|
DISORDERS OF THE BILIARY TRACT WITH CC
|
Facility
|
IP
|
$11,788.98
|
|
|
Service Code
|
MSDRG 445
|
| Min. Negotiated Rate |
$11,618.12 |
| Max. Negotiated Rate |
$11,788.98 |
| Rate for Payer: Amerigroup Medicaid |
$11,732.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11,618.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11,788.98
|
|
|
DISORDERS OF THE BILIARY TRACT WITH MCC
|
Facility
|
IP
|
$13,584.91
|
|
|
Service Code
|
MSDRG 444
|
| Min. Negotiated Rate |
$13,388.02 |
| Max. Negotiated Rate |
$13,584.91 |
| Rate for Payer: Amerigroup Medicaid |
$13,519.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13,388.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,584.91
|
|
|
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC
|
Facility
|
IP
|
$8,050.74
|
|
|
Service Code
|
MSDRG 446
|
| Min. Negotiated Rate |
$7,934.05 |
| Max. Negotiated Rate |
$8,050.74 |
| Rate for Payer: Amerigroup Medicaid |
$8,011.84
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,934.05
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,050.74
|
|
|
DISPOSABLE KIT HIP /BLADES
|
Facility
|
OP
|
$810.00
|
|
| Hospital Charge Code |
8047066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$364.50 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Aetna of IA Commercial |
$729.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$729.00
|
| Rate for Payer: Aetna of IA Medicare |
$461.70
|
| Rate for Payer: Amerigroup Medicaid |
$467.21
|
| Rate for Payer: Amerigroup Medicare |
$368.14
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$607.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$364.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$462.67
|
| Rate for Payer: Medical Associates Commercial |
$607.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$364.50
|
| Rate for Payer: Midlands Choice Commercial |
$567.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$469.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$419.18
|
| Rate for Payer: United Healthcare Commercial |
$729.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$477.90
|
|
|
DISPOSABLE KIT HIP /BLADES
|
Facility
|
IP
|
$810.00
|
|
| Hospital Charge Code |
8047066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Aetna of IA Commercial |
$729.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$729.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$607.50
|
| Rate for Payer: Medical Associates Commercial |
$607.50
|
| Rate for Payer: Midlands Choice Commercial |
$567.00
|
| Rate for Payer: United Healthcare Commercial |
$729.00
|
|
|
divalproex sodium 125 mg DR Cap [VDMC]
|
Facility
|
OP
|
$3.34
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10383966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.01 |
| Rate for Payer: Aetna of IA Commercial |
$3.01
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.01
|
| Rate for Payer: Aetna of IA Medicare |
$1.91
|
| Rate for Payer: Amerigroup Medicaid |
$1.93
|
| Rate for Payer: Amerigroup Medicare |
$1.52
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.51
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.91
|
| Rate for Payer: Medical Associates Commercial |
$2.51
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.50
|
| Rate for Payer: Midlands Choice Commercial |
$2.34
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.73
|
| Rate for Payer: United Healthcare Commercial |
$3.01
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.97
|
|
|
divalproex sodium 125 mg DR Cap [VDMC]
|
Facility
|
IP
|
$3.34
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10383966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3.01 |
| Rate for Payer: Aetna of IA Commercial |
$3.01
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.01
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.51
|
| Rate for Payer: Medical Associates Commercial |
$2.51
|
| Rate for Payer: Midlands Choice Commercial |
$2.34
|
| Rate for Payer: United Healthcare Commercial |
$3.01
|
|
|
divalproex sodium 250 mg DR Tab [VDMC]
|
Facility
|
OP
|
$1.73
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10384037
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Aetna of IA Commercial |
$1.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.56
|
| Rate for Payer: Aetna of IA Medicare |
$0.99
|
| Rate for Payer: Amerigroup Medicaid |
$1.00
|
| Rate for Payer: Amerigroup Medicare |
$0.79
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.30
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.99
|
| Rate for Payer: Medical Associates Commercial |
$1.30
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.78
|
| Rate for Payer: Midlands Choice Commercial |
$1.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.56
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.02
|
|
|
divalproex sodium 250 mg DR Tab [VDMC]
|
Facility
|
IP
|
$1.73
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10384037
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Aetna of IA Commercial |
$1.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.56
