|
Bone Fixation
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8942329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.40 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna of IA Commercial |
$445.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$445.50
|
| Rate for Payer: Aetna of IA Medicare |
$282.15
|
| Rate for Payer: Amerigroup Medicaid |
$249.83
|
| Rate for Payer: Amerigroup Medicare |
$249.98
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$371.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$247.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$247.40
|
| Rate for Payer: Medical Associates Commercial |
$371.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$247.50
|
| Rate for Payer: Midlands Choice Commercial |
$346.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$251.21
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$251.06
|
| Rate for Payer: Oscar Health of IA Commercial |
$371.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$371.25
|
| Rate for Payer: United Healthcare Commercial |
$445.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$292.05
|
|
|
Bone Fixation
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8942321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,249.50 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,250.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,250.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,425.00
|
| Rate for Payer: Amerigroup Medicaid |
$1,261.75
|
| Rate for Payer: Amerigroup Medicare |
$1,262.50
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,875.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,250.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,249.50
|
| Rate for Payer: Medical Associates Commercial |
$1,875.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,250.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,750.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,268.75
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,268.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,875.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,875.00
|
| Rate for Payer: United Healthcare Commercial |
$2,250.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,475.00
|
|
|
Bone Fixation
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8942329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna of IA Commercial |
$445.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$445.50
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$371.25
|
| Rate for Payer: Medical Associates Commercial |
$371.25
|
| Rate for Payer: Midlands Choice Commercial |
$346.50
|
| Rate for Payer: United Healthcare Commercial |
$445.50
|
|
|
Bone Fixation System
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8942319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of IA Commercial |
$315.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$262.50
|
| Rate for Payer: Medical Associates Commercial |
$262.50
|
| Rate for Payer: Midlands Choice Commercial |
$245.00
|
| Rate for Payer: United Healthcare Commercial |
$315.00
|
|
|
Bone Fixation System
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8942319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.93 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of IA Commercial |
$315.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.00
|
| Rate for Payer: Aetna of IA Medicare |
$199.50
|
| Rate for Payer: Amerigroup Medicaid |
$176.64
|
| Rate for Payer: Amerigroup Medicare |
$176.75
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$262.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$175.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$174.93
|
| Rate for Payer: Medical Associates Commercial |
$262.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$175.00
|
| Rate for Payer: Midlands Choice Commercial |
$245.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$177.62
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$177.52
|
| Rate for Payer: Oscar Health of IA Commercial |
$262.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$262.50
|
| Rate for Payer: United Healthcare Commercial |
$315.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$206.50
|
|
|
BONE FIXATION SYSTEM
|
Facility
|
OP
|
$2,880.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8883880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,439.42 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,592.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,592.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,641.60
|
| Rate for Payer: Amerigroup Medicaid |
$1,453.54
|
| Rate for Payer: Amerigroup Medicare |
$1,454.40
|
| Rate for Payer: Cash Price |
$2,304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,160.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,440.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,439.42
|
| Rate for Payer: Medical Associates Commercial |
$2,160.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,440.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,016.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,461.60
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,460.74
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,160.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,699.20
|
|
|
BONE FIXATION SYSTEM
|
Facility
|
IP
|
$2,880.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8883880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,592.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,160.00
|
| Rate for Payer: Medical Associates Commercial |
$2,160.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare Commercial |
$2,592.00
|
|
|
BONE FIXATION SYSTEM 14X14X14 3000-00-141414
|
Facility
|
IP
|
$2,880.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,592.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,160.00
|
| Rate for Payer: Medical Associates Commercial |
$2,160.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare Commercial |
$2,592.00
|
|
|
BONE FIXATION SYSTEM 14X14X14 3000-00-141414
|
Facility
|
OP
|
$2,880.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,439.42 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,592.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,592.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,641.60
|
| Rate for Payer: Amerigroup Medicaid |
$1,453.54
|
| Rate for Payer: Amerigroup Medicare |
$1,454.40
|
| Rate for Payer: Cash Price |
$2,304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,160.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,440.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,439.42
|
| Rate for Payer: Medical Associates Commercial |
