|
amoxicillin-clavulanate 875 mg-125 mg Tab [VDMC]
|
Facility
|
OP
|
$2.19
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10366729
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Aetna of IA Commercial |
$1.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.97
|
| Rate for Payer: Aetna of IA Medicare |
$1.25
|
| Rate for Payer: Amerigroup Medicaid |
$1.26
|
| Rate for Payer: Amerigroup Medicare |
$1.00
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.25
|
| Rate for Payer: Medical Associates Commercial |
$1.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.99
|
| Rate for Payer: Midlands Choice Commercial |
$1.53
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.13
|
| Rate for Payer: United Healthcare Commercial |
$1.97
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.29
|
|
|
amphotericin B liposomal 50 mg IV Inj SDV [VDMC]
|
Facility
|
OP
|
$289.84
|
|
|
Service Code
|
HCPCS J0289
|
| Hospital Charge Code |
10366798
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$130.43 |
| Max. Negotiated Rate |
$260.86 |
| Rate for Payer: Aetna of IA Commercial |
$260.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$260.86
|
| Rate for Payer: Aetna of IA Medicare |
$165.21
|
| Rate for Payer: Amerigroup Medicaid |
$167.18
|
| Rate for Payer: Amerigroup Medicare |
$131.73
|
| Rate for Payer: Cash Price |
$231.87
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$217.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$130.43
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$165.56
|
| Rate for Payer: Medical Associates Commercial |
$217.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$130.43
|
| Rate for Payer: Midlands Choice Commercial |
$202.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$167.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$149.99
|
| Rate for Payer: United Healthcare Commercial |
$260.86
|
| Rate for Payer: United Healthcare Managed Medicare |
$171.01
|
|
|
amphotericin B liposomal 50 mg IV Inj SDV [VDMC]
|
Facility
|
IP
|
$289.84
|
|
|
Service Code
|
HCPCS J0289
|
| Hospital Charge Code |
10366798
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$202.89 |
| Max. Negotiated Rate |
$260.86 |
| Rate for Payer: Aetna of IA Commercial |
$260.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$260.86
|
| Rate for Payer: Cash Price |
$231.87
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$217.38
|
| Rate for Payer: Medical Associates Commercial |
$217.38
|
| Rate for Payer: Midlands Choice Commercial |
$202.89
|
| Rate for Payer: United Healthcare Commercial |
$260.86
|
|
|
ampicillin 1 g Inj SDV [VDMC]
|
Facility
|
IP
|
$24.82
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
10366865
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$22.34 |
| Rate for Payer: Aetna of IA Commercial |
$22.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.34
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.61
|
| Rate for Payer: Medical Associates Commercial |
$18.61
|
| Rate for Payer: Midlands Choice Commercial |
$17.37
|
| Rate for Payer: United Healthcare Commercial |
$22.34
|
|
|
ampicillin 1 g Inj SDV [VDMC]
|
Facility
|
OP
|
$24.82
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
10366865
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$22.34 |
| Rate for Payer: Aetna of IA Commercial |
$22.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.34
|
| Rate for Payer: Aetna of IA Medicare |
$14.15
|
| Rate for Payer: Amerigroup Medicaid |
$14.32
|
| Rate for Payer: Amerigroup Medicare |
$11.28
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.61
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.17
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.18
|
| Rate for Payer: Medical Associates Commercial |
$18.61
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.17
|
| Rate for Payer: Midlands Choice Commercial |
$17.37
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.84
|
| Rate for Payer: United Healthcare Commercial |
$22.34
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.64
|
|
|
ampicillin 2 g Inj SDV [VDMC]
|
Facility
|
IP
|
$28.57
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
10367003
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$25.71 |
| Rate for Payer: Aetna of IA Commercial |
$25.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.71
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.43
|
| Rate for Payer: Medical Associates Commercial |
$21.43
|
| Rate for Payer: Midlands Choice Commercial |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$25.71
|
|
|
ampicillin 2 g Inj SDV [VDMC]
|
Facility
|
OP
|
$28.57
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
10367003
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$25.71 |
| Rate for Payer: Aetna of IA Commercial |
$25.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.71
|
| Rate for Payer: Aetna of IA Medicare |
$16.28
|
| Rate for Payer: Amerigroup Medicaid |
$16.48
|
| Rate for Payer: Amerigroup Medicare |
$12.98
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.43
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.32
|
| Rate for Payer: Medical Associates Commercial |
$21.43
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.86
|
| Rate for Payer: Midlands Choice Commercial |
$20.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.78
|
| Rate for Payer: United Healthcare Commercial |
$25.71
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.86
|
|
|
ampicillin 500 mg Cap [VDMC]
|
Facility
|
OP
|
$2.57
|
|
|
Service Code
|
HCPCS a9270
|
| Hospital Charge Code |
28497464
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna of IA Commercial |
$2.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.31
|
| Rate for Payer: Aetna of IA Medicare |
$1.46
|
| Rate for Payer: Amerigroup Medicaid |
$1.48
|
| Rate for Payer: Amerigroup Medicare |
$1.17
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.93
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.47
|
| Rate for Payer: Medical Associates Commercial |
$1.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.16
|
| Rate for Payer: Midlands Choice Commercial |
$1.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.33
