|
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 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 |
$827.67 |
| 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 |
$835.78
|
| Rate for Payer: Amerigroup Medicare |
$836.28
|
| Rate for Payer: Cash Price |
$1,324.80
|
| 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 |
$828.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$827.67
|
| Rate for Payer: Medical Associates Commercial |
$1,242.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$828.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,159.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$840.42
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$839.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,242.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,242.00
|
| Rate for Payer: United Healthcare Commercial |
$1,490.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$977.04
|
| Rate for Payer: Wellmark IA HMO |
$1,042.22
|
| Rate for Payer: Wellmark IA PPO |
$1,146.44
|
|
|
VDMC Hsg-Contrast Injection
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
7922827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$1,642.94 |
| 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 |
$64.10
|
| Rate for Payer: Amerigroup Medicare |
$64.14
|
| Rate for Payer: Cash Price |
$101.60
|
| 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 |
$63.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$63.47
|
| Rate for Payer: Medical Associates Commercial |
$95.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$63.50
|
| Rate for Payer: Midlands Choice Commercial |
$88.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$64.45
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$64.41
|
| Rate for Payer: Oscar Health of IA Commercial |
$95.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$95.25
|
| Rate for Payer: United Healthcare Commercial |
$114.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$74.93
|
| Rate for Payer: Wellmark IA HMO |
$1,493.58
|
| Rate for Payer: Wellmark IA PPO |
$1,642.94
|
|
|
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 Isotope Kinevac/Sincalide
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT J2805
|
| Hospital Charge Code |
7922837
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.47 |
| 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 |
$72.17
|
| Rate for Payer: Amerigroup Medicare |
$72.22
|
| 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 |
$71.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.47
|
| Rate for Payer: Medical Associates Commercial |
$107.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.50
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$72.57
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$72.53
|
| Rate for Payer: Oscar Health of IA Commercial |
$107.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$107.25
|
| 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
|
CPT 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: Medical Associates Commercial |
$247.50
|
| 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: 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 |
$164.93 |
| 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 |
$166.55
|
| Rate for Payer: Amerigroup Medicare |
$166.65
|
| 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 |
$165.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$164.93
|
| Rate for Payer: Medical Associates Commercial |
$247.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$231.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$167.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$167.38
|
| Rate for Payer: Oscar Health of IA Commercial |
$247.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$247.50
|
| Rate for Payer: United Healthcare Commercial |
$297.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$194.70
|
|
|
VDMC Lumbar Puncture Myelogram
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
7922862
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.34 |
| Max. Negotiated Rate |
$1,642.94 |
| 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 |
$416.38
|
| Rate for Payer: Amerigroup Medicare |
$416.62
|
| Rate for Payer: Cash Price |
$660.00
|
| 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 |
$412.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$412.34
|
| Rate for Payer: Medical Associates Commercial |
$618.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$412.50
|
| Rate for Payer: Midlands Choice Commercial |
$577.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$418.69
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$418.44
|
| Rate for Payer: Oscar Health of IA Commercial |
$618.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$618.75
|
| Rate for Payer: United Healthcare Commercial |
$742.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$486.75
|
| Rate for Payer: Wellmark IA HMO |
$1,493.58
|
| Rate for Payer: Wellmark IA PPO |
$1,642.94
|
|
|
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 Pc Injection Major Joint
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
8018861
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.92 |
| Max. Negotiated Rate |
$705.87 |
| 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 |
$202.89
|
| Rate for Payer: Amerigroup Medicare |
$203.01
|
| Rate for Payer: Cash Price |
$321.60
|
| 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 |
$201.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$200.92
|
| Rate for Payer: Medical Associates Commercial |
$301.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$201.00
|
| Rate for Payer: Midlands Choice Commercial |
$281.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$204.02
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$203.89
|
| Rate for Payer: Oscar Health of IA Commercial |
$301.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$301.50
|
| Rate for Payer: United Healthcare Commercial |
$361.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$237.18
|
| Rate for Payer: Wellmark IA HMO |
$641.70
|
| Rate for Payer: Wellmark IA PPO |
$705.87
|
|
|
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 Si Joint Injection
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
8018863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$17.99 |
| 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 |
$18.17
|
| Rate for Payer: Amerigroup Medicare |
$18.18
|
| 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 |
$18.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.99
|
| Rate for Payer: Medical Associates Commercial |
$27.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$25.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.27
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$18.26
|
| Rate for Payer: Oscar Health of IA Commercial |
$27.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.00
|
| 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
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
8018865
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.93 |
| Max. Negotiated Rate |
$1,642.94 |
| 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 |
$166.55
|
| Rate for Payer: Amerigroup Medicare |
$166.65
|