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.30
|
| Rate for Payer: Medical Associates Commercial |
$1.30
|
| Rate for Payer: Midlands Choice Commercial |
$1.21
|
| Rate for Payer: United Healthcare Commercial |
$1.56
|
|
|
divalproex sodium 250 mg ER Tab 24hr [VDMC]
|
Facility
|
OP
|
$2.01
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27358339
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna of IA Commercial |
$1.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.81
|
| Rate for Payer: Aetna of IA Medicare |
$1.15
|
| Rate for Payer: Amerigroup Medicaid |
$1.16
|
| Rate for Payer: Amerigroup Medicare |
$0.91
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.51
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.15
|
| Rate for Payer: Medical Associates Commercial |
$1.51
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.91
|
| Rate for Payer: Midlands Choice Commercial |
$1.41
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.81
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.19
|
|
|
divalproex sodium 250 mg ER Tab 24hr [VDMC]
|
Facility
|
IP
|
$2.01
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27358339
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna of IA Commercial |
$1.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.81
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.51
|
| Rate for Payer: Medical Associates Commercial |
$1.51
|
| Rate for Payer: Midlands Choice Commercial |
$1.41
|
| Rate for Payer: United Healthcare Commercial |
$1.81
|
|
|
divalproex sodium 500 mg ER Tab 24hr[VDMC]
|
Facility
|
IP
|
$1.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
20152589
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Aetna of IA Commercial |
$1.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.69
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.41
|
| Rate for Payer: Medical Associates Commercial |
$1.41
|
| Rate for Payer: Midlands Choice Commercial |
$1.32
|
| Rate for Payer: United Healthcare Commercial |
$1.69
|
|
|
divalproex sodium 500 mg ER Tab 24hr[VDMC]
|
Facility
|
OP
|
$1.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
20152589
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Aetna of IA Commercial |
$1.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.69
|
| Rate for Payer: Aetna of IA Medicare |
$1.07
|
| Rate for Payer: Amerigroup Medicaid |
$1.09
|
| Rate for Payer: Amerigroup Medicare |
$0.86
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.08
|
| Rate for Payer: Medical Associates Commercial |
$1.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.85
|
| Rate for Payer: Midlands Choice Commercial |
$1.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.97
|
| Rate for Payer: United Healthcare Commercial |
$1.69
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.11
|
|
|
DLCO/DIFUSION
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
5338933
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
|
|
DLCO/DIFUSION
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
5338933
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Aetna of IA Medicare |
$148.20
|
| Rate for Payer: Amerigroup Medicaid |
$149.97
|
| Rate for Payer: Amerigroup Medicare |
$118.17
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$117.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$148.51
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$117.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$150.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$134.55
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.40
|
| Rate for Payer: Wellmark IA HMO WHPI |
$185.05
|
| Rate for Payer: Wellmark IA PPO |
$203.84
|
|
|
DNA Double Stranded Antibody DMCL
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
8037838
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.83 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Aetna of IA Medicare |
$62.70
|
| Rate for Payer: Amerigroup Medicaid |
$63.45
|
| Rate for Payer: Amerigroup Medicare |
$50.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$62.83
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$63.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.92
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
DNA Double Stranded Antibody DMCL
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
8037838
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
|
|
DOBUTamine 250mg/20ml SDV vial [VDMC]
|
Facility
|
OP
|
$36.72
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
16300791
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$33.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.05
|
| Rate for Payer: Aetna of IA Medicare |
$20.93
|
| Rate for Payer: Amerigroup Medicaid |
$21.18
|
| Rate for Payer: Amerigroup Medicare |
$16.69
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.54
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.97
|
| Rate for Payer: Medical Associates Commercial |
$27.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.52
|
| Rate for Payer: Midlands Choice Commercial |
