|
VDMC DOT LAW ENFORCEMENT PHYSICAL
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
8015869
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of IA Commercial |
$112.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$112.50
|
| Rate for Payer: Aetna of IA Medicare |
$71.25
|
| Rate for Payer: Amerigroup Medicaid |
$72.10
|
| Rate for Payer: Amerigroup Medicare |
$56.81
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$56.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.40
|
| Rate for Payer: Medical Associates Commercial |
$93.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.25
|
| Rate for Payer: Midlands Choice Commercial |
$87.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$72.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.69
|
| Rate for Payer: United Healthcare Commercial |
$112.50
|
|
|
VDMC EMPLOYMENT FLU SHOTS
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
8015870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna of IA Commercial |
$22.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.50
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.75
|
| Rate for Payer: Medical Associates Commercial |
$18.75
|
| Rate for Payer: Midlands Choice Commercial |
$17.50
|
| Rate for Payer: United Healthcare Commercial |
$22.50
|
|
|
VDMC EMPLOYMENT FLU SHOTS
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
8015870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna of IA Commercial |
$22.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.50
|
| Rate for Payer: Aetna of IA Medicare |
$14.25
|
| Rate for Payer: Amerigroup Medicaid |
$14.42
|
| Rate for Payer: Amerigroup Medicare |
$11.36
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.28
|
| Rate for Payer: Medical Associates Commercial |
$18.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.25
|
| Rate for Payer: Midlands Choice Commercial |
$17.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.94
|
| Rate for Payer: United Healthcare Commercial |
$22.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.75
|
|
|
VDMC Hsg-Contrast Injection
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
7922827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$114.30 |
| Rate for Payer: Aetna of IA Commercial |
$114.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$114.30
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$95.25
|
| Rate for Payer: Medical Associates Commercial |
$95.25
|
| Rate for Payer: Midlands Choice Commercial |
$88.90
|
| Rate for Payer: United Healthcare Commercial |
$114.30
|
|
|
VDMC Hsg-Contrast Injection
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
7922827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.15 |
| Max. Negotiated Rate |
$447.51 |
| Rate for Payer: Aetna of IA Commercial |
$114.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$114.30
|
| Rate for Payer: Aetna of IA Medicare |
$72.39
|
| Rate for Payer: Amerigroup Medicaid |
$73.25
|
| Rate for Payer: Amerigroup Medicare |
$57.72
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$95.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$72.54
|
| Rate for Payer: Medical Associates Commercial |
$95.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.15
|
| Rate for Payer: Midlands Choice Commercial |
$88.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$73.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$65.72
|
| Rate for Payer: United Healthcare Commercial |
$114.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$74.93
|
| Rate for Payer: Wellmark IA HMO WHPI |
$406.26
|
| Rate for Payer: Wellmark IA PPO |
$447.51
|
|
|
VDMC Isotope Kinevac/Sincalide
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
7922837
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Aetna of IA Commercial |
$128.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$128.70
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$107.25
|
| Rate for Payer: Medical Associates Commercial |
$107.25
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: United Healthcare Commercial |
$128.70
|
|
|
VDMC Isotope Kinevac/Sincalide
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
7922837
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Aetna of IA Commercial |
$128.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$128.70
|
| Rate for Payer: Aetna of IA Medicare |
$81.51
|
| Rate for Payer: Amerigroup Medicaid |
$82.48
|
| Rate for Payer: Amerigroup Medicare |
$64.99
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$107.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$81.68
|
| Rate for Payer: Medical Associates Commercial |
$107.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.35
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$82.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.00
|
| Rate for Payer: United Healthcare Commercial |
$128.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.37
|
|
|
VDMC Knee Arthrogram Inj
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 27370
|
| Hospital Charge Code |
7922856
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.50 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Aetna of IA Commercial |
$297.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$297.00
|
| Rate for Payer: Aetna of IA Medicare |
$188.10
|
| Rate for Payer: Amerigroup Medicaid |
$190.34
|
| Rate for Payer: Amerigroup Medicare |
$149.98
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$247.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$148.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$188.50
