|
VENTRIO SM CIRCLE HERNIA PATCH
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8025828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.50 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Aetna of IA Commercial |
$850.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$850.50
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$708.75
|
| Rate for Payer: Medical Associates Commercial |
$708.75
|
| Rate for Payer: Midlands Choice Commercial |
$661.50
|
| Rate for Payer: United Healthcare Commercial |
$850.50
|
|
|
VENTRIO SM CIRCLE HERNIA PATCH
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8025828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.31 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Aetna of IA Commercial |
$850.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$850.50
|
| Rate for Payer: Aetna of IA Medicare |
$538.65
|
| Rate for Payer: Amerigroup Medicaid |
$476.94
|
| Rate for Payer: Amerigroup Medicare |
$477.22
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$708.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$472.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$472.31
|
| Rate for Payer: Medical Associates Commercial |
$708.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$472.50
|
| Rate for Payer: Midlands Choice Commercial |
$661.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$479.59
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$479.30
|
| Rate for Payer: Oscar Health of IA Commercial |
$708.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$708.75
|
| Rate for Payer: United Healthcare Commercial |
$850.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$557.55
|
|
|
VENTRIO SM OVAL HERNIA PATCH
|
Facility
|
OP
|
$1,087.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8025936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.28 |
| Max. Negotiated Rate |
$978.30 |
| Rate for Payer: Aetna of IA Commercial |
$978.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$978.30
|
| Rate for Payer: Aetna of IA Medicare |
$619.59
|
| Rate for Payer: Amerigroup Medicaid |
$548.61
|
| Rate for Payer: Amerigroup Medicare |
$548.94
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$815.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$543.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$543.28
|
| Rate for Payer: Medical Associates Commercial |
$815.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$543.50
|
| Rate for Payer: Midlands Choice Commercial |
$760.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$551.65
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$551.33
|
| Rate for Payer: Oscar Health of IA Commercial |
$815.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$815.25
|
| Rate for Payer: United Healthcare Commercial |
$978.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$641.33
|
|
|
VENTRIO SM OVAL HERNIA PATCH
|
Facility
|
IP
|
$1,087.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8025936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$760.90 |
| Max. Negotiated Rate |
$978.30 |
| Rate for Payer: Aetna of IA Commercial |
$978.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$978.30
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$815.25
|
| Rate for Payer: Medical Associates Commercial |
$815.25
|
| Rate for Payer: Midlands Choice Commercial |
$760.90
|
| Rate for Payer: United Healthcare Commercial |
$978.30
|
|
|
VENTRO ST HERNIA PATCH 11.4 cm LARGE CIRCLE
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8940608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$349.86 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna of IA Commercial |
$630.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$630.00
|
| Rate for Payer: Aetna of IA Medicare |
$399.00
|
| Rate for Payer: Amerigroup Medicaid |
$353.29
|
| Rate for Payer: Amerigroup Medicare |
$353.50
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$525.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$350.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$349.86
|
| Rate for Payer: Medical Associates Commercial |
$525.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$350.00
|
| Rate for Payer: Midlands Choice Commercial |
$490.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$355.25
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$355.04
|
| Rate for Payer: Oscar Health of IA Commercial |
$525.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$525.00
|
| Rate for Payer: United Healthcare Commercial |
$630.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$413.00
|
|
|
VENTRO ST HERNIA PATCH 11.4 cm LARGE CIRCLE
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8940608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna of IA Commercial |
$630.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$630.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$525.00
|
| Rate for Payer: Medical Associates Commercial |
$525.00
|
| Rate for Payer: Midlands Choice Commercial |
$490.00
|
| Rate for Payer: United Healthcare Commercial |
$630.00
|
|
|
VENTRO ST HERNIA PATCH LARGE OVAL13.8CM x 17.8CM
|
Facility
|
OP
|
$1,179.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8940610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.26 |
| Max. Negotiated Rate |
$1,061.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,061.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,061.10
|
| Rate for Payer: Aetna of IA Medicare |
$672.03
|
| Rate for Payer: Amerigroup Medicaid |
$595.04
|
| Rate for Payer: Amerigroup Medicare |
$595.40
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$884.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$589.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$589.26
|
| Rate for Payer: Medical Associates Commercial |
$884.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$589.50
|
| Rate for Payer: Midlands Choice Commercial |
$825.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$598.34
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$597.99
|
| Rate for Payer: Oscar Health of IA Commercial |
$884.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$884.25
|
| Rate for Payer: United Healthcare Commercial |
