|
CARDIOVERSION ELECTRIC EXT
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
4866863
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$666.40 |
| Max. Negotiated Rate |
$856.80 |
| Rate for Payer: Aetna of IA Commercial |
$856.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$856.80
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$714.00
|
| Rate for Payer: Medical Associates Commercial |
$714.00
|
| Rate for Payer: Midlands Choice Commercial |
$666.40
|
| Rate for Payer: United Healthcare Commercial |
$856.80
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Professional
|
Both
|
$524.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
7982756
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$98.53 |
| Max. Negotiated Rate |
$231.63 |
| Rate for Payer: Aetna of IA Medicare |
$98.53
|
| Rate for Payer: Amerigroup Medicaid |
$101.88
|
| Rate for Payer: Cash Price |
$419.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$118.24
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.50
|
| Rate for Payer: Medical Associates Commercial |
$177.35
|
| Rate for Payer: Medical Associates Managed Medicare |
$98.53
|
| Rate for Payer: Midlands Choice Commercial |
$231.63
|
| Rate for Payer: Oscar Health of IA Commercial |
$177.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$147.80
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
4866863
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$475.81 |
| Max. Negotiated Rate |
$1,506.54 |
| Rate for Payer: Aetna of IA Commercial |
$856.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$856.80
|
| Rate for Payer: Aetna of IA Medicare |
$542.64
|
| Rate for Payer: Amerigroup Medicaid |
$480.47
|
| Rate for Payer: Amerigroup Medicare |
$480.76
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$714.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$476.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$475.81
|
| Rate for Payer: Medical Associates Commercial |
$714.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$476.00
|
| Rate for Payer: Midlands Choice Commercial |
$666.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$483.14
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$482.85
|
| Rate for Payer: Oscar Health of IA Commercial |
$714.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$714.00
|
| Rate for Payer: United Healthcare Commercial |
$856.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$561.68
|
| Rate for Payer: Wellmark IA HMO |
$1,369.58
|
| Rate for Payer: Wellmark IA PPO |
$1,506.54
|
|
|
CARD REHAB PHASE II;W.MONITOR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
8654179
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$109.96 |
| Max. Negotiated Rate |
$255.07 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$111.03
|
| Rate for Payer: Amerigroup Medicare |
$111.10
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$110.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$109.96
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$110.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$111.65
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$111.58
|
| Rate for Payer: Oscar Health of IA Commercial |
$165.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
| Rate for Payer: Wellmark IA HMO |
$231.88
|
| Rate for Payer: Wellmark IA PPO |
$255.07
|
|
|
CARD REHAB PHASE II;W.MONITOR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
8654179
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
6380786
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 93798 KX
|
| Hospital Charge Code |
7722943
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 93798 KX
|
| Hospital Charge Code |
7722942
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$109.96 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$111.03
|
| Rate for Payer: Amerigroup Medicare |
$111.10
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$110.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$109.96
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$110.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$111.65
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$111.58
|
| Rate for Payer: Oscar Health of IA Commercial |
$165.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 93798 KX
|
| Hospital Charge Code |
7722943
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$109.96 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$111.03
|
| Rate for Payer: Amerigroup Medicare |
$111.10
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$110.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$109.96
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$110.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$111.65
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$111.58
|
| Rate for Payer: Oscar Health of IA Commercial |
$165.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 93798 KX
|
| Hospital Charge Code |
8654178
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$109.96 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$111.03
|
| Rate for Payer: Amerigroup Medicare |
$111.10
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$110.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$109.96
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$110.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$111.65
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$111.58
|
| Rate for Payer: Oscar Health of IA Commercial |
$165.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
6380786
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$109.96 |
| Max. Negotiated Rate |
$255.07 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$111.03
|
| Rate for Payer: Amerigroup Medicare |
$111.10
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$110.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$109.96
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$110.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$111.65
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$111.58
|
| Rate for Payer: Oscar Health of IA Commercial |
$165.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
| Rate for Payer: Wellmark IA HMO |
$231.88
|
| Rate for Payer: Wellmark IA PPO |
$255.07
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 93798 KX
|
| Hospital Charge Code |
8654178
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 93798 KX
|
| Hospital Charge Code |
7722942
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
6380787
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$109.96 |
| Max. Negotiated Rate |
$255.07 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$111.03
|
| Rate for Payer: Amerigroup Medicare |
$111.10
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$110.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$109.96
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$110.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$111.65
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$111.58
|
| Rate for Payer: Oscar Health of IA Commercial |
$165.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
| Rate for Payer: Wellmark IA HMO |
$231.88
|
| Rate for Payer: Wellmark IA PPO |
$255.07
|
|
|
CARD REHAB PHASE II;W/MONITOR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
6380787
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
|
|
carfilzomib 10 mg Pow SDV [VDMC]
|
Facility
|
OP
|
$2,135.44
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
22278206
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,067.29 |
