|
VDMC CT Soft Tissue Neck w/ Contrast
|
Facility
|
IP
|
$1,445.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
8027206
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,011.50 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,300.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,300.50
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,083.75
|
| Rate for Payer: Medical Associates Commercial |
$1,083.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,011.50
|
| Rate for Payer: United Healthcare Commercial |
$1,300.50
|
|
|
VDMC CT Soft Tissue Neck w/ Contrast
|
Facility
|
OP
|
$1,445.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
8027206
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$650.25 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,300.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,300.50
|
| Rate for Payer: Aetna of IA Medicare |
$823.65
|
| Rate for Payer: Amerigroup Medicaid |
$833.48
|
| Rate for Payer: Amerigroup Medicare |
$656.75
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,083.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$650.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$825.38
|
| Rate for Payer: Medical Associates Commercial |
$1,083.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$650.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,011.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$837.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$747.79
|
| Rate for Payer: United Healthcare Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$852.55
|
|
|
VDMC CT Soft Tissue Neck w/o Contrast
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
8027207
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$531.00 |
| Max. Negotiated Rate |
$1,062.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,062.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,062.00
|
| Rate for Payer: Aetna of IA Medicare |
$672.60
|
| Rate for Payer: Amerigroup Medicaid |
$680.62
|
| Rate for Payer: Amerigroup Medicare |
$536.31
|
| Rate for Payer: Cash Price |
$944.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$885.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$531.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$674.02
|
| Rate for Payer: Medical Associates Commercial |
$885.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$531.00
|
| Rate for Payer: Midlands Choice Commercial |
$826.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$683.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$610.65
|
| Rate for Payer: United Healthcare Commercial |
$1,062.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$696.20
|
|
|
VDMC CT Soft Tissue Neck w/o Contrast
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
8027207
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$826.00 |
| Max. Negotiated Rate |
$1,062.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,062.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,062.00
|
| Rate for Payer: Cash Price |
$944.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$885.00
|
| Rate for Payer: Medical Associates Commercial |
$885.00
|
| Rate for Payer: Midlands Choice Commercial |
$826.00
|
| Rate for Payer: United Healthcare Commercial |
$1,062.00
|
|
|
VDMC CT Soft Tissue Neck w/ + w/o Contrast
|
Facility
|
OP
|
$1,656.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
8027205
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$745.20 |
| Max. Negotiated Rate |
$1,490.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,490.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,490.40
|
| Rate for Payer: Aetna of IA Medicare |
$943.92
|
| Rate for Payer: Amerigroup Medicaid |
$955.18
|
| Rate for Payer: Amerigroup Medicare |
$752.65
|
| Rate for Payer: Cash Price |
$1,324.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,242.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$745.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$945.91
|
| Rate for Payer: Medical Associates Commercial |
$1,242.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$745.20
|
| Rate for Payer: Midlands Choice Commercial |
$1,159.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$959.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$856.98
|
| Rate for Payer: United Healthcare Commercial |
$1,490.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$977.04
|
|
|
VDMC CT Soft Tissue Neck w/ + w/o Contrast
|
Facility
|
IP
|
$1,656.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
8027205
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,159.20 |
| Max. Negotiated Rate |
$1,490.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,490.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,490.40
|
| Rate for Payer: Cash Price |
$1,324.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,242.00
|
| Rate for Payer: Medical Associates Commercial |
$1,242.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,159.20
|
| Rate for Payer: United Healthcare Commercial |
$1,490.40
|
|
|
VDMC DOT LAW ENFORCEMENT PHYSICAL
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
8015869
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of IA Commercial |
$112.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$112.50
|
| Rate for Payer: Aetna of IA Medicare |
$71.25
|
| Rate for Payer: Amerigroup Medicaid |
$72.10
|
| Rate for Payer: Amerigroup Medicare |
$56.81