$1,061.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$695.61
|
|
|
VENTRO ST HERNIA PATCH LARGE OVAL13.8CM x 17.8CM
|
Facility
|
IP
|
$1,179.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8940610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.30 |
| Max. Negotiated Rate |
$1,061.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,061.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,061.10
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$884.25
|
| Rate for Payer: Medical Associates Commercial |
$884.25
|
| Rate for Payer: Midlands Choice Commercial |
$825.30
|
| Rate for Payer: United Healthcare Commercial |
$1,061.10
|
|
|
verapamil 120 mg ER Tab [VDMC]
|
Facility
|
OP
|
$1.84
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10427939
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Aetna of IA Commercial |
$1.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.66
|
| Rate for Payer: Aetna of IA Medicare |
$1.05
|
| Rate for Payer: Amerigroup Medicaid |
$0.93
|
| Rate for Payer: Amerigroup Medicare |
$0.93
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.92
|
| Rate for Payer: Medical Associates Commercial |
$1.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.92
|
| Rate for Payer: Midlands Choice Commercial |
$1.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.93
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.93
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.38
|
| Rate for Payer: United Healthcare Commercial |
$1.66
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.09
|
|
|
verapamil 120 mg ER Tab [VDMC]
|
Facility
|
IP
|
$1.84
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10427939
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Aetna of IA Commercial |
$1.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.66
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.38
|
| Rate for Payer: Medical Associates Commercial |
$1.38
|
| Rate for Payer: Midlands Choice Commercial |
$1.29
|
| Rate for Payer: United Healthcare Commercial |
$1.66
|
|
|
verapamil 180 mg ER Tab [VDMC]
|
Facility
|
IP
|
$1.86
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10428008
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna of IA Commercial |
$1.67
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.67
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.40
|
| Rate for Payer: Medical Associates Commercial |
$1.40
|
| Rate for Payer: Midlands Choice Commercial |
$1.30
|
| Rate for Payer: United Healthcare Commercial |
$1.67
|
|
|
verapamil 180 mg ER Tab [VDMC]
|
Facility
|
OP
|
$1.86
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10428008
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna of IA Commercial |
$1.67
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.67
|
| Rate for Payer: Aetna of IA Medicare |
$1.06
|
| Rate for Payer: Amerigroup Medicaid |
$0.94
|
| Rate for Payer: Amerigroup Medicare |
$0.94
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.40
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.93
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.93
|
| Rate for Payer: Medical Associates Commercial |
$1.40
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.93
|
| Rate for Payer: Midlands Choice Commercial |
$1.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.94
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.94
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.40
|
| Rate for Payer: United Healthcare Commercial |
$1.67
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.10
|
|
|
verapamil 2.5 mg/mL 2ml SDV IV Sol [VDMC]
|
Facility
|
IP
|
$36.58
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10428077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.61 |
| Max. Negotiated Rate |
$32.92 |
| Rate for Payer: Aetna of IA Commercial |
$32.92
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.92
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.44
|
| Rate for Payer: Medical Associates Commercial |
$27.44
|
| Rate for Payer: Midlands Choice Commercial |
$25.61
|
| Rate for Payer: United Healthcare Commercial |
$32.92
|
|
|
verapamil 2.5 mg/mL 2ml SDV IV Sol [VDMC]
|
Facility
|
OP
|
$36.58
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10428077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$32.92 |
| Rate for Payer: Aetna of IA Commercial |
$32.92
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.92
|
| Rate for Payer: Aetna of IA Medicare |
$20.85
|
| Rate for Payer: Amerigroup Medicaid |
$18.46
|
| Rate for Payer: Amerigroup Medicare |
$18.47
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.29
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.28
|
| Rate for Payer: Medical Associates Commercial |
$27.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.29
|
| Rate for Payer: Midlands Choice Commercial |
$25.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.56
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$18.55
|
| Rate for Payer: Oscar Health of IA Commercial |
$27.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.44
|
| Rate for Payer: United Healthcare Commercial |
$32.92
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.58
|
|
|
verapamil 80 mg Tab [VDMC]
|
Facility
|
IP
|
$1.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10428148
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of IA Commercial |
$1.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.05
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.88
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.05
|
|
|
verapamil 80 mg Tab [VDMC]
|
Facility
|
OP
|
$1.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10428148
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of IA Commercial |
$1.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.05
|
| Rate for Payer: Aetna of IA Medicare |
$0.67
|
| Rate for Payer: Amerigroup Medicaid |
$0.59
|
| Rate for Payer: Amerigroup Medicare |
$0.59
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.88
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.59
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.58
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.59
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.59
