|
acetaZOLAMIDE 250 mg Tab [VDMC]
|
Facility
|
IP
|
$3.29
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10363462
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna of IA Commercial |
$2.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.96
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.47
|
| Rate for Payer: Medical Associates Commercial |
$2.47
|
| Rate for Payer: Midlands Choice Commercial |
$2.30
|
| Rate for Payer: United Healthcare Commercial |
$2.96
|
|
|
acetaZOLAMIDE 250 mg Tab [VDMC]
|
Facility
|
OP
|
$3.29
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10363462
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna of IA Commercial |
$2.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.96
|
| Rate for Payer: Aetna of IA Medicare |
$1.88
|
| Rate for Payer: Amerigroup Medicaid |
$1.90
|
| Rate for Payer: Amerigroup Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.47
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.88
|
| Rate for Payer: Medical Associates Commercial |
$2.47
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.48
|
| Rate for Payer: Midlands Choice Commercial |
$2.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.70
|
| Rate for Payer: United Healthcare Commercial |
$2.96
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.94
|
|
|
Acetylcholine Recep Bind Ab DMCL
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
8037484
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna of IA Commercial |
$132.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$132.30
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$110.25
|
| Rate for Payer: Medical Associates Commercial |
$110.25
|
| Rate for Payer: Midlands Choice Commercial |
$102.90
|
| Rate for Payer: United Healthcare Commercial |
$132.30
|
|
|
Acetylcholine Recep Bind Ab DMCL
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
8037484
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.68 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna of IA Commercial |
$132.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$132.30
|
| Rate for Payer: Aetna of IA Medicare |
$83.79
|
| Rate for Payer: Amerigroup Medicaid |
$84.79
|
| Rate for Payer: Amerigroup Medicare |
$66.81
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$110.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$66.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$83.97
|
| Rate for Payer: Medical Associates Commercial |
$110.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$66.15
|
| Rate for Payer: Midlands Choice Commercial |
$102.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$85.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$76.07
|
| Rate for Payer: United Healthcare Commercial |
$132.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.73
|
| Rate for Payer: Wellmark IA HMO WHPI |
$61.68
|
| Rate for Payer: Wellmark IA PPO |
$67.95
|
|
|
acetylcysteine 20% inh 800mg 4 mL [VDMC]
|
Facility
|
IP
|
$18.24
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
10363675
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: Aetna of IA Commercial |
$16.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.41
|
| Rate for Payer: Cash Price |
$14.59
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.68
|
| Rate for Payer: Medical Associates Commercial |
$13.68
|
| Rate for Payer: Midlands Choice Commercial |
$12.76
|
| Rate for Payer: United Healthcare Commercial |
$16.41
|
|
|
acetylcysteine 20% inh 800mg 4 mL [VDMC]
|
Facility
|
OP
|
$18.24
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
10363675
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$16.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.41
|
| Rate for Payer: Aetna of IA Medicare |
$10.39
|
| Rate for Payer: Amerigroup Medicaid |
$10.52
|
| Rate for Payer: Amerigroup Medicare |
$8.29
|
| Rate for Payer: Cash Price |
$14.59
|
| Rate for Payer: Cash Price |
$14.59
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.68
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.21
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.42
|
| Rate for Payer: Medical Associates Commercial |
$13.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.21
|
| Rate for Payer: Midlands Choice Commercial |
$12.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.44
|
| Rate for Payer: United Healthcare Commercial |
$16.41
|
| Rate for Payer: United Healthcare Managed Medicare |
$10.76
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
acetylcysteine 20% inj 6gm/30 ml SDV [VDMC]
|
Facility
|
OP
|
$154.69
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
13411165
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$69.61 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$139.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$139.22
|
| Rate for Payer: Aetna of IA Medicare |
$88.17
|
| Rate for Payer: Amerigroup Medicaid |
$89.23
|
| Rate for Payer: Amerigroup Medicare |
$70.31
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$116.02
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.61
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$88.36
|
| Rate for Payer: Medical Associates Commercial |
$116.02
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.61
|
| Rate for Payer: Midlands Choice Commercial |
$108.28
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$89.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$80.05
|
| Rate for Payer: United Healthcare Commercial |
$139.22
|
| Rate for Payer: United Healthcare Managed Medicare |
$91.27
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
acetylcysteine 20% inj 6gm/30 ml SDV [VDMC]
|
Facility
|
IP
|
$154.69
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
13411165
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$108.28 |
| Max. Negotiated Rate |
$139.22 |
| Rate for Payer: Aetna of IA Commercial |
$139.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$139.22
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$116.02
|
| Rate for Payer: Medical Associates Commercial |
$116.02
|
| Rate for Payer: Midlands Choice Commercial |
$108.28
|
| Rate for Payer: United Healthcare Commercial |
$139.22
|
|
|
acetylcysteine 600 mg oral capsule [VDMC]
|
Facility
|
IP
|
$1.33
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10363746
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Aetna of IA Commercial |
$1.19
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.19
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.99
|
| Rate for Payer: Medical Associates Commercial |
$0.99
|
| Rate for Payer: Midlands Choice Commercial |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$1.19
|
|
|
acetylcysteine 600 mg oral capsule [VDMC]
|
Facility
|
OP
|
$1.33
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10363746
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Aetna of IA Commercial |
$1.19
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.19
|
| Rate for Payer: Aetna of IA Medicare |
$0.76
|
| Rate for Payer: Amerigroup Medicaid |
$0.77
|
| Rate for Payer: Amerigroup Medicare |
$0.60
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.99
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.76
|
| Rate for Payer: Medical Associates Commercial |
$0.99
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.60
|
