|
PHLEBOTOMY, SCHEDULED
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
8012944
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$99.90 |
| Max. Negotiated Rate |
$459.23 |
| Rate for Payer: Aetna of IA Commercial |
$199.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$199.80
|
| Rate for Payer: Aetna of IA Medicare |
$126.54
|
| Rate for Payer: Amerigroup Medicaid |
$128.05
|
| Rate for Payer: Amerigroup Medicare |
$100.90
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$166.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.81
|
| Rate for Payer: Medical Associates Commercial |
$166.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.90
|
| Rate for Payer: Midlands Choice Commercial |
$155.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$114.88
|
| Rate for Payer: United Healthcare Commercial |
$199.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$130.98
|
| Rate for Payer: Wellmark IA HMO WHPI |
$416.89
|
| Rate for Payer: Wellmark IA PPO |
$459.23
|
|
|
PHLEBOTOMY, SCHEDULED
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
8012944
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$155.40 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Aetna of IA Commercial |
$199.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$199.80
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$166.50
|
| Rate for Payer: Medical Associates Commercial |
$166.50
|
| Rate for Payer: Midlands Choice Commercial |
$155.40
|
| Rate for Payer: United Healthcare Commercial |
$199.80
|
|
|
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 |
$26.10 |
| 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: Aetna of IA Medicare |
$33.06
|
| Rate for Payer: Amerigroup Medicaid |
$33.45
|
| Rate for Payer: Amerigroup Medicare |
$26.36
|
| 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 |
$26.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.13
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.10
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.02
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.22
|
| Rate for Payer: Wellmark IA HMO WHPI |
$29.07
|
| Rate for Payer: Wellmark IA PPO |
$32.02
|
|
|
PHOSPHOROUS
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
633803
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.25 |
| 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 |
$25.96
|
| Rate for Payer: Amerigroup Medicare |
$20.45
|
| 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 |
$20.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.70
|
| Rate for Payer: Medical Associates Commercial |
$33.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.25
|
| Rate for Payer: Midlands Choice Commercial |
$31.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.29
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.55
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
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
|
|
|
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 |
$139.32 |
| 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 |
$178.57
|
| Rate for Payer: Amerigroup Medicare |
$140.71
|
| 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 |
$139.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$176.84
|
| Rate for Payer: Medical Associates Commercial |
$232.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$139.32
|
| Rate for Payer: Midlands Choice Commercial |
$216.72
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$179.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$160.22
|
| Rate for Payer: United Healthcare Commercial |
$278.64
|
| Rate for Payer: United Healthcare Managed Medicare |
$182.66
|
|
|
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
|
|
|
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 |
$120.40 |
| Rate for Payer: Aetna of IA Commercial |
$120.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.40
|
| 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 |
$120.40
|
|
|
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 |
$60.20 |
| Max. Negotiated Rate |
$120.40 |
| Rate for Payer: Aetna of IA Commercial |
$120.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.40
|
| Rate for Payer: Aetna of IA Medicare |
$76.25
|
| Rate for Payer: Amerigroup Medicaid |
$77.16
|
| Rate for Payer: Amerigroup Medicare |
$60.80
|
| 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 |
$60.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$76.41
|
| Rate for Payer: Medical Associates Commercial |
$100.33
|
| Rate for Payer: Medical Associates Managed Medicare |
$60.20
|
| Rate for Payer: Midlands Choice Commercial |
$93.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$77.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$69.23
|
| Rate for Payer: United Healthcare Commercial |
$120.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$78.93
|
|
|
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 |
$11.70 |
| Max. Negotiated Rate |
$459.23 |
| 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 |
$15.00
|
| Rate for Payer: Amerigroup Medicare |
$11.82
|
| 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 |
$11.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.85
|
| Rate for Payer: Medical Associates Commercial |
$19.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.70
|
| Rate for Payer: Midlands Choice Commercial |
$18.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$13.46
|
| Rate for Payer: United Healthcare Commercial |
$23.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.34
|
| Rate for Payer: Wellmark IA HMO WHPI |
$416.89
|
| Rate for Payer: Wellmark IA PPO |
$459.23
|
|
|
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 |
$777.15 |
| Max. Negotiated Rate |
$3,010.76 |
| 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 |
$996.13
|
| Rate for Payer: Amerigroup Medicare |
$784.92
|
| 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 |
$777.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$986.46
|
| Rate for Payer: Medical Associates Commercial |
$1,295.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$777.15
|
| Rate for Payer: Midlands Choice Commercial |
$1,208.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,000.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$893.72
|
