
|
|
|
phytonadione 10 mg/mL 1 ml SDV Inj Sol [VDMC]
|
Facility
|
OP
|
$133.77
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
10413508
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$66.86 |
| Max. Negotiated Rate |
$120.39 |
| Rate for Payer: Aetna of IA Commercial |
$120.39
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.39
|
| Rate for Payer: Aetna of IA Medicare |
$76.25
|
| Rate for Payer: Amerigroup Medicaid |
$67.51
|
| Rate for Payer: Amerigroup Medicare |
$67.55
|
| Rate for Payer: Cash Price |
$107.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.33
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$66.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$66.86
|
| Rate for Payer: Medical Associates Commercial |
$100.33
|
| Rate for Payer: Medical Associates Managed Medicare |
$66.88
|
| Rate for Payer: Midlands Choice Commercial |
$93.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$67.89
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$67.85
|
| Rate for Payer: Oscar Health of IA Commercial |
$100.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$100.33
|
| Rate for Payer: United Healthcare Commercial |
$120.39
|
| Rate for Payer: United Healthcare Managed Medicare |
$78.92
|
|
|
PICC DRAW FOR LAB
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
7983015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna of IA Commercial |
$23.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.50
|
| Rate for Payer: Medical Associates Commercial |
$19.50
|
| Rate for Payer: Midlands Choice Commercial |
$18.20
|
| Rate for Payer: United Healthcare Commercial |
$23.40
|
|
|
PICC DRAW FOR LAB
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
7983015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$387.38 |
| Rate for Payer: Aetna of IA Commercial |
$23.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.40
|
| Rate for Payer: Aetna of IA Medicare |
$14.82
|
| Rate for Payer: Amerigroup Medicaid |
$13.12
|
| Rate for Payer: Amerigroup Medicare |
$13.13
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.99
|
| Rate for Payer: Medical Associates Commercial |
$19.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.00
|
| Rate for Payer: Midlands Choice Commercial |
$18.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.20
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$13.19
|
| Rate for Payer: Oscar Health of IA Commercial |
$19.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.50
|
| Rate for Payer: United Healthcare Commercial |
$23.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.34
|
| Rate for Payer: Wellmark IA HMO |
$352.16
|
| Rate for Payer: Wellmark IA PPO |
$387.38
|
|
|
PICC Line Insertion
|
Facility
|
IP
|
$1,727.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
4745352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,208.90 |
| Max. Negotiated Rate |
$1,554.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,554.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,554.30
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,295.25
|
| Rate for Payer: Medical Associates Commercial |
$1,295.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,208.90
|
| Rate for Payer: United Healthcare Commercial |
$1,554.30
|
|
|
PICC Line Insertion
|
Facility
|
OP
|
$1,727.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
4745352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$863.15 |
| Max. Negotiated Rate |
$2,271.06 |
| Rate for Payer: Aetna of IA Commercial |
$1,554.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,554.30
|
| Rate for Payer: Aetna of IA Medicare |
$984.39
|
| Rate for Payer: Amerigroup Medicaid |
$871.62
|
| Rate for Payer: Amerigroup Medicare |
$872.14
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,295.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$863.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$863.15
|
| Rate for Payer: Medical Associates Commercial |
$1,295.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$863.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,208.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$876.45
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$875.93
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,295.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,295.25
|
| Rate for Payer: United Healthcare Commercial |
$1,554.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,018.93
|
| Rate for Payer: Wellmark IA HMO |
$2,064.60
|
| Rate for Payer: Wellmark IA PPO |
$2,271.06
|
|
|
PICC, SCHEDULED >5 YEARS OF AGE
|
Facility
|
IP
|
$1,727.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
8012931
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,208.90 |
| Max. Negotiated Rate |
$1,554.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,554.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,554.30
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,295.25
|
| Rate for Payer: Medical Associates Commercial |
$1,295.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,208.90
|