|
| Rate for Payer: Medical Associates Commercial |
$247.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$231.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$191.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$170.78
|
| Rate for Payer: United Healthcare Commercial |
$297.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$194.70
|
|
|
VDMC Knee Arthrogram Inj
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 27370
|
| Hospital Charge Code |
7922856
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Aetna of IA Commercial |
$297.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$297.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$247.50
|
| Rate for Payer: Medical Associates Commercial |
$247.50
|
| Rate for Payer: Midlands Choice Commercial |
$231.00
|
| Rate for Payer: United Healthcare Commercial |
$297.00
|
|
|
VDMC Lumbar Puncture Myelogram
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
7922862
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$742.50 |
| Rate for Payer: Aetna of IA Commercial |
$742.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$742.50
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$618.75
|
| Rate for Payer: Medical Associates Commercial |
$618.75
|
| Rate for Payer: Midlands Choice Commercial |
$577.50
|
| Rate for Payer: United Healthcare Commercial |
$742.50
|
|
|
VDMC Lumbar Puncture Myelogram
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
7922862
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$371.25 |
| Max. Negotiated Rate |
$742.50 |
| Rate for Payer: Aetna of IA Commercial |
$742.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$742.50
|
| Rate for Payer: Aetna of IA Medicare |
$470.25
|
| Rate for Payer: Amerigroup Medicaid |
$475.86
|
| Rate for Payer: Amerigroup Medicare |
$374.96
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$618.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$371.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$471.24
|
| Rate for Payer: Medical Associates Commercial |
$618.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$371.25
|
| Rate for Payer: Midlands Choice Commercial |
$577.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$478.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$426.94
|
| Rate for Payer: United Healthcare Commercial |
$742.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$486.75
|
| Rate for Payer: Wellmark IA HMO WHPI |
$406.26
|
| Rate for Payer: Wellmark IA PPO |
$447.51
|
|
|
VDMC Pc Injection Major Joint
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
8018861
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.40 |
| Max. Negotiated Rate |
$361.80 |
| Rate for Payer: Aetna of IA Commercial |
$361.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$361.80
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$301.50
|
| Rate for Payer: Medical Associates Commercial |
$301.50
|
| Rate for Payer: Midlands Choice Commercial |
$281.40
|
| Rate for Payer: United Healthcare Commercial |
$361.80
|
|
|
VDMC Pc Injection Major Joint
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
8018861
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.90 |
| Max. Negotiated Rate |
$782.56 |
| Rate for Payer: Aetna of IA Commercial |
$361.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$361.80
|
| Rate for Payer: Aetna of IA Medicare |
$229.14
|
| Rate for Payer: Amerigroup Medicaid |
$231.87
|
| Rate for Payer: Amerigroup Medicare |
$182.71
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$301.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$180.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$229.62
|
| Rate for Payer: Medical Associates Commercial |
$301.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$180.90
|
| Rate for Payer: Midlands Choice Commercial |
$281.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$233.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$208.04
|
| Rate for Payer: United Healthcare Commercial |
$361.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$237.18
|
| Rate for Payer: Wellmark IA HMO WHPI |
$710.42
|
| Rate for Payer: Wellmark IA PPO |
$782.56
|
|
|
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 Si Joint Injection
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
8018863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of IA Commercial |
$32.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.40
|
| Rate for Payer: Aetna of IA Medicare |
$20.52
|
| Rate for Payer: Amerigroup Medicaid |
$20.76
|
| Rate for Payer: Amerigroup Medicare |
$16.36
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.56
|
| Rate for Payer: Medical Associates Commercial |
$27.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.20
|
| Rate for Payer: Midlands Choice Commercial |
$25.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.63
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.24
|
|
|
VDMC Wrist Arthrogram Injection
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
8018865
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.50 |
| Max. Negotiated Rate |
$447.51 |
| Rate for Payer: Aetna of IA Commercial |
$297.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$297.00
|
| Rate for Payer: Aetna of IA Medicare |
$188.10
|
| Rate for Payer: Amerigroup Medicaid |
$190.34
|
| Rate for Payer: Amerigroup Medicare |
$149.98
|
| 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 |
$148.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$188.50
|