|
| Rate for Payer: United Healthcare Commercial |
$2.31
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.51
|
|
|
ampicillin 500 mg Cap [VDMC]
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
HCPCS a9270
|
| Hospital Charge Code |
28497464
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna of IA Commercial |
$2.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.31
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.93
|
| Rate for Payer: Medical Associates Commercial |
$1.93
|
| Rate for Payer: Midlands Choice Commercial |
$1.80
|
| Rate for Payer: United Healthcare Commercial |
$2.31
|
|
|
ampicillin 500 mg Inj SDV [VDMC]
|
Facility
|
OP
|
$23.32
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
10367072
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$20.98 |
| Rate for Payer: Aetna of IA Commercial |
$20.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.98
|
| Rate for Payer: Aetna of IA Medicare |
$13.29
|
| Rate for Payer: Amerigroup Medicaid |
$13.45
|
| Rate for Payer: Amerigroup Medicare |
$10.60
|
| Rate for Payer: Cash Price |
$18.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.49
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.49
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.32
|
| Rate for Payer: Medical Associates Commercial |
$17.49
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.49
|
| Rate for Payer: Midlands Choice Commercial |
$16.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.07
|
| Rate for Payer: United Healthcare Commercial |
$20.98
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.76
|
|
|
ampicillin 500 mg Inj SDV [VDMC]
|
Facility
|
IP
|
$23.32
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
10367072
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$20.98 |
| Rate for Payer: Aetna of IA Commercial |
$20.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.98
|
| Rate for Payer: Cash Price |
$18.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.49
|
| Rate for Payer: Medical Associates Commercial |
$17.49
|
| Rate for Payer: Midlands Choice Commercial |
$16.32
|
| Rate for Payer: United Healthcare Commercial |
$20.98
|
|
|
ampicillin-sulbactam 1.5 GM Inj SDV [VDMC]
|
Facility
|
OP
|
$25.04
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
10367141
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$22.54 |
| Rate for Payer: Aetna of IA Commercial |
$22.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.54
|
| Rate for Payer: Aetna of IA Medicare |
$14.28
|
| Rate for Payer: Amerigroup Medicaid |
$14.45
|
| Rate for Payer: Amerigroup Medicare |
$11.38
|
| Rate for Payer: Cash Price |
$20.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.27
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.31
|
| Rate for Payer: Medical Associates Commercial |
$18.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.27
|
| Rate for Payer: Midlands Choice Commercial |
$17.53
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.96
|
| Rate for Payer: United Healthcare Commercial |
$22.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.78
|
|
|
ampicillin-sulbactam 1.5 GM Inj SDV [VDMC]
|
Facility
|
IP
|
$25.04
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
10367141
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.53 |
| Max. Negotiated Rate |
$22.54 |
| Rate for Payer: Aetna of IA Commercial |
$22.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.54
|
| Rate for Payer: Cash Price |
$20.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.78
|
| Rate for Payer: Medical Associates Commercial |
$18.78
|
| Rate for Payer: Midlands Choice Commercial |
$17.53
|
| Rate for Payer: United Healthcare Commercial |
$22.54
|
|
|
ampicillin-sulbactam 3 GM Inj SDV [VDMC]
|
Facility
|
OP
|
$31.59
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
10367210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.22 |
| Max. Negotiated Rate |
$28.43 |
| Rate for Payer: Aetna of IA Commercial |
$28.43
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.43
|
| Rate for Payer: Aetna of IA Medicare |
$18.01
|
| Rate for Payer: Amerigroup Medicaid |
$18.22
|
| Rate for Payer: Amerigroup Medicare |
$14.36
|
| Rate for Payer: Cash Price |
$25.27
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.69
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.05
|
| Rate for Payer: Medical Associates Commercial |
$23.69
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.22
|
| Rate for Payer: Midlands Choice Commercial |
$22.11
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.35
|
| Rate for Payer: United Healthcare Commercial |
$28.43
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.64
|
|
|
ampicillin-sulbactam 3 GM Inj SDV [VDMC]
|
Facility
|
IP
|
$31.59
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
10367210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$28.43 |
| Rate for Payer: Aetna of IA Commercial |
$28.43
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.43
|
| Rate for Payer: Cash Price |
$25.27
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.69
|
| Rate for Payer: Medical Associates Commercial |
$23.69
|
| Rate for Payer: Midlands Choice Commercial |
$22.11
|
| Rate for Payer: United Healthcare Commercial |
$28.43
|
|
|
AMPUTATE METATARSAL WITH TOE SINGLE
|
Professional
|
Both
|
$1,453.00
|
|
|
Service Code
|
CPT 28810
|
| Hospital Charge Code |
8825539
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$653.39 |
| Max. Negotiated Rate |
$1,089.75 |
| Rate for Payer: Cash Price |
$1,162.40
|
| Rate for Payer: Cash Price |
$1,162.40
|
| Rate for Payer: Medical Associates Commercial |
$1,089.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,017.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,089.75
|
| Rate for Payer: United Healthcare Commercial |
$653.39
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
OP
|
$2,907.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
4863429
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,308.15 |
| Max. Negotiated Rate |
$2,616.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,616.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,616.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,656.99