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$56.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.40
|
| Rate for Payer: Medical Associates Commercial |
$93.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.25
|
| Rate for Payer: Midlands Choice Commercial |
$87.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$72.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.69
|
| Rate for Payer: United Healthcare Commercial |
$112.50
|
|
|
VDMC DOT LAW ENFORCEMENT PHYSICAL
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
8015869
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of IA Commercial |
$112.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$112.50
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.75
|
| Rate for Payer: Medical Associates Commercial |
$93.75
|
| Rate for Payer: Midlands Choice Commercial |
$87.50
|
| Rate for Payer: United Healthcare Commercial |
$112.50
|
|
|
VDMC EMPLOYMENT FLU SHOTS
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
8015870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna of IA Commercial |
$22.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.50
|
| Rate for Payer: Aetna of IA Medicare |
$14.25
|
| Rate for Payer: Amerigroup Medicaid |
$14.42
|
| Rate for Payer: Amerigroup Medicare |
$11.36
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.28
|
| Rate for Payer: Medical Associates Commercial |
$18.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.25
|
| Rate for Payer: Midlands Choice Commercial |
$17.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.94
|
| Rate for Payer: United Healthcare Commercial |
$22.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.75
|
|
|
VDMC EMPLOYMENT FLU SHOTS
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
8015870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna of IA Commercial |
$22.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.50
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.75
|
| Rate for Payer: Medical Associates Commercial |
$18.75
|
| Rate for Payer: Midlands Choice Commercial |
$17.50
|
| Rate for Payer: United Healthcare Commercial |
$22.50
|
|
|
VDMC Hsg-Contrast Injection
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
7922827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$114.30 |
| Rate for Payer: Aetna of IA Commercial |
$114.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$114.30
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$95.25
|
| Rate for Payer: Medical Associates Commercial |
$95.25
|
| Rate for Payer: Midlands Choice Commercial |
$88.90
|
| Rate for Payer: United Healthcare Commercial |
$114.30
|
|
|
VDMC Hsg-Contrast Injection
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
7922827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.15 |
| Max. Negotiated Rate |
$114.30 |
| Rate for Payer: Aetna of IA Commercial |
$114.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$114.30
|
| Rate for Payer: Aetna of IA Medicare |
$72.39
|
| Rate for Payer: Amerigroup Medicaid |
$73.25
|
| Rate for Payer: Amerigroup Medicare |
$57.72
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$95.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$72.54
|
| Rate for Payer: Medical Associates Commercial |
$95.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.15
|
| Rate for Payer: Midlands Choice Commercial |
$88.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$73.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$65.72
|
| Rate for Payer: United Healthcare Commercial |
$114.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$74.93
|
|
|
VDMC Isotope Kinevac/Sincalide
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
7922837
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Aetna of IA Commercial |
$128.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$128.70
|
| Rate for Payer: Aetna of IA Medicare |
$81.51
|
| Rate for Payer: Amerigroup Medicaid |
$82.48
|
| Rate for Payer: Amerigroup Medicare |
$64.99
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$107.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$81.68
|
| Rate for Payer: Medical Associates Commercial |
$107.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.35
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$82.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.00
|
| Rate for Payer: United Healthcare Commercial |
$128.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.37
|
|
|
VDMC Isotope Kinevac/Sincalide
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
7922837
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Aetna of IA Commercial |
$128.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$128.70
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$107.25
|
| Rate for Payer: Medical Associates Commercial |
$107.25
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: United Healthcare Commercial |
$128.70
|
|
|
VDMC Knee Arthrogram Inj
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 27370
|
| Hospital Charge Code |
7922856
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
VDMC Knee Arthrogram Inj
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 27370
|
| Hospital Charge Code |
7922856
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.50 |
| 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: Aetna of IA Medicare |
$188.10
|
| Rate for Payer: Amerigroup Medicaid |
$190.34
|
| Rate for Payer: Amerigroup Medicare |