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.59
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$1.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.69
|
|
|
VIABLE BONE MATRIX (PUTTY)
|
Facility
|
OP
|
$4,465.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8884279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,232.01 |
| Max. Negotiated Rate |
$4,019.22 |
| Rate for Payer: Aetna of IA Commercial |
$4,019.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,019.22
|
| Rate for Payer: Aetna of IA Medicare |
$2,545.51
|
| Rate for Payer: Amerigroup Medicaid |
$2,253.89
|
| Rate for Payer: Amerigroup Medicare |
$2,255.23
|
| Rate for Payer: Cash Price |
$3,572.64
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,349.35
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,232.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,232.01
|
| Rate for Payer: Medical Associates Commercial |
$3,349.35
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,232.90
|
| Rate for Payer: Midlands Choice Commercial |
$3,126.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,266.39
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$2,265.05
|
| Rate for Payer: Oscar Health of IA Commercial |
$3,349.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,349.35
|
| Rate for Payer: United Healthcare Commercial |
$4,019.22
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,634.82
|
|
|
VIABLE BONE MATRIX (PUTTY)
|
Facility
|
IP
|
$4,465.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8884279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,126.06 |
| Max. Negotiated Rate |
$4,019.22 |
| Rate for Payer: Aetna of IA Commercial |
$4,019.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,019.22
|
| Rate for Payer: Cash Price |
$3,572.64
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,349.35
|
| Rate for Payer: Medical Associates Commercial |
$3,349.35
|
| Rate for Payer: Midlands Choice Commercial |
$3,126.06
|
| Rate for Payer: United Healthcare Commercial |
$4,019.22
|
|
|
VinBLAStine 1 mg/mL 10ml MDV [VDMC]
|
Facility
|
IP
|
$181.32
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
19517861
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$126.92 |
| Max. Negotiated Rate |
$163.19 |
| Rate for Payer: Aetna of IA Commercial |
$163.19
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$163.19
|
| Rate for Payer: Cash Price |
$145.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.99
|
| Rate for Payer: Medical Associates Commercial |
$135.99
|
| Rate for Payer: Midlands Choice Commercial |
$126.92
|
| Rate for Payer: United Healthcare Commercial |
$163.19
|
|
|
VinBLAStine 1 mg/mL 10ml MDV [VDMC]
|
Facility
|
OP
|
$181.32
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
19517861
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$90.62 |
| Max. Negotiated Rate |
$163.19 |
| Rate for Payer: Aetna of IA Commercial |
$163.19
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$163.19
|
| Rate for Payer: Aetna of IA Medicare |
$103.35
|
| Rate for Payer: Amerigroup Medicaid |
$91.51
|
| Rate for Payer: Amerigroup Medicare |
$91.57
|
| Rate for Payer: Cash Price |
$145.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.99
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.62
|
| Rate for Payer: Medical Associates Commercial |
$135.99
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.66
|
| Rate for Payer: Midlands Choice Commercial |
$126.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.02
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$91.97
|
| Rate for Payer: Oscar Health of IA Commercial |
$135.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.99
|
| Rate for Payer: United Healthcare Commercial |
$163.19
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.98
|
|
|
vincristine 1 mg/ml SDV 2 ml [VDMC]
|
Facility
|
OP
|
$38.54
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
10428286
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$34.69 |
| Rate for Payer: Aetna of IA Commercial |
$34.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.69
|
| Rate for Payer: Aetna of IA Medicare |
$21.97
|
| Rate for Payer: Amerigroup Medicaid |
$19.45
|
| Rate for Payer: Amerigroup Medicare |
$19.46
|
| Rate for Payer: Cash Price |
$30.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.90
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$19.27
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.26
|
| Rate for Payer: Medical Associates Commercial |
$28.90
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.27
|
| Rate for Payer: Midlands Choice Commercial |
$26.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19.56
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$19.55
|
| Rate for Payer: Oscar Health of IA Commercial |
$28.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.90
|
| Rate for Payer: United Healthcare Commercial |
$34.69
|
| Rate for Payer: United Healthcare Managed Medicare |
$22.74
|
|
|
vincristine 1 mg/ml SDV 2 ml [VDMC]
|
Facility
|
IP
|
$38.54
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
10428286
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.98 |
| Max. Negotiated Rate |
$34.69 |
| Rate for Payer: Aetna of IA Commercial |
$34.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.69
|
| Rate for Payer: Cash Price |
$30.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.90
|
| Rate for Payer: Medical Associates Commercial |
$28.90
|
| Rate for Payer: Midlands Choice Commercial |
$26.98
|
| Rate for Payer: United Healthcare Commercial |
$34.69
|
|
|
VIRAL CULTURE
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
8519125
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$70.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$104.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
VIRAL CULTURE
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
8519126
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$70.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$104.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
VIRAL CULTURE
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
8519126
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
