|
coagulation factor IX 2000 IU/5 mL recombinant [VDMC]
|
Facility
|
IP
|
$4,445.20
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
28525009
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3,111.64 |
| Max. Negotiated Rate |
$4,000.68 |
| Rate for Payer: Aetna of IA Commercial |
$4,000.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,000.68
|
| Rate for Payer: Cash Price |
$3,556.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,333.90
|
| Rate for Payer: Medical Associates Commercial |
$3,333.90
|
| Rate for Payer: Midlands Choice Commercial |
$3,111.64
|
| Rate for Payer: United Healthcare Commercial |
$4,000.68
|
|
|
coagulation factor IX 2000 IU/5 mL recombinant [VDMC]
|
Facility
|
OP
|
$4,445.20
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
28525009
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2,000.34 |
| Max. Negotiated Rate |
$4,000.68 |
| Rate for Payer: Aetna of IA Commercial |
$4,000.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,000.68
|
| Rate for Payer: Aetna of IA Medicare |
$2,533.76
|
| Rate for Payer: Amerigroup Medicaid |
$2,563.99
|
| Rate for Payer: Amerigroup Medicare |
$2,020.34
|
| Rate for Payer: Cash Price |
$3,556.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,333.90
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,000.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,539.10
|
| Rate for Payer: Medical Associates Commercial |
$3,333.90
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,000.34
|
| Rate for Payer: Midlands Choice Commercial |
$3,111.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,576.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,300.39
|
| Rate for Payer: United Healthcare Commercial |
$4,000.68
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,622.67
|
|
|
CoEnzyme Q-10 100 mg Cap
|
Facility
|
IP
|
$1.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
19626908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Aetna of IA Commercial |
$1.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.37
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.14
|
| Rate for Payer: Medical Associates Commercial |
$1.14
|
| Rate for Payer: Midlands Choice Commercial |
$1.06
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
|
|
CoEnzyme Q-10 100 mg Cap
|
Facility
|
OP
|
$1.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
19626908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Aetna of IA Commercial |
$1.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.37
|
| Rate for Payer: Aetna of IA Medicare |
$0.87
|
| Rate for Payer: Amerigroup Medicaid |
$0.88
|
| Rate for Payer: Amerigroup Medicare |
$0.69
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.14
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.68
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.87
|
| Rate for Payer: Medical Associates Commercial |
$1.14
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.68
|
| Rate for Payer: Midlands Choice Commercial |
$1.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.90
|
|
|
COG EVAL
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 96125 GN
|
| Hospital Charge Code |
7106809
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$155.70 |
| Max. Negotiated Rate |
$311.40 |
| Rate for Payer: Aetna of IA Commercial |
$311.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$311.40
|
| Rate for Payer: Aetna of IA Medicare |
$197.22
|
| Rate for Payer: Amerigroup Medicaid |
$199.57
|
| Rate for Payer: Amerigroup Medicare |
$157.26
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$259.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$155.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$197.64
|
| Rate for Payer: Medical Associates Commercial |
$259.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$155.70
|
| Rate for Payer: Midlands Choice Commercial |
$242.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$200.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$179.06
|
| Rate for Payer: United Healthcare Commercial |
$311.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$204.14
|
|
|
COG EVAL
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 96125 GN
|
| Hospital Charge Code |
7106809
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$311.40 |
| Rate for Payer: Aetna of IA Commercial |
$311.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$311.40
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$259.50
|
| Rate for Payer: Medical Associates Commercial |
$259.50
|
| Rate for Payer: Midlands Choice Commercial |
$242.20
|
| Rate for Payer: United Healthcare Commercial |
$311.40
|
|
|
COGNITIVE DEV 15 MIN
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 97532 GN
|
| Hospital Charge Code |
1373954
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna of IA Commercial |
$79.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$79.20
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$66.00
|
| Rate for Payer: Medical Associates Commercial |
$66.00
|
| Rate for Payer: Midlands Choice Commercial |
$61.60
|
| Rate for Payer: United Healthcare Commercial |
$79.20
|
|
|
COGNITIVE DEV 15 MIN
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 97532 GN
|
| Hospital Charge Code |
1373954
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna of IA Commercial |
$79.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$79.20
|
| Rate for Payer: Aetna of IA Medicare |
$50.16
|
| Rate for Payer: Amerigroup Medicaid |
$50.76
|
| Rate for Payer: Amerigroup Medicare |
$40.00
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$66.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$39.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$50.27
|
| Rate for Payer: Medical Associates Commercial |
$66.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$39.60
|
| Rate for Payer: Midlands Choice Commercial |
$61.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$51.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.54
|
| Rate for Payer: United Healthcare Commercial |
$79.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$51.92
|
|
|
