|
venlafaxine 75 mg ER Cap [VDMC]
|
Facility
|
OP
|
$1.22
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10427868
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna of IA Commercial |
$1.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.10
|
| Rate for Payer: Aetna of IA Medicare |
$0.70
|
| Rate for Payer: Amerigroup Medicaid |
$0.62
|
| Rate for Payer: Amerigroup Medicare |
$0.62
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.92
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.61
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.61
|
| Rate for Payer: Medical Associates Commercial |
$0.92
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.61
|
| Rate for Payer: Midlands Choice Commercial |
$0.85
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.62
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.62
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.92
|
| Rate for Payer: United Healthcare Commercial |
$1.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.72
|
|
|
venlafaxine 75 mg ER Cap [VDMC]
|
Facility
|
IP
|
$1.22
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10427868
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna of IA Commercial |
$1.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.10
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.92
|
| Rate for Payer: Medical Associates Commercial |
$0.92
|
| Rate for Payer: Midlands Choice Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.10
|
|
|
VENT ASSIST MGMT,INITIAL
|
Facility
|
IP
|
$1,078.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
4770840
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$754.60 |
| Max. Negotiated Rate |
$970.20 |
| Rate for Payer: Aetna of IA Commercial |
$970.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$970.20
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$808.50
|
| Rate for Payer: Medical Associates Commercial |
$808.50
|
| Rate for Payer: Midlands Choice Commercial |
$754.60
|
| Rate for Payer: United Healthcare Commercial |
$970.20
|
|
|
VENT ASSIST MGMT,INITIAL
|
Facility
|
OP
|
$1,078.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
4770840
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$538.78 |
| Max. Negotiated Rate |
$970.20 |
| Rate for Payer: Aetna of IA Commercial |
$970.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$970.20
|
| Rate for Payer: Aetna of IA Medicare |
$614.46
|
| Rate for Payer: Amerigroup Medicaid |
$544.07
|
| Rate for Payer: Amerigroup Medicare |
$544.39
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$808.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$539.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$538.78
|
| Rate for Payer: Medical Associates Commercial |
$808.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$539.00
|
| Rate for Payer: Midlands Choice Commercial |
$754.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$547.08
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$546.76
|
| Rate for Payer: Oscar Health of IA Commercial |
$808.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$808.50
|
| Rate for Payer: United Healthcare Commercial |
$970.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$636.02
|
| Rate for Payer: Wellmark IA HMO |
$778.72
|
| Rate for Payer: Wellmark IA PPO |
$856.59
|
|
|
VENT ASSIST MGNT SUBSQ DAY
|
Facility
|
IP
|
$1,078.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
4770839
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$754.60 |
| Max. Negotiated Rate |
$970.20 |
| Rate for Payer: Aetna of IA Commercial |
$970.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$970.20
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$808.50
|
| Rate for Payer: Medical Associates Commercial |
$808.50
|
| Rate for Payer: Midlands Choice Commercial |
$754.60
|
| Rate for Payer: United Healthcare Commercial |
$970.20
|
|
|
VENT ASSIST MGNT SUBSQ DAY
|
Facility
|
OP
|
$1,078.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
4770839
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$538.78 |
| Max. Negotiated Rate |
$970.20 |
| Rate for Payer: Aetna of IA Commercial |
$970.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$970.20
|
| Rate for Payer: Aetna of IA Medicare |
$614.46
|
| Rate for Payer: Amerigroup Medicaid |
$544.07
|
| Rate for Payer: Amerigroup Medicare |
$544.39
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$808.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$539.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$538.78
|
| Rate for Payer: Medical Associates Commercial |
$808.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$539.00
|
| Rate for Payer: Midlands Choice Commercial |
$754.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$547.08
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$546.76
|
| Rate for Payer: Oscar Health of IA Commercial |
$808.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$808.50
|
| Rate for Payer: United Healthcare Commercial |
$970.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$636.02
|
| Rate for Payer: Wellmark IA HMO |
$778.72
|
| Rate for Payer: Wellmark IA PPO |
$856.59
|
|
|
VENTRAL EX LARGE MESH
|
Facility
|
OP
|
$1,053.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8449030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.29 |
| Max. Negotiated Rate |
$947.70 |
| Rate for Payer: Aetna of IA Commercial |
$947.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$947.70
|
| Rate for Payer: Aetna of IA Medicare |
$600.21
|
| Rate for Payer: Amerigroup Medicaid |
$531.45
|
| Rate for Payer: Amerigroup Medicare |
$531.76
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$789.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$526.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$526.29
|
| Rate for Payer: Medical Associates Commercial |
$789.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$526.50
|
| Rate for Payer: Midlands Choice Commercial |
$737.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$534.40
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$534.08
|
| Rate for Payer: Oscar Health of IA Commercial |
$789.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$789.75
|
| Rate for Payer: United Healthcare Commercial |
$947.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$621.27
|
|
|
VENTRAL EX LARGE MESH
|
Facility
|
IP
|
$1,053.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8449030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$737.10 |
| Max. Negotiated Rate |
$947.70 |
| Rate for Payer: Aetna of IA Commercial |
$947.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$947.70
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$789.75
|
| Rate for Payer: Medical Associates Commercial |
$789.75
|
| Rate for Payer: Midlands Choice Commercial |