$149.99
|
| 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
|
|
|
VDMC Lumbar Puncture Myelogram
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
7922862
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$742.50 |
| Rate for Payer: Aetna of IA Commercial |
$742.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$742.50
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$618.75
|
| Rate for Payer: Medical Associates Commercial |
$618.75
|
| Rate for Payer: Midlands Choice Commercial |
$577.50
|
| Rate for Payer: United Healthcare Commercial |
$742.50
|
|
|
VDMC Lumbar Puncture Myelogram
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
7922862
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$371.25 |
| Max. Negotiated Rate |
$742.50 |
| Rate for Payer: Aetna of IA Commercial |
$742.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$742.50
|
| Rate for Payer: Aetna of IA Medicare |
$470.25
|
| Rate for Payer: Amerigroup Medicaid |
$475.86
|
| Rate for Payer: Amerigroup Medicare |
$374.96
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$618.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$371.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$471.24
|
| Rate for Payer: Medical Associates Commercial |
$618.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$371.25
|
| Rate for Payer: Midlands Choice Commercial |
$577.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$478.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$426.94
|
| Rate for Payer: United Healthcare Commercial |
$742.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$486.75
|
|
|
VDMC Pc Injection Major Joint
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
8018861
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.40 |
| Max. Negotiated Rate |
$361.80 |
| Rate for Payer: Aetna of IA Commercial |
$361.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$361.80
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$301.50
|
| Rate for Payer: Medical Associates Commercial |
$301.50
|
| Rate for Payer: Midlands Choice Commercial |
$281.40
|
| Rate for Payer: United Healthcare Commercial |
$361.80
|
|
|
VDMC Pc Injection Major Joint
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
8018861
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.90 |
| Max. Negotiated Rate |
$361.80 |
| Rate for Payer: Aetna of IA Commercial |
$361.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$361.80
|
| Rate for Payer: Aetna of IA Medicare |
$229.14
|
| Rate for Payer: Amerigroup Medicaid |
$231.87
|
| Rate for Payer: Amerigroup Medicare |
$182.71
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$301.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$180.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$229.62
|
| Rate for Payer: Medical Associates Commercial |
$301.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$180.90
|
| Rate for Payer: Midlands Choice Commercial |
$281.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$233.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$208.03
|
| Rate for Payer: United Healthcare Commercial |
$361.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$237.18
|
|
|
VDMC Si Joint Injection
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
8018863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of IA Commercial |
$32.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.40
|
| Rate for Payer: Aetna of IA Medicare |
$20.52
|
| Rate for Payer: Amerigroup Medicaid |
$20.76
|
| Rate for Payer: Amerigroup Medicare |
$16.36
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.56
|
| Rate for Payer: Medical Associates Commercial |
$27.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.20
|
| Rate for Payer: Midlands Choice Commercial |
$25.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.63
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.24
|
|
|
VDMC Si Joint Injection
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
8018863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of IA Commercial |
$32.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.00
|
| Rate for Payer: Medical Associates Commercial |
$27.00
|
| Rate for Payer: Midlands Choice Commercial |
$25.20
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
|
|
VDMC Wrist Arthrogram Injection
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
8018865
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
VDMC Wrist Arthrogram Injection
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
8018865
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.50 |
| 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: Aetna of IA Medicare |
$188.10
|
| Rate for Payer: Amerigroup Medicaid |
$190.34
|
| Rate for Payer: Amerigroup Medicare |
$149.99
|
| 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
|
|
|
vecuronium 10 mg Pow[VDMC]
|
Facility
|
IP
|
$42.55
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
11348952
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.78 |
| Max. Negotiated Rate |
$38.29 |
| Rate for Payer: Aetna of IA Commercial |
$38.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.29
|
| Rate for Payer: Cash Price |
$34.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.91
|
| Rate for Payer: Medical Associates Commercial |
$31.91
|
| Rate for Payer: Midlands Choice Commercial |
$29.78
|
| Rate for Payer: United Healthcare Commercial |
$38.29
|
|