| Rate for Payer: Midlands Choice Commercial |
$0.93
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.69
|
| Rate for Payer: United Healthcare Commercial |
$1.19
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.78
|
|
|
ACL TIGHTROPE
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.75 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna of IA Commercial |
$445.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$445.50
|
| Rate for Payer: Aetna of IA Medicare |
$282.15
|
| Rate for Payer: Amerigroup Medicaid |
$285.52
|
| Rate for Payer: Amerigroup Medicare |
$224.98
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$371.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$222.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$282.74
|
| Rate for Payer: Medical Associates Commercial |
$371.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$222.75
|
| Rate for Payer: Midlands Choice Commercial |
$346.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$286.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$256.16
|
| Rate for Payer: United Healthcare Commercial |
$445.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$292.05
|
|
|
ACL TIGHTROPE
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna of IA Commercial |
$445.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$445.50
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$371.25
|
| Rate for Payer: Medical Associates Commercial |
$371.25
|
| Rate for Payer: Midlands Choice Commercial |
$346.50
|
| Rate for Payer: United Healthcare Commercial |
$445.50
|
|
|
ACNE SURGERY
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 10040
|
| Hospital Charge Code |
7983051
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Aetna of IA Commercial |
$297.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$297.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$247.50
|
| Rate for Payer: Medical Associates Commercial |
$247.50
|
| Rate for Payer: Midlands Choice Commercial |
$231.00
|
| Rate for Payer: United Healthcare Commercial |
$297.00
|
|
|
ACNE SURGERY
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
CPT 10040
|
| Hospital Charge Code |
7982861
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$74.85 |
| Max. Negotiated Rate |
$252.75 |
| Rate for Payer: Amerigroup Medicaid |
$75.58
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.85
|
| Rate for Payer: Medical Associates Commercial |
$252.75
|
| Rate for Payer: Midlands Choice Commercial |
$235.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$252.75
|
| Rate for Payer: United Healthcare Commercial |
$165.26
|
| Rate for Payer: Wellmark IA HMO WHPI |
$212.70
|
| Rate for Payer: Wellmark IA PPO |
$250.30
|
|
|
ACNE SURGERY
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 10040
|
| Hospital Charge Code |
7983051
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.50 |
| Max. Negotiated Rate |
$333.49 |
| Rate for Payer: Aetna of IA Commercial |
$297.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$297.00
|
| Rate for Payer: Aetna of IA Medicare |
$188.10
|
| Rate for Payer: Amerigroup Medicaid |
$190.34
|
| Rate for Payer: Amerigroup Medicare |
$149.98
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$247.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$148.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$188.50
|
| Rate for Payer: Medical Associates Commercial |
$247.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$231.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$191.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$170.78
|
| Rate for Payer: United Healthcare Commercial |
$297.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$194.70
|
| Rate for Payer: Wellmark IA HMO WHPI |
$302.74
|
| Rate for Payer: Wellmark IA PPO |
$333.49
|
|
|
ACRYSOF IQ 13.5 LENS
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
8891548
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Aetna of IA Medicare |
$153.90
|
| Rate for Payer: Amerigroup Medicaid |
$155.74
|
| Rate for Payer: Amerigroup Medicare |
$122.72
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$121.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$154.22
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$156.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$139.72
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.30
|
|
|
ACRYSOF IQ 13.5 LENS
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
8891548
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
|
|
ACRYSOF IQ 16.5 LENS
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
8885207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Aetna of IA Medicare |
$153.90
|
| Rate for Payer: Amerigroup Medicaid |
$155.74
|
| Rate for Payer: Amerigroup Medicare |
$122.72
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$121.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$154.22
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$156.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$139.72
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.30
|
|
|
ACRYSOF IQ 16.5 LENS
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
8885207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
|
|
ACRYSOF IQ 18.0 LENS
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
8891550
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
|
|
ACRYSOF IQ 18.0 LENS
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
8891550
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Aetna of IA Medicare |
$153.90
|
| Rate for Payer: Amerigroup Medicaid |
$155.74
|
| Rate for Payer: Amerigroup Medicare |
$122.72
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$121.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$154.22
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$156.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$139.72
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.30
|
|
|
ACRYSOF IQ 18.5 LENS
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
8885193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Aetna of IA Medicare |
$153.90
|
| Rate for Payer: Amerigroup Medicaid |
$155.74
|
| Rate for Payer: Amerigroup Medicare |
$122.72
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$121.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$154.22
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$156.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$139.72
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.30
|
|
|
ACRYSOF IQ 18.5 LENS
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
8885193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
|
|
ACRYSOF IQ 19.5 LENS
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
8885195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Aetna of IA Medicare |
$153.90
|
| Rate for Payer: Amerigroup Medicaid |
$155.74
|
| Rate for Payer: Amerigroup Medicare |
$122.72
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$121.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$154.22
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$156.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$139.72
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.30
|
|
|
ACRYSOF IQ 19.5 LENS
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
8885195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
|