$737.10
|
| Rate for Payer: United Healthcare Commercial |
$947.70
|
|
|
VENTRAL EX MEDIUM MESH
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8449028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.83 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Aetna of IA Commercial |
$745.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$745.20
|
| Rate for Payer: Aetna of IA Medicare |
$471.96
|
| Rate for Payer: Amerigroup Medicaid |
$417.89
|
| Rate for Payer: Amerigroup Medicare |
$418.14
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$621.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$414.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$413.83
|
| Rate for Payer: Medical Associates Commercial |
$621.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$414.00
|
| Rate for Payer: Midlands Choice Commercial |
$579.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$420.21
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$419.96
|
| Rate for Payer: Oscar Health of IA Commercial |
$621.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$621.00
|
| Rate for Payer: United Healthcare Commercial |
$745.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$488.52
|
|
|
VENTRAL EX MEDIUM MESH
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8449028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.60 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Aetna of IA Commercial |
$745.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$745.20
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$621.00
|
| Rate for Payer: Medical Associates Commercial |
$621.00
|
| Rate for Payer: Midlands Choice Commercial |
$579.60
|
| Rate for Payer: United Healthcare Commercial |
$745.20
|
|
|
VENTRAL EX SMALL MESH
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8463903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$485.10 |
| Max. Negotiated Rate |
$623.70 |
| Rate for Payer: Aetna of IA Commercial |
$623.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$623.70
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$519.75
|
| Rate for Payer: Medical Associates Commercial |
$519.75
|
| Rate for Payer: Midlands Choice Commercial |
$485.10
|
| Rate for Payer: United Healthcare Commercial |
$623.70
|
|
|
VENTRAL EX SMALL MESH
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8463903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.36 |
| Max. Negotiated Rate |
$623.70 |
| Rate for Payer: Aetna of IA Commercial |
$623.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$623.70
|
| Rate for Payer: Aetna of IA Medicare |
$395.01
|
| Rate for Payer: Amerigroup Medicaid |
$349.76
|
| Rate for Payer: Amerigroup Medicare |
$349.96
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$519.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$346.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$346.36
|
| Rate for Payer: Medical Associates Commercial |
$519.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$346.50
|
| Rate for Payer: Midlands Choice Commercial |
$485.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$351.70
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$351.49
|
| Rate for Payer: Oscar Health of IA Commercial |
$519.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$519.75
|
| Rate for Payer: United Healthcare Commercial |
$623.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$408.87
|
|
|
VENTRALIGHT MESH 15X20CM
|
Facility
|
OP
|
$1,804.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8481703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$901.64 |
| Max. Negotiated Rate |
$1,623.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,623.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,623.60
|
| Rate for Payer: Aetna of IA Medicare |
$1,028.28
|
| Rate for Payer: Amerigroup Medicaid |
$910.48
|
| Rate for Payer: Amerigroup Medicare |
$911.02
|
| Rate for Payer: Cash Price |
$1,443.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,353.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$902.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$901.64
|
| Rate for Payer: Medical Associates Commercial |
$1,353.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$902.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,262.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$915.53
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$914.99
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,353.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,353.00
|
| Rate for Payer: United Healthcare Commercial |
$1,623.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,064.36
|
|
|
VENTRALIGHT MESH 15X20CM
|
Facility
|
IP
|
$1,804.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8481703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,262.80 |
| Max. Negotiated Rate |
$1,623.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,623.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,623.60
|
| Rate for Payer: Cash Price |
$1,443.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,353.00
|
| Rate for Payer: Medical Associates Commercial |
$1,353.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,262.80
|
| Rate for Payer: United Healthcare Commercial |
$1,623.60
|
|
|
VENTRALIGHT ST MESH ELLIPSE 7"X9"
|
Facility
|
IP
|
$1,773.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8937693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,241.10 |
| Max. Negotiated Rate |
$1,595.70 |
| Rate for Payer: Aetna of IA Commercial |
$1,595.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,595.70
|
| Rate for Payer: Cash Price |
$1,418.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,329.75
|
| Rate for Payer: Medical Associates Commercial |
$1,329.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,241.10
|
| Rate for Payer: United Healthcare Commercial |
$1,595.70
|
|
|
VENTRALIGHT ST MESH ELLIPSE 7"X9"
|
Facility
|
OP
|
$1,773.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8937693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$886.15 |
| Max. Negotiated Rate |
$1,595.70 |
| Rate for Payer: Aetna of IA Commercial |
$1,595.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,595.70
|
| Rate for Payer: Aetna of IA Medicare |
$1,010.61
|
| Rate for Payer: Amerigroup Medicaid |
$894.83
|
| Rate for Payer: Amerigroup Medicare |
$895.36
|
| Rate for Payer: Cash Price |
$1,418.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,329.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$886.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$886.15
|
| Rate for Payer: Medical Associates Commercial |
$1,329.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$886.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,241.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$899.80