| Rate for Payer: Medical Associates Commercial |
$247.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$231.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$191.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$170.78
|
| Rate for Payer: United Healthcare Commercial |
$297.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$194.70
|
| Rate for Payer: Wellmark IA HMO WHPI |
$406.26
|
| Rate for Payer: Wellmark IA PPO |
$447.51
|
|
|
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 |
$38.29 |
| Rate for Payer: Aetna of IA Commercial |
$38.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.29
|
| Rate for Payer: Cash Price |
$34.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.91
|
| Rate for Payer: Medical Associates Commercial |
$31.91
|
| Rate for Payer: Midlands Choice Commercial |
$29.78
|
| Rate for Payer: United Healthcare Commercial |
$38.29
|
|
|
vecuronium 10 mg Pow[VDMC]
|
Facility
|
OP
|
$42.55
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
11348952
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.15 |
| Max. Negotiated Rate |
$38.29 |
| Rate for Payer: Aetna of IA Commercial |
$38.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.29
|
| Rate for Payer: Aetna of IA Medicare |
$24.25
|
| Rate for Payer: Amerigroup Medicaid |
$24.54
|
| Rate for Payer: Amerigroup Medicare |
$19.34
|
| 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 |
$19.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$24.30
|
| Rate for Payer: Medical Associates Commercial |
$31.91
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.15
|
| Rate for Payer: Midlands Choice Commercial |
$29.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.02
|
| Rate for Payer: United Healthcare Commercial |
$38.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.10
|
|
|
Vedolizumab 300 mg SDV [VDMC]
|
Facility
|
OP
|
$18,819.82
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
19779403
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8,468.92 |
| Max. Negotiated Rate |
$16,937.84 |
| Rate for Payer: Aetna of IA Commercial |
$16,937.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16,937.84
|
| Rate for Payer: Aetna of IA Medicare |
$10,727.30
|
| Rate for Payer: Amerigroup Medicaid |
$10,855.27
|
| Rate for Payer: Amerigroup Medicare |
$8,553.61
|
| Rate for Payer: Cash Price |
$15,055.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14,114.86
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8,468.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10,749.88
|
| Rate for Payer: Medical Associates Commercial |
$14,114.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$8,468.92
|
| Rate for Payer: Midlands Choice Commercial |
$13,173.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,907.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$9,739.26
|
| Rate for Payer: United Healthcare Commercial |
$16,937.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$11,103.69
|
|
|
Vedolizumab 300 mg SDV [VDMC]
|
Facility
|
IP
|
$18,819.82
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
19779403
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13,173.87 |
| Max. Negotiated Rate |
$16,937.84 |
| Rate for Payer: Aetna of IA Commercial |
$16,937.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16,937.84
|
| Rate for Payer: Cash Price |
$15,055.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14,114.86
|
| Rate for Payer: Medical Associates Commercial |
$14,114.86
|
| Rate for Payer: Midlands Choice Commercial |
$13,173.87
|
| Rate for Payer: United Healthcare Commercial |
$16,937.84
|
|
|
VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$25,957.15
|
|
|
Service Code
|
MSDRG 263
|
| Min. Negotiated Rate |
$25,580.95 |
| Max. Negotiated Rate |
$25,957.15 |
| Rate for Payer: Amerigroup Medicaid |
$25,831.74
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25,580.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25,957.15
|
|
|
VENIPUNCTURE
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
1779400
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.45 |
| 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: Aetna of IA Medicare |
$11.97
|
| Rate for Payer: Amerigroup Medicaid |
$12.11
|
| Rate for Payer: Amerigroup Medicare |
$9.54
|
| 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 |
$9.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.00
|
| Rate for Payer: Medical Associates Commercial |
$15.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.45
|
| Rate for Payer: Midlands Choice Commercial |
$14.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$10.87
|
| Rate for Payer: United Healthcare Commercial |
$18.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.39
|
| Rate for Payer: Wellmark IA HMO WHPI |
$12.05
|
| Rate for Payer: Wellmark IA PPO |
$13.28
|
|
|
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
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10427797
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| 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 |
$0.69
|
| Rate for Payer: Amerigroup Medicare |
$0.55
|
| 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 |
$0.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.69
|
| Rate for Payer: Medical Associates Commercial |
$0.90
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.54
|
| Rate for Payer: Midlands Choice Commercial |
$0.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.62
|
| Rate for Payer: United Healthcare Commercial |
$1.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.71
|
|