$2,160.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,440.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,016.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,461.60
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,460.74
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,160.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,699.20
|
|
|
BONE FIXATION SYSTEM "3000-00-201818"
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8930772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.40 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna of IA Commercial |
$445.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$445.50
|
| Rate for Payer: Aetna of IA Medicare |
$282.15
|
| Rate for Payer: Amerigroup Medicaid |
$249.83
|
| Rate for Payer: Amerigroup Medicare |
$249.98
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$371.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$247.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$247.40
|
| Rate for Payer: Medical Associates Commercial |
$371.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$247.50
|
| Rate for Payer: Midlands Choice Commercial |
$346.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$251.21
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$251.06
|
| Rate for Payer: Oscar Health of IA Commercial |
$371.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$371.25
|
| Rate for Payer: United Healthcare Commercial |
$445.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$292.05
|
|
|
BONE FIXATION SYSTEM "3000-00-201818"
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8930772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna of IA Commercial |
$445.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$445.50
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$371.25
|
| Rate for Payer: Medical Associates Commercial |
$371.25
|
| Rate for Payer: Midlands Choice Commercial |
$346.50
|
| Rate for Payer: United Healthcare Commercial |
$445.50
|
|
|
BONE FIXATION SYSTEM PROCEDURE PACK
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8883877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.40 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna of IA Commercial |
$445.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$445.50
|
| Rate for Payer: Aetna of IA Medicare |
$282.15
|
| Rate for Payer: Amerigroup Medicaid |
$249.83
|
| Rate for Payer: Amerigroup Medicare |
$249.98
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$371.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$247.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$247.40
|
| Rate for Payer: Medical Associates Commercial |
$371.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$247.50
|
| Rate for Payer: Midlands Choice Commercial |
$346.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$251.21
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$251.06
|
| Rate for Payer: Oscar Health of IA Commercial |
$371.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$371.25
|
| Rate for Payer: United Healthcare Commercial |
$445.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$292.05
|
|
|
BONE FIXATION SYSTEM PROCEDURE PACK
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8883877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna of IA Commercial |
$445.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$445.50
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$371.25
|
| Rate for Payer: Medical Associates Commercial |
$371.25
|
| Rate for Payer: Midlands Choice Commercial |
$346.50
|
| Rate for Payer: United Healthcare Commercial |
$445.50
|
|
|
BONE GRAFT HEMI-FEMORAL SHAFT
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,890.00 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,430.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,430.00
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,025.00
|
| Rate for Payer: Medical Associates Commercial |
$2,025.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,890.00
|
| Rate for Payer: United Healthcare Commercial |
$2,430.00
|
|
|
BONE GRAFT HEMI-FEMORAL SHAFT
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,349.46 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,430.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,430.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,539.00
|
| Rate for Payer: Amerigroup Medicaid |
$1,362.69
|
| Rate for Payer: Amerigroup Medicare |
$1,363.50
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,025.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,350.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,349.46
|
| Rate for Payer: Medical Associates Commercial |
$2,025.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,350.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,890.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,370.25
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,369.44
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,025.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,025.00
|
| Rate for Payer: United Healthcare Commercial |
$2,430.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,593.00
|
|
|
Bone Marrow Procedure
|
Facility
|
IP
|
$1,390.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
8060783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$1,251.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,251.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,251.00
|
| Rate for Payer: Cash Price |
$1,112.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,042.50
|
| Rate for Payer: Medical Associates Commercial |
$1,042.50
|
| Rate for Payer: Midlands Choice Commercial |
$973.00
|
| Rate for Payer: United Healthcare Commercial |
$1,251.00
|
|
|
Bone Marrow Procedure
|
Facility
|
OP
|
$1,390.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
8060783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$694.72 |
| Max. Negotiated Rate |
$1,251.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,251.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,251.00
|
| Rate for Payer: Aetna of IA Medicare |
$792.30
|
| Rate for Payer: Amerigroup Medicaid |
$701.53
|
| Rate for Payer: Amerigroup Medicare |
$701.95
|
| Rate for Payer: Cash Price |
$1,112.00
|
| Rate for Payer: Cash Price |
$1,112.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,042.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$695.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$694.72
|
| Rate for Payer: Medical Associates Commercial |
$1,042.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$695.00
|
| Rate for Payer: Midlands Choice Commercial |
$973.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$705.42
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$705.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,042.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,042.50