|
| Rate for Payer: Amerigroup Medicaid |
$1,676.76
|
| Rate for Payer: Amerigroup Medicare |
$1,321.23
|
| Rate for Payer: Cash Price |
$2,325.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,180.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,308.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,660.48
|
| Rate for Payer: Medical Associates Commercial |
$2,180.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,308.15
|
| Rate for Payer: Midlands Choice Commercial |
$2,034.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,684.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,504.37
|
| Rate for Payer: United Healthcare Commercial |
$2,616.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,715.13
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
IP
|
$1,943.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
4863423
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,360.10 |
| Max. Negotiated Rate |
$1,748.70 |
| Rate for Payer: Aetna of IA Commercial |
$1,748.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,748.70
|
| Rate for Payer: Cash Price |
$1,554.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,457.25
|
| Rate for Payer: Medical Associates Commercial |
$1,457.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,360.10
|
| Rate for Payer: United Healthcare Commercial |
$1,748.70
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
OP
|
$1,943.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
4863423
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$874.35 |
| Max. Negotiated Rate |
$1,748.70 |
| Rate for Payer: Aetna of IA Commercial |
$1,748.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,748.70
|
| Rate for Payer: Aetna of IA Medicare |
$1,107.51
|
| Rate for Payer: Amerigroup Medicaid |
$1,120.72
|
| Rate for Payer: Amerigroup Medicare |
$883.09
|
| Rate for Payer: Cash Price |
$1,554.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,457.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$874.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,109.84
|
| Rate for Payer: Medical Associates Commercial |
$1,457.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$874.35
|
| Rate for Payer: Midlands Choice Commercial |
$1,360.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,126.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,005.50
|
| Rate for Payer: United Healthcare Commercial |
$1,748.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,146.37
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
IP
|
$2,907.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
4863429
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,034.90 |
| Max. Negotiated Rate |
$2,616.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,616.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,616.30
|
| Rate for Payer: Cash Price |
$2,325.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,180.25
|
| Rate for Payer: Medical Associates Commercial |
$2,180.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,034.90
|
| Rate for Payer: United Healthcare Commercial |
$2,616.30
|
|
|
AMYLASE
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
631567
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
|
|
AMYLASE
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
631567
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Aetna of IA Medicare |
$36.48
|
| Rate for Payer: Amerigroup Medicaid |
$36.92
|
| Rate for Payer: Amerigroup Medicare |
$29.09
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.56
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.80
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.12
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
|
|
ANCA Screen DMCL
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
8037494
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna of IA Commercial |
$103.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$103.50
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$86.25
|
| Rate for Payer: Medical Associates Commercial |
$86.25
|
| Rate for Payer: Midlands Choice Commercial |
$80.50
|
| Rate for Payer: United Healthcare Commercial |
$103.50
|
|
|
ANCA Screen DMCL
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
8037494
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.75 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna of IA Commercial |
$103.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$103.50
|
| Rate for Payer: Aetna of IA Medicare |
$65.55
|
| Rate for Payer: Amerigroup Medicaid |
$66.33
|
| Rate for Payer: Amerigroup Medicare |
$52.27
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$86.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.69
|
| Rate for Payer: Medical Associates Commercial |
$86.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.75
|
| Rate for Payer: Midlands Choice Commercial |
$80.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$59.51
|
| Rate for Payer: United Healthcare Commercial |
$103.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.85
|
|
|
ANCHOR SUTURE 2.5MM
|
Facility
|
OP
|
$788.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8871630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.78 |
| Max. Negotiated Rate |
$709.56 |
| Rate for Payer: Aetna of IA Commercial |
$709.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$709.56
|
| Rate for Payer: Aetna of IA Medicare |
$449.39
|
| Rate for Payer: Amerigroup Medicaid |
$454.75
|
| Rate for Payer: Amerigroup Medicare |
$358.33
|
| Rate for Payer: Cash Price |
$630.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$591.30
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$354.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$450.33
|
| Rate for Payer: Medical Associates Commercial |
$591.30
|
| Rate for Payer: Medical Associates Managed Medicare |
$354.78
|
| Rate for Payer: Midlands Choice Commercial |
$551.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$456.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$408.00
|
| Rate for Payer: United Healthcare Commercial |
$709.56
|
| Rate for Payer: United Healthcare Managed Medicare |
$465.16
|
|