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$899.27
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,329.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,329.75
|
| Rate for Payer: United Healthcare Commercial |
$1,595.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,046.07
|
|
|
Ventricular Shunt Procedures With CC
|
Facility
|
IP
|
$13,446.71
|
|
|
Service Code
|
MS-DRG 032
|
| Hospital Charge Code |
721
|
| Min. Negotiated Rate |
$13,251.83 |
| Max. Negotiated Rate |
$13,446.71 |
| Rate for Payer: Amerigroup Medicaid |
$13,381.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13,251.83
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,446.71
|
|
|
Ventricular Shunt Procedures With MCC
|
Facility
|
IP
|
$23,291.09
|
|
|
Service Code
|
MS-DRG 031
|
| Hospital Charge Code |
720
|
| Min. Negotiated Rate |
$22,953.54 |
| Max. Negotiated Rate |
$23,291.09 |
| Rate for Payer: Amerigroup Medicaid |
$23,178.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22,953.54
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23,291.09
|
|
|
Ventricular Shunt Procedures Without CC/MCC
|
Facility
|
IP
|
$11,559.92
|
|
|
Service Code
|
MS-DRG 033
|
| Hospital Charge Code |
722
|
| Min. Negotiated Rate |
$11,392.38 |
| Max. Negotiated Rate |
$11,559.92 |
| Rate for Payer: Amerigroup Medicaid |
$11,504.07
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11,392.38
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11,559.92
|
|
|
VENTRIO LG CIRCLE HERNIA PATCH
|
Facility
|
OP
|
$1,305.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8026204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.24 |
| Max. Negotiated Rate |
$1,174.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,174.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,174.50
|
| Rate for Payer: Aetna of IA Medicare |
$743.85
|
| Rate for Payer: Amerigroup Medicaid |
$658.63
|
| Rate for Payer: Amerigroup Medicare |
$659.02
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$978.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$652.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$652.24
|
| Rate for Payer: Medical Associates Commercial |
$978.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$652.50
|
| Rate for Payer: Midlands Choice Commercial |
$913.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$662.29
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$661.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$978.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$978.75
|
| Rate for Payer: United Healthcare Commercial |
$1,174.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$769.95
|
|
|
VENTRIO LG CIRCLE HERNIA PATCH
|
Facility
|
IP
|
$1,305.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8026204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.50 |
| Max. Negotiated Rate |
$1,174.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,174.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,174.50
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$978.75
|
| Rate for Payer: Medical Associates Commercial |
$978.75
|
| Rate for Payer: Midlands Choice Commercial |
$913.50
|
| Rate for Payer: United Healthcare Commercial |
$1,174.50
|
|
|
VENTRIO LG OVAL HERNIA PATCH
|
Facility
|
IP
|
$1,547.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8026046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,082.90 |
| Max. Negotiated Rate |
$1,392.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,392.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,392.30
|
| Rate for Payer: Cash Price |
$1,237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,160.25
|
| Rate for Payer: Medical Associates Commercial |
$1,160.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,082.90
|
| Rate for Payer: United Healthcare Commercial |
$1,392.30
|
|
|
VENTRIO LG OVAL HERNIA PATCH
|
Facility
|
OP
|
$1,547.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8026046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$773.19 |
| Max. Negotiated Rate |
$1,392.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,392.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,392.30
|
| Rate for Payer: Aetna of IA Medicare |
$881.79
|
| Rate for Payer: Amerigroup Medicaid |
$780.77
|
| Rate for Payer: Amerigroup Medicare |
$781.24
|
| Rate for Payer: Cash Price |
$1,237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,160.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$773.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$773.19
|
| Rate for Payer: Medical Associates Commercial |
$1,160.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$773.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,082.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$785.10
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$784.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,160.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,160.25
|
| Rate for Payer: United Healthcare Commercial |
$1,392.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$912.73
|
|
|
VENTRIO MED OVAL HERNIA PATCH
|
Facility
|
OP
|
$1,305.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8026376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.24 |
| Max. Negotiated Rate |
$1,174.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,174.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,174.50
|
| Rate for Payer: Aetna of IA Medicare |
$743.85
|
| Rate for Payer: Amerigroup Medicaid |
$658.63
|
| Rate for Payer: Amerigroup Medicare |
$659.02
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$978.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$652.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$652.24
|
| Rate for Payer: Medical Associates Commercial |
$978.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$652.50
|
| Rate for Payer: Midlands Choice Commercial |
$913.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$662.29
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$661.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$978.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$978.75
|
| Rate for Payer: United Healthcare Commercial |
$1,174.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$769.95
|
|
|
VENTRIO MED OVAL HERNIA PATCH
|
Facility
|
IP
|
$1,305.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8026376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.50 |
| Max. Negotiated Rate |
$1,174.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,174.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,174.50
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$978.75
|
| Rate for Payer: Medical Associates Commercial |
$978.75
|
| Rate for Payer: Midlands Choice Commercial |
$913.50
|
| Rate for Payer: United Healthcare Commercial |
$1,174.50
|
|