| Max. Negotiated Rate |
$1,921.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,921.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,921.90
|
| Rate for Payer: Aetna of IA Medicare |
$1,217.20
|
| Rate for Payer: Amerigroup Medicaid |
$1,077.76
|
| Rate for Payer: Amerigroup Medicare |
$1,078.40
|
| Rate for Payer: Cash Price |
$1,708.35
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,601.58
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,067.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,067.29
|
| Rate for Payer: Medical Associates Commercial |
$1,601.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,067.72
|
| Rate for Payer: Midlands Choice Commercial |
$1,494.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,083.74
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,083.10
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,601.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,601.58
|
| Rate for Payer: United Healthcare Commercial |
$1,921.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,259.91
|
|
|
carfilzomib 10 mg Pow SDV [VDMC]
|
Facility
|
IP
|
$2,135.44
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
22278206
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,494.81 |
| Max. Negotiated Rate |
$1,921.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,921.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,921.90
|
| Rate for Payer: Cash Price |
$1,708.35
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,601.58
|
| Rate for Payer: Medical Associates Commercial |
$1,601.58
|
| Rate for Payer: Midlands Choice Commercial |
$1,494.81
|
| Rate for Payer: United Healthcare Commercial |
$1,921.90
|
|
|
carfilzomib 30 mg Pow SDV [VDMC]
|
Facility
|
IP
|
$2,679.12
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
22278329
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,875.38 |
| Max. Negotiated Rate |
$2,411.21 |
| Rate for Payer: Aetna of IA Commercial |
$2,411.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,411.21
|
| Rate for Payer: Cash Price |
$2,143.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,009.34
|
| Rate for Payer: Medical Associates Commercial |
$2,009.34
|
| Rate for Payer: Midlands Choice Commercial |
$1,875.38
|
| Rate for Payer: United Healthcare Commercial |
$2,411.21
|
|
|
carfilzomib 30 mg Pow SDV [VDMC]
|
Facility
|
OP
|
$2,679.12
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
22278329
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,339.02 |
| Max. Negotiated Rate |
$2,411.21 |
| Rate for Payer: Aetna of IA Commercial |
$2,411.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,411.21
|
| Rate for Payer: Aetna of IA Medicare |
$1,527.10
|
| Rate for Payer: Amerigroup Medicaid |
$1,352.15
|
| Rate for Payer: Amerigroup Medicare |
$1,352.96
|
| Rate for Payer: Cash Price |
$2,143.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,009.34
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,339.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,339.02
|
| Rate for Payer: Medical Associates Commercial |
$2,009.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,339.56
|
| Rate for Payer: Midlands Choice Commercial |
$1,875.38
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,359.65
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,358.85
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,009.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,009.34
|
| Rate for Payer: United Healthcare Commercial |
$2,411.21
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,580.68
|
|
|
carfilzomib 60 mg Pow SDV [VDMC]
|
Facility
|
IP
|
$6,356.32
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
22278386
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4,449.42 |
| Max. Negotiated Rate |
$5,720.69 |
| Rate for Payer: Aetna of IA Commercial |
$5,720.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,720.69
|
| Rate for Payer: Cash Price |
$5,085.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,767.24
|
| Rate for Payer: Medical Associates Commercial |
$4,767.24
|
| Rate for Payer: Midlands Choice Commercial |
$4,449.42
|
| Rate for Payer: United Healthcare Commercial |
$5,720.69
|
|
|
carfilzomib 60 mg Pow SDV [VDMC]
|
Facility
|
OP
|
$6,356.32
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
22278386
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3,176.89 |
| Max. Negotiated Rate |
$5,720.69 |
| Rate for Payer: Aetna of IA Commercial |
$5,720.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,720.69
|
| Rate for Payer: Aetna of IA Medicare |
$3,623.10
|
| Rate for Payer: Amerigroup Medicaid |
$3,208.03
|
| Rate for Payer: Amerigroup Medicare |
$3,209.94
|
| Rate for Payer: Cash Price |
$5,085.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,767.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,178.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,176.89
|
| Rate for Payer: Medical Associates Commercial |
$4,767.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,178.16
|
| Rate for Payer: Midlands Choice Commercial |
$4,449.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,225.83
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$3,223.93
|
| Rate for Payer: Oscar Health of IA Commercial |
$4,767.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,767.24
|
| Rate for Payer: United Healthcare Commercial |
$5,720.69
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,750.23
|
|
|
Carotid Artery Stent Procedures With CC
|
Facility
|
IP
|
$19,308.85
|
|
|
Service Code
|
MS-DRG 035
|
| Hospital Charge Code |
724
|
| Min. Negotiated Rate |
$19,029.01 |
| Max. Negotiated Rate |
$19,308.85 |
| Rate for Payer: Amerigroup Medicaid |
$19,215.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19,029.01
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19,308.85
|
|
|
Carotid Artery Stent Procedures With MCC
|
Facility
|
IP
|
$24,134.59
|
|
|
Service Code
|
MS-DRG 034
|
| Hospital Charge Code |
723
|
| Min. Negotiated Rate |
$23,784.81 |
| Max. Negotiated Rate |
$24,134.59 |
| Rate for Payer: Amerigroup Medicaid |
$24,017.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23,784.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24,134.59
|
|
|
Carotid Artery Stent Procedures Without CC/MCC
|
Facility
|
IP
|
$16,490.97
|
|
|
Service Code
|
MS-DRG 036
|
| Hospital Charge Code |
725
|
| Min. Negotiated Rate |
$16,251.97 |
| Max. Negotiated Rate |
$16,490.97 |
| Rate for Payer: Amerigroup Medicaid |
$16,411.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16,251.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16,490.97
|
|
|
carvedilol 12.5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10374624
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Aetna of IA Commercial |
$0.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.97
|
| Rate for Payer: Aetna of IA Medicare |
$0.62
|
| Rate for Payer: Amerigroup Medicaid |
$0.55
|
| Rate for Payer: Amerigroup Medicare |
$0.55
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.81
|
| 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 |
$0.54
|
| Rate for Payer: Medical Associates Commercial |
$0.81
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.54
|
| Rate for Payer: Midlands Choice Commercial |
$0.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.55
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.55
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$0.97
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.64
|
|