| 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 |
$165.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$164.93
|
| Rate for Payer: Medical Associates Commercial |
$247.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$231.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$167.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$167.38
|
| Rate for Payer: Oscar Health of IA Commercial |
$247.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$247.50
|
| Rate for Payer: United Healthcare Commercial |
$297.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$194.70
|
| Rate for Payer: Wellmark IA HMO |
$1,493.58
|
| Rate for Payer: Wellmark IA PPO |
$1,642.94
|
|
|
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
|
|
|
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 |
$38.30 |
| Rate for Payer: Aetna of IA Commercial |
$38.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.30
|
| 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 |
$38.30
|
|
|
vecuronium 10 mg Pow[VDMC]
|
Facility
|
OP
|
$42.55
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
11348952
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.27 |
| Max. Negotiated Rate |
$38.30 |
| Rate for Payer: Aetna of IA Commercial |
$38.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.30
|
| Rate for Payer: Aetna of IA Medicare |
$24.25
|
| Rate for Payer: Amerigroup Medicaid |
$21.47
|
| Rate for Payer: Amerigroup Medicare |
$21.49
|
| Rate for Payer: Cash Price |
$34.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.91
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$21.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.27
|
| Rate for Payer: Medical Associates Commercial |
$31.91
|
| Rate for Payer: Medical Associates Managed Medicare |
$21.28
|
| Rate for Payer: Midlands Choice Commercial |
$29.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21.59
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$21.58
|
| Rate for Payer: Oscar Health of IA Commercial |
$31.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.91
|
| Rate for Payer: United Healthcare Commercial |
$38.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.10
|
|
|
Vedolizumab 300 mg SDV [VDMC]
|
Facility
|
OP
|
$17,433.16
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
19779403
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8,713.09 |
| Max. Negotiated Rate |
$15,689.84 |
| Rate for Payer: Aetna of IA Commercial |
$15,689.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$15,689.84
|
| Rate for Payer: Aetna of IA Medicare |
$9,936.90
|
| Rate for Payer: Amerigroup Medicaid |
$8,798.52
|
| Rate for Payer: Amerigroup Medicare |
$8,803.75
|
| Rate for Payer: Cash Price |
$13,946.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13,074.87
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8,716.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,713.09
|
| Rate for Payer: Medical Associates Commercial |
$13,074.87
|
| Rate for Payer: Medical Associates Managed Medicare |
$8,716.58
|
| Rate for Payer: Midlands Choice Commercial |
$12,203.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,847.33
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$8,842.10
|
| Rate for Payer: Oscar Health of IA Commercial |
$13,074.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$13,074.87
|
| Rate for Payer: United Healthcare Commercial |
$15,689.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$10,285.56
|
|
|
Vedolizumab 300 mg SDV [VDMC]
|
Facility
|
IP
|
$17,433.16
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
19779403
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12,203.21 |
| Max. Negotiated Rate |
$15,689.84 |
| Rate for Payer: Aetna of IA Commercial |
$15,689.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$15,689.84
|
| Rate for Payer: Cash Price |
$13,946.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13,074.87
|
| Rate for Payer: Medical Associates Commercial |
$13,074.87
|
| Rate for Payer: Midlands Choice Commercial |
$12,203.21
|
| Rate for Payer: United Healthcare Commercial |
$15,689.84
|
|
|
Vein Ligation and Stripping
|
Facility
|
IP
|
$22,689.72
|
|
|
Service Code
|
MS-DRG 263
|
| Hospital Charge Code |
125
|
| Min. Negotiated Rate |
$22,360.88 |
| Max. Negotiated Rate |
$22,689.72 |
| Rate for Payer: Amerigroup Medicaid |
$22,580.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22,360.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22,689.72
|
|
|
VENIPUNCTURE
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
1779400
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$45.69 |
| Rate for Payer: Aetna of IA Commercial |
$18.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.90
|
| Rate for Payer: Aetna of IA Medicare |
$11.97
|
| Rate for Payer: Amerigroup Medicaid |
$10.60
|
| Rate for Payer: Amerigroup Medicare |
$10.60
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.50
|
| Rate for Payer: Medical Associates Commercial |
$15.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.50
|
| Rate for Payer: Midlands Choice Commercial |
$14.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.66
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$10.65
|
| Rate for Payer: Oscar Health of IA Commercial |
$15.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$15.75
|
| Rate for Payer: United Healthcare Commercial |
$18.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.39
|
| Rate for Payer: Wellmark IA HMO |
$41.54
|
| Rate for Payer: Wellmark IA PPO |
$45.69
|
|
|
VENIPUNCTURE
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
1779400
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna of IA Commercial |
$18.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.90
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.75
|
| Rate for Payer: Medical Associates Commercial |
$15.75
|
| Rate for Payer: Midlands Choice Commercial |
$14.70
|
| Rate for Payer: United Healthcare Commercial |
$18.90
|
|
|
venlafaxine 37.5 mg ER Cap [VDMC]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10427797
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna of IA Commercial |
$1.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.08
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.90
|
| Rate for Payer: Medical Associates Commercial |
$0.90
|
| Rate for Payer: Midlands Choice Commercial |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.08
|
|
|
venlafaxine 37.5 mg ER Cap [VDMC]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10427797
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna of IA Commercial |
$1.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.08
|
| Rate for Payer: Aetna of IA Medicare |
$0.68
|
| Rate for Payer: Amerigroup Medicaid |
$0.61
|
| Rate for Payer: Amerigroup Medicare |
$0.61
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.90
|
| 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 |
$0.60
|
| Rate for Payer: Medical Associates Commercial |
$0.90
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.60
|
| Rate for Payer: Midlands Choice Commercial |
$0.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.61
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.61
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.71
|
|