| Rate for Payer: United Healthcare Commercial |
$1,554.30
|
|
|
PICC, SCHEDULED >5 YEARS OF AGE
|
Facility
|
OP
|
$1,727.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
8012931
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$863.15 |
| Max. Negotiated Rate |
$2,271.06 |
| Rate for Payer: Aetna of IA Commercial |
$1,554.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,554.30
|
| Rate for Payer: Aetna of IA Medicare |
$984.39
|
| Rate for Payer: Amerigroup Medicaid |
$871.62
|
| Rate for Payer: Amerigroup Medicare |
$872.14
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,295.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$863.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$863.15
|
| Rate for Payer: Medical Associates Commercial |
$1,295.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$863.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,208.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$876.45
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$875.93
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,295.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,295.25
|
| Rate for Payer: United Healthcare Commercial |
$1,554.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,018.93
|
| Rate for Payer: Wellmark IA HMO |
$2,064.60
|
| Rate for Payer: Wellmark IA PPO |
$2,271.06
|
|
|
pilocarpine 5 mg Tab [VDMC]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10413646
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna of IA Commercial |
$1.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.26
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.05
|
| Rate for Payer: Medical Associates Commercial |
$1.05
|
| Rate for Payer: Midlands Choice Commercial |
$0.98
|
| Rate for Payer: United Healthcare Commercial |
$1.26
|
|
|
pilocarpine 5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10413646
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna of IA Commercial |
$1.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.26
|
| Rate for Payer: Aetna of IA Medicare |
$0.80
|
| Rate for Payer: Amerigroup Medicaid |
$0.71
|
| Rate for Payer: Amerigroup Medicare |
$0.71
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.05
|
| 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 |
$0.70
|
| Rate for Payer: Medical Associates Commercial |
$1.05
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.70
|
| Rate for Payer: Midlands Choice Commercial |
$0.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.71
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.71
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$1.26
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.83
|
|
|
pilocarpine Ophth 1% 15ml Sol [VDMC]
|
Facility
|
IP
|
$177.96
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10436971
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$124.57 |
| Max. Negotiated Rate |
$160.16 |
| Rate for Payer: Aetna of IA Commercial |
$160.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$160.16
|
| Rate for Payer: Cash Price |
$142.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$133.47
|
| Rate for Payer: Medical Associates Commercial |
$133.47
|
| Rate for Payer: Midlands Choice Commercial |
$124.57
|
| Rate for Payer: United Healthcare Commercial |
$160.16
|
|
|
pilocarpine Ophth 1% 15ml Sol [VDMC]
|
Facility
|
OP
|
$177.96
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10436971
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$88.94 |
| Max. Negotiated Rate |
$160.16 |
| Rate for Payer: Aetna of IA Commercial |
$160.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$160.16
|
| Rate for Payer: Aetna of IA Medicare |
$101.44
|
| Rate for Payer: Amerigroup Medicaid |
$89.82
|
| Rate for Payer: Amerigroup Medicare |
$89.87
|
| Rate for Payer: Cash Price |
$142.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$133.47
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$88.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$88.94
|
| Rate for Payer: Medical Associates Commercial |
$133.47
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.98
|
| Rate for Payer: Midlands Choice Commercial |
$124.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$90.31
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$90.26
|
| Rate for Payer: Oscar Health of IA Commercial |
$133.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$133.47
|
| Rate for Payer: United Healthcare Commercial |
$160.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$105.00
|
|
|
pilocarpine Ophth 2% 15 ml [VDMC]
|
Facility
|
IP
|
$137.40
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10437036
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$96.18 |
| Max. Negotiated Rate |
$123.66 |
| Rate for Payer: Aetna of IA Commercial |
$123.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$123.66
|
| Rate for Payer: Cash Price |
$109.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.05
|
| Rate for Payer: Medical Associates Commercial |
$103.05
|
| Rate for Payer: Midlands Choice Commercial |
$96.18
|