| 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 WHPI |
$2,733.20
|
| Rate for Payer: Wellmark IA PPO |
$3,010.76
|
|
|
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 |
$777.15 |
| Max. Negotiated Rate |
$3,010.76 |
| 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 |
$996.13
|
| Rate for Payer: Amerigroup Medicare |
$784.92
|
| 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 |
$777.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$986.46
|
| Rate for Payer: Medical Associates Commercial |
$1,295.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$777.15
|
| Rate for Payer: Midlands Choice Commercial |
$1,208.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,000.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$893.72
|
| 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 WHPI |
$2,733.20
|
| Rate for Payer: Wellmark IA PPO |
$3,010.76
|
|
|
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
|
|
|
pilocarpine 5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10413646
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| 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 |
$0.81
|
| Rate for Payer: Amerigroup Medicare |
$0.64
|
| 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 |
$0.63
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.80
|
| Rate for Payer: Medical Associates Commercial |
$1.05
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.63
|
| Rate for Payer: Midlands Choice Commercial |
$0.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.73
|
| Rate for Payer: United Healthcare Commercial |
$1.26
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.83
|
|
|
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 Ophth 1% 15ml Sol [VDMC]
|
Facility
|
OP
|
$177.96
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10436971
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$80.08 |
| 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 |
$102.65
|
| Rate for Payer: Amerigroup Medicare |
$80.88
|
| 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 |
$80.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$101.65
|
| Rate for Payer: Medical Associates Commercial |
$133.47
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.08
|
| Rate for Payer: Midlands Choice Commercial |
$124.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$103.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$92.09
|
| Rate for Payer: United Healthcare Commercial |
$160.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$105.00
|
|
|
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 2% 15 ml [VDMC]
|
Facility
|
OP
|
$140.32
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10437036
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$63.14 |
| Max. Negotiated Rate |
$126.28 |
| Rate for Payer: Aetna of IA Commercial |
$126.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.28
|
| Rate for Payer: Aetna of IA Medicare |
$79.98
|
| Rate for Payer: Amerigroup Medicaid |
$80.93
|
| Rate for Payer: Amerigroup Medicare |
$63.77
|
| Rate for Payer: Cash Price |
$112.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$63.14
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.15
|
| Rate for Payer: Medical Associates Commercial |
$105.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$63.14
|
| Rate for Payer: Midlands Choice Commercial |
$98.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$72.61
|
| Rate for Payer: United Healthcare Commercial |
$126.28
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.79
|
|
|
pilocarpine Ophth 2% 15 ml [VDMC]
|
Facility
|
IP
|
$140.32
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10437036
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$98.22 |
| Max. Negotiated Rate |
$126.28 |
| Rate for Payer: Aetna of IA Commercial |
$126.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.28
|
| Rate for Payer: Cash Price |
$112.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.24
|
| Rate for Payer: Medical Associates Commercial |
$105.24
|
| Rate for Payer: Midlands Choice Commercial |
$98.22
|
| Rate for Payer: United Healthcare Commercial |
$126.28
|
|
|
pilocarpine Ophth 4% 15ml Sol [VDMC]
|
Facility
|
IP
|
$160.72
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10437166
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$144.65 |
| Rate for Payer: Aetna of IA Commercial |
$144.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.65
|
| Rate for Payer: Cash Price |
$128.58
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.54
|
| Rate for Payer: Medical Associates Commercial |
$120.54
|
| Rate for Payer: Midlands Choice Commercial |
$112.50
|
| Rate for Payer: United Healthcare Commercial |
$144.65
|
|
|
pilocarpine Ophth 4% 15ml Sol [VDMC]
|
Facility
|
OP
|
$160.72
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10437166
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$72.32 |
| Max. Negotiated Rate |
$144.65 |
| Rate for Payer: Aetna of IA Commercial |
$144.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.65
|
| Rate for Payer: Aetna of IA Medicare |
$91.61
|
| Rate for Payer: Amerigroup Medicaid |
$92.70
|
| Rate for Payer: Amerigroup Medicare |
$73.05
|
| Rate for Payer: Cash Price |
$128.58
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.54
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$72.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$91.80
|
| Rate for Payer: Medical Associates Commercial |
$120.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.32
|
| Rate for Payer: Midlands Choice Commercial |
$112.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$93.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$83.17
|
| Rate for Payer: United Healthcare Commercial |
$144.65
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.82
|
|
|
PIN STEINMANN 9X.079 DIAMOND POINT
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.20 |
| 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: Aetna of IA Medicare |
$31.92
|
| Rate for Payer: Amerigroup Medicaid |
$32.30
|
| Rate for Payer: Amerigroup Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.99
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.20
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.98
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.04
|
|