COGNITIVE TRAINING/PER 15 MIN
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 97532 GO
|
| Hospital Charge Code |
1373452
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of IA Commercial |
$77.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.40
|
| Rate for Payer: Aetna of IA Medicare |
$49.02
|
| Rate for Payer: Amerigroup Medicaid |
$49.60
|
| Rate for Payer: Amerigroup Medicare |
$39.09
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.12
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.70
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.51
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.74
|
|
|
COGNITIVE TRAINING/PER 15 MIN
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 97532 GO
|
| Hospital Charge Code |
1373452
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of IA Commercial |
$77.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.40
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.50
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
|
|
colchicine 0.6 mg Tab [VDMC]
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
22541047
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of IA Commercial |
$1.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.54
|
| Rate for Payer: Aetna of IA Medicare |
$0.97
|
| Rate for Payer: Amerigroup Medicaid |
$0.99
|
| Rate for Payer: Amerigroup Medicare |
$0.78
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.77
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.98
|
| Rate for Payer: Medical Associates Commercial |
$1.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.77
|
| Rate for Payer: Midlands Choice Commercial |
$1.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.01
|
|
|
colchicine 0.6 mg Tab [VDMC]
|
Facility
|
IP
|
$1.71
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
22541047
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of IA Commercial |
$1.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.54
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.28
|
| Rate for Payer: Medical Associates Commercial |
$1.28
|
| Rate for Payer: Midlands Choice Commercial |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
|
|
colesevelam 3.75 g Pow [VDMC]
|
Facility
|
OP
|
$14.81
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10379367
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna of IA Commercial |
$13.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.32
|
| Rate for Payer: Aetna of IA Medicare |
$8.44
|
| Rate for Payer: Amerigroup Medicaid |
$8.54
|
| Rate for Payer: Amerigroup Medicare |
$6.73
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.10
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.46
|
| Rate for Payer: Medical Associates Commercial |
$11.10
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.66
|
| Rate for Payer: Midlands Choice Commercial |
$10.36
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.66
|
| Rate for Payer: United Healthcare Commercial |
$13.32
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.74
|
|
|
colesevelam 3.75 g Pow [VDMC]
|
Facility
|
IP
|
$14.81
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10379367
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna of IA Commercial |
$13.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.32
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.10
|
| Rate for Payer: Medical Associates Commercial |
$11.10
|
| Rate for Payer: Midlands Choice Commercial |
$10.36
|
| Rate for Payer: United Healthcare Commercial |
$13.32
|
|
|
colesevelam 625 mg Tab [VDMC]
|
Facility
|
IP
|
$2.05
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10379436
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna of IA Commercial |
$1.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.85
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.54
|
| Rate for Payer: Medical Associates Commercial |
$1.54
|
| Rate for Payer: Midlands Choice Commercial |
$1.44
|
| Rate for Payer: United Healthcare Commercial |
$1.85
|
|
|
colesevelam 625 mg Tab [VDMC]
|
Facility
|
OP
|
$2.05
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10379436
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna of IA Commercial |
$1.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.85
|
| Rate for Payer: Aetna of IA Medicare |
$1.17
|
| Rate for Payer: Amerigroup Medicaid |
$1.18
|
| Rate for Payer: Amerigroup Medicare |
$0.93
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.54
|
| 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 |
$1.17
|
| Rate for Payer: Medical Associates Commercial |
$1.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.92
|
| Rate for Payer: Midlands Choice Commercial |
$1.44
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.06
|
| Rate for Payer: United Healthcare Commercial |
$1.85
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.21
|
|
|
Colestipol HCL 1 g Tab [VDMC]
|
Facility
|
IP
|
$3.67
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10379505
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna of IA Commercial |
$3.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.30
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.75
|
| Rate for Payer: Medical Associates Commercial |
$2.75
|
| Rate for Payer: Midlands Choice Commercial |
$2.57
|
| Rate for Payer: United Healthcare Commercial |
$3.30
|
|
|
Colestipol HCL 1 g Tab [VDMC]
|
Facility
|
OP
|
$3.67
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10379505
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna of IA Commercial |
$3.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.30
|
| Rate for Payer: Aetna of IA Medicare |
$2.09
|
| Rate for Payer: Amerigroup Medicaid |
$2.12
|
| Rate for Payer: Amerigroup Medicare |
$1.67
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.10
|
| Rate for Payer: Medical Associates Commercial |
$2.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.65
|
| Rate for Payer: Midlands Choice Commercial |
$2.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.13
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.90
|