| Rate for Payer: United Healthcare Commercial |
$123.66
|
|
|
pilocarpine Ophth 2% 15 ml [VDMC]
|
Facility
|
OP
|
$137.40
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10437036
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$68.67 |
| Max. Negotiated Rate |
$123.66 |
| Rate for Payer: Aetna of IA Commercial |
$123.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$123.66
|
| Rate for Payer: Aetna of IA Medicare |
$78.32
|
| Rate for Payer: Amerigroup Medicaid |
$69.35
|
| Rate for Payer: Amerigroup Medicare |
$69.39
|
| Rate for Payer: Cash Price |
$109.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.05
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$68.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$68.67
|
| Rate for Payer: Medical Associates Commercial |
$103.05
|
| Rate for Payer: Medical Associates Managed Medicare |
$68.70
|
| Rate for Payer: Midlands Choice Commercial |
$96.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$69.73
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$69.69
|
| Rate for Payer: Oscar Health of IA Commercial |
$103.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$103.05
|
| Rate for Payer: United Healthcare Commercial |
$123.66
|
| Rate for Payer: United Healthcare Managed Medicare |
$81.07
|
|
|
pilocarpine Ophth 4% 15ml Sol [VDMC]
|
Facility
|
IP
|
$240.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10437166
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$168.62 |
| Max. Negotiated Rate |
$216.79 |
| Rate for Payer: Aetna of IA Commercial |
$216.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$216.79
|
| Rate for Payer: Cash Price |
$192.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$180.66
|
| Rate for Payer: Medical Associates Commercial |
$180.66
|
| Rate for Payer: Midlands Choice Commercial |
$168.62
|
| Rate for Payer: United Healthcare Commercial |
$216.79
|
|
|
pilocarpine Ophth 4% 15ml Sol [VDMC]
|
Facility
|
OP
|
$240.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10437166
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$120.39 |
| Max. Negotiated Rate |
$216.79 |
| Rate for Payer: Aetna of IA Commercial |
$216.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$216.79
|
| Rate for Payer: Aetna of IA Medicare |
$137.30
|
| Rate for Payer: Amerigroup Medicaid |
$121.57
|
| Rate for Payer: Amerigroup Medicare |
$121.64
|
| Rate for Payer: Cash Price |
$192.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$180.66
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$120.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$120.39
|
| Rate for Payer: Medical Associates Commercial |
$180.66
|
| Rate for Payer: Medical Associates Managed Medicare |
$120.44
|
| Rate for Payer: Midlands Choice Commercial |
$168.62
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$122.25
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$122.17
|
| Rate for Payer: Oscar Health of IA Commercial |
$180.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$180.66
|
| Rate for Payer: United Healthcare Commercial |
$216.79
|
| Rate for Payer: United Healthcare Managed Medicare |
$142.12
|
|
|
pimecrolimus 1%Top Crm 30 gm [VDMC]
|
Facility
|
IP
|
$801.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10437231
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$561.32 |
| Max. Negotiated Rate |
$721.69 |
| Rate for Payer: Aetna of IA Commercial |
$721.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$721.69
|
| Rate for Payer: Cash Price |
$641.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$601.41
|
| Rate for Payer: Medical Associates Commercial |
$601.41
|
| Rate for Payer: Midlands Choice Commercial |
$561.32
|
| Rate for Payer: United Healthcare Commercial |
$721.69
|
|
|
pimecrolimus 1%Top Crm 30 gm [VDMC]
|
Facility
|
OP
|
$801.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10437231
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$400.78 |
| Max. Negotiated Rate |
$721.69 |
| Rate for Payer: Aetna of IA Commercial |
$721.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$721.69
|
| Rate for Payer: Aetna of IA Medicare |
$457.07
|
| Rate for Payer: Amerigroup Medicaid |
$404.71
|
| Rate for Payer: Amerigroup Medicare |
$404.95
|
| Rate for Payer: Cash Price |
$641.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$601.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$400.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$400.78
|
| Rate for Payer: Medical Associates Commercial |
$601.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$400.94
|
| Rate for Payer: Midlands Choice Commercial |
$561.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$406.95
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$406.71
|
| Rate for Payer: Oscar Health of IA Commercial |
$601.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$601.41
|
| Rate for Payer: United Healthcare Commercial |
$721.69
|
| Rate for Payer: United Healthcare Managed Medicare |
$473.11
|
|
|
PIN STEINMANN 9X.079 DIAMOND POINT
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
|