$25.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.00
|
| Rate for Payer: United Healthcare Commercial |
$33.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.66
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
DOBUTamine 250mg/20ml SDV vial [VDMC]
|
Facility
|
IP
|
$36.72
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
16300791
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna of IA Commercial |
$33.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.05
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.54
|
| Rate for Payer: Medical Associates Commercial |
$27.54
|
| Rate for Payer: Midlands Choice Commercial |
$25.70
|
| Rate for Payer: United Healthcare Commercial |
$33.05
|
|
|
DOBUTamine in D5W 250mg/250mL soln [VDMC]
|
Facility
|
OP
|
$94.47
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
19684450
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$85.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.02
|
| Rate for Payer: Aetna of IA Medicare |
$53.85
|
| Rate for Payer: Amerigroup Medicaid |
$54.49
|
| Rate for Payer: Amerigroup Medicare |
$42.94
|
| Rate for Payer: Cash Price |
$75.58
|
| Rate for Payer: Cash Price |
$75.58
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$70.85
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.51
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$53.96
|
| Rate for Payer: Medical Associates Commercial |
$70.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.51
|
| Rate for Payer: Midlands Choice Commercial |
$66.13
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$54.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.89
|
| Rate for Payer: United Healthcare Commercial |
$85.02
|
| Rate for Payer: United Healthcare Managed Medicare |
$55.74
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
DOBUTamine in D5W 250mg/250mL soln [VDMC]
|
Facility
|
IP
|
$94.47
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
19684450
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$66.13 |
| Max. Negotiated Rate |
$85.02 |
| Rate for Payer: Aetna of IA Commercial |
$85.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.02
|
| Rate for Payer: Cash Price |
$75.58
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$70.85
|
| Rate for Payer: Medical Associates Commercial |
$70.85
|
| Rate for Payer: Midlands Choice Commercial |
$66.13
|
| Rate for Payer: United Healthcare Commercial |
$85.02
|
|
|
docusate sodium 100 mg Cap [VDMC]
|
Facility
|
IP
|
$1.13
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10384175
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of IA Commercial |
$1.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.02
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.85
|
| Rate for Payer: Medical Associates Commercial |
$0.85
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
|
|
docusate sodium 100 mg Cap [VDMC]
|
Facility
|
OP
|
$1.13
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10384175
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of IA Commercial |
$1.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.02
|
| Rate for Payer: Aetna of IA Medicare |
$0.65
|
| Rate for Payer: Amerigroup Medicaid |
$0.65
|
| Rate for Payer: Amerigroup Medicare |
$0.51
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.85
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.51
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.65
|
| Rate for Payer: Medical Associates Commercial |
$0.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.51
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.59
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.67
|
|
|
docusate sodium 150 mg/15 mL Oral Liq [VDMC]
|
Facility
|
IP
|
$6.01
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10384244
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Aetna of IA Commercial |
$5.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.41
|
| Rate for Payer: Cash Price |
$4.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.51
|
| Rate for Payer: Medical Associates Commercial |
$4.51
|
| Rate for Payer: Midlands Choice Commercial |
$4.21
|
| Rate for Payer: United Healthcare Commercial |
$5.41
|
|
|
docusate sodium 150 mg/15 mL Oral Liq [VDMC]
|
Facility
|
OP
|
$6.01
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10384244
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Aetna of IA Commercial |
$5.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.41
|
| Rate for Payer: Aetna of IA Medicare |
$3.43
|
| Rate for Payer: Amerigroup Medicaid |
$3.47
|
| Rate for Payer: Amerigroup Medicare |
$2.73
|
| Rate for Payer: Cash Price |
$4.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.51
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.43
|
| Rate for Payer: Medical Associates Commercial |
$4.51
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.71
|
| Rate for Payer: Midlands Choice Commercial |
$4.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.11
|
| Rate for Payer: United Healthcare Commercial |
$5.41
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.55
|
|