| Rate for Payer: United Healthcare Commercial |
$3.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.17
|
|
|
COLLAGENASE 30 GRAM
|
Facility
|
OP
|
$581.00
|
|
| Hospital Charge Code |
8013715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$261.45 |
| Max. Negotiated Rate |
$522.90 |
| Rate for Payer: Aetna of IA Commercial |
$522.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$522.90
|
| Rate for Payer: Aetna of IA Medicare |
$331.17
|
| Rate for Payer: Amerigroup Medicaid |
$335.12
|
| Rate for Payer: Amerigroup Medicare |
$264.06
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$435.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$261.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$331.87
|
| Rate for Payer: Medical Associates Commercial |
$435.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$261.45
|
| Rate for Payer: Midlands Choice Commercial |
$406.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$336.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$300.67
|
| Rate for Payer: United Healthcare Commercial |
$522.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$342.79
|
|
|
COLLAGENASE 30 GRAM
|
Facility
|
IP
|
$581.00
|
|
| Hospital Charge Code |
8013715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$406.70 |
| Max. Negotiated Rate |
$522.90 |
| Rate for Payer: Aetna of IA Commercial |
$522.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$522.90
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$435.75
|
| Rate for Payer: Medical Associates Commercial |
$435.75
|
| Rate for Payer: Midlands Choice Commercial |
$406.70
|
| Rate for Payer: United Healthcare Commercial |
$522.90
|
|
|
collagenase Top 250 units/g Oint [VDMC]
|
Facility
|
OP
|
$1,079.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10379574
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$485.82 |
| Max. Negotiated Rate |
$971.64 |
| Rate for Payer: Aetna of IA Commercial |
$971.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$971.64
|
| Rate for Payer: Aetna of IA Medicare |
$615.37
|
| Rate for Payer: Amerigroup Medicaid |
$622.71
|
| Rate for Payer: Amerigroup Medicare |
$490.68
|
| Rate for Payer: Cash Price |
$863.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$809.70
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$485.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$616.67
|
| Rate for Payer: Medical Associates Commercial |
$809.70
|
| Rate for Payer: Medical Associates Managed Medicare |
$485.82
|
| Rate for Payer: Midlands Choice Commercial |
$755.72
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$625.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$558.69
|
| Rate for Payer: United Healthcare Commercial |
$971.64
|
| Rate for Payer: United Healthcare Managed Medicare |
$636.96
|
|
|
collagenase Top 250 units/g Oint [VDMC]
|
Facility
|
IP
|
$1,079.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10379574
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$755.72 |
| Max. Negotiated Rate |
$971.64 |
| Rate for Payer: Aetna of IA Commercial |
$971.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$971.64
|
| Rate for Payer: Cash Price |
$863.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$809.70
|
| Rate for Payer: Medical Associates Commercial |
$809.70
|
| Rate for Payer: Midlands Choice Commercial |
$755.72
|
| Rate for Payer: United Healthcare Commercial |
$971.64
|
|
|
Colonoscopy
|
Facility
|
IP
|
$2,780.00
|
|
| Hospital Charge Code |
1376935
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,946.00 |
| Max. Negotiated Rate |
$2,502.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,502.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,502.00
|
| Rate for Payer: Cash Price |
$2,224.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,085.00
|
| Rate for Payer: Medical Associates Commercial |
$2,085.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,946.00
|
| Rate for Payer: United Healthcare Commercial |
$2,502.00
|
|
|
Colonoscopy
|
Facility
|
OP
|
$2,780.00
|
|
| Hospital Charge Code |
1376935
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,251.00 |
| Max. Negotiated Rate |
$2,502.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,502.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,502.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,584.60
|
| Rate for Payer: Amerigroup Medicaid |
$1,603.50
|
| Rate for Payer: Amerigroup Medicare |
$1,263.51
|
| Rate for Payer: Cash Price |
$2,224.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,085.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,251.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,587.94
|
| Rate for Payer: Medical Associates Commercial |
$2,085.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,251.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,946.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,611.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,438.65
|
| Rate for Payer: United Healthcare Commercial |
$2,502.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,640.20
|
|
|
Colonoscopy Biopsy Charge
|
Facility
|
OP
|
$199.00
|
|
| Hospital Charge Code |
7825138
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$89.55 |
| Max. Negotiated Rate |
$179.10 |
| Rate for Payer: Aetna of IA Commercial |
$179.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$179.10
|
| Rate for Payer: Aetna of IA Medicare |
$113.43
|
| Rate for Payer: Amerigroup Medicaid |
$114.78
|
| Rate for Payer: Amerigroup Medicare |
$90.45
|
| Rate for Payer: Cash Price |
$159.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$149.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$89.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.67
|
| Rate for Payer: Medical Associates Commercial |
$149.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.55
|
| Rate for Payer: Midlands Choice Commercial |
$139.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$115.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.98
|
| Rate for Payer: United Healthcare Commercial |
$179.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$117.41
|
|