|
| Rate for Payer: United Healthcare Commercial |
$1,251.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$820.10
|
| Rate for Payer: Wellmark IA HMO |
$1,026.72
|
| Rate for Payer: Wellmark IA PPO |
$1,129.39
|
|
|
bortezomib 3.5 mg Powder-Inj SDV [VDMC]
|
Facility
|
OP
|
$521.84
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
24162939
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$260.82 |
| Max. Negotiated Rate |
$469.66 |
| Rate for Payer: Aetna of IA Commercial |
$469.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$469.66
|
| Rate for Payer: Aetna of IA Medicare |
$297.45
|
| Rate for Payer: Amerigroup Medicaid |
$263.37
|
| Rate for Payer: Amerigroup Medicare |
$263.53
|
| Rate for Payer: Cash Price |
$417.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$391.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$260.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$260.82
|
| Rate for Payer: Medical Associates Commercial |
$391.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$260.92
|
| Rate for Payer: Midlands Choice Commercial |
$365.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$264.83
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$264.68
|
| Rate for Payer: Oscar Health of IA Commercial |
$391.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$391.38
|
| Rate for Payer: United Healthcare Commercial |
$469.66
|
| Rate for Payer: United Healthcare Managed Medicare |
$307.89
|
|
|
bortezomib 3.5 mg Powder-Inj SDV [VDMC]
|
Facility
|
IP
|
$521.84
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
24162939
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$365.29 |
| Max. Negotiated Rate |
$469.66 |
| Rate for Payer: Aetna of IA Commercial |
$469.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$469.66
|
| Rate for Payer: Cash Price |
$417.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$391.38
|
| Rate for Payer: Medical Associates Commercial |
$391.38
|
| Rate for Payer: Midlands Choice Commercial |
$365.29
|
| Rate for Payer: United Healthcare Commercial |
$469.66
|
|
|
Breast Biopsy, Local Excision and Other Breast Procedures With CC/MCC
|
Facility
|
IP
|
$13,948.67
|
|
|
Service Code
|
MS-DRG 584
|
| Hospital Charge Code |
388
|
| Min. Negotiated Rate |
$13,746.52 |
| Max. Negotiated Rate |
$13,948.67 |
| Rate for Payer: Amerigroup Medicaid |
$13,881.29
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13,746.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,948.67
|
|
|
Breast Biopsy, Local Excision and Other Breast Procedures Without CC/MCC
|
Facility
|
IP
|
$13,948.67
|
|
|
Service Code
|
MS-DRG 585
|
| Hospital Charge Code |
389
|
| Min. Negotiated Rate |
$13,746.52 |
| Max. Negotiated Rate |
$13,948.67 |
| Rate for Payer: Amerigroup Medicaid |
$13,881.29
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13,746.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,948.67
|
|
|
brentuximab vedotin 50 mg Pow SDV [VDMC]
|
Facility
|
IP
|
$34,421.96
|
|
|
Service Code
|
HCPCS J9042
|
| Hospital Charge Code |
18282502
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24,095.37 |
| Max. Negotiated Rate |
$30,979.76 |
| Rate for Payer: Aetna of IA Commercial |
$30,979.76
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30,979.76
|
| Rate for Payer: Cash Price |
$27,537.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25,816.47
|
| Rate for Payer: Medical Associates Commercial |
$25,816.47
|
| Rate for Payer: Midlands Choice Commercial |
$24,095.37
|
| Rate for Payer: United Healthcare Commercial |
$30,979.76
|
|
|
brentuximab vedotin 50 mg Pow SDV [VDMC]
|
Facility
|
OP
|
$34,421.96
|
|
|
Service Code
|
HCPCS J9042
|
| Hospital Charge Code |
18282502
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17,204.10 |
| Max. Negotiated Rate |
$30,979.76 |
| Rate for Payer: Aetna of IA Commercial |
$30,979.76
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30,979.76
|
| Rate for Payer: Aetna of IA Medicare |
$19,620.52
|
| Rate for Payer: Amerigroup Medicaid |
$17,372.76
|
| Rate for Payer: Amerigroup Medicare |
$17,383.09
|
| Rate for Payer: Cash Price |
$27,537.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25,816.47
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17,210.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17,204.10
|
| Rate for Payer: Medical Associates Commercial |
$25,816.47
|
| Rate for Payer: Medical Associates Managed Medicare |
$17,210.98
|
| Rate for Payer: Midlands Choice Commercial |
$24,095.37
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17,469.14
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$17,458.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$25,816.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$25,816.47
|
| Rate for Payer: United Healthcare Commercial |
$30,979.76
|
| Rate for Payer: United Healthcare Managed Medicare |
$20,308.96
|
|
|
brimonidine Ophth 0.15% Sol 5 ml [VDMC]
|
Facility
|
IP
|
$519.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433477
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$363.66 |
| Max. Negotiated Rate |
$467.57 |
| Rate for Payer: Aetna of IA Commercial |
$467.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$467.57
|
| Rate for Payer: Cash Price |
$415.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$389.64
|
| Rate for Payer: Medical Associates Commercial |
$389.64
|
| Rate for Payer: Midlands Choice Commercial |
$363.66
|
| Rate for Payer: United Healthcare Commercial |
$467.57
|
|
|
brimonidine Ophth 0.15% Sol 5 ml [VDMC]
|
Facility
|
OP
|
$519.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433477
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$259.66 |
| Max. Negotiated Rate |
$467.57 |
| Rate for Payer: Aetna of IA Commercial |
$467.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$467.57
|
| Rate for Payer: Aetna of IA Medicare |
$296.13
|
| Rate for Payer: Amerigroup Medicaid |
$262.20
|
| Rate for Payer: Amerigroup Medicare |
$262.36
|
| Rate for Payer: Cash Price |
$415.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$389.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$259.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$259.66
|
| Rate for Payer: Medical Associates Commercial |
$389.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$259.76
|
| Rate for Payer: Midlands Choice Commercial |
$363.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$263.66
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$263.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$389.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$389.64
|
| Rate for Payer: United Healthcare Commercial |
$467.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$306.52
|
|
