|
enoxaparin 60 mg/0.6 mL SDV syringe [VDMC]
|
Facility
|
OP
|
$31.85
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
10385835
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.33 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.66
|
| Rate for Payer: Aetna of IA Medicare |
$18.15
|
| Rate for Payer: Amerigroup Medicaid |
$18.37
|
| Rate for Payer: Amerigroup Medicare |
$14.47
|
| Rate for Payer: Cash Price |
$25.48
|
| Rate for Payer: Cash Price |
$25.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.89
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.33
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.19
|
| Rate for Payer: Medical Associates Commercial |
$23.89
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.33
|
| Rate for Payer: Midlands Choice Commercial |
$22.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.48
|
| Rate for Payer: United Healthcare Commercial |
$28.66
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.79
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
enoxaparin 60 mg/0.6 mL SDV syringe [VDMC]
|
Facility
|
IP
|
$31.85
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
10385835
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.29 |
| Max. Negotiated Rate |
$28.66 |
| Rate for Payer: Aetna of IA Commercial |
$28.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.66
|
| Rate for Payer: Cash Price |
$25.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.89
|
| Rate for Payer: Medical Associates Commercial |
$23.89
|
| Rate for Payer: Midlands Choice Commercial |
$22.29
|
| Rate for Payer: United Healthcare Commercial |
$28.66
|
|
|
enoxaparin 80 mg/0.8 mL SDV syringe [VDMC]
|
Facility
|
IP
|
$36.35
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
10385906
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$32.71 |
| Rate for Payer: Aetna of IA Commercial |
$32.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.71
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.26
|
| Rate for Payer: Medical Associates Commercial |
$27.26
|
| Rate for Payer: Midlands Choice Commercial |
$25.44
|
| Rate for Payer: United Healthcare Commercial |
$32.71
|
|
|
enoxaparin 80 mg/0.8 mL SDV syringe [VDMC]
|
Facility
|
OP
|
$36.35
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
10385906
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$32.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.71
|
| Rate for Payer: Aetna of IA Medicare |
$20.72
|
| Rate for Payer: Amerigroup Medicaid |
$20.97
|
| Rate for Payer: Amerigroup Medicare |
$16.52
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.26
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.76
|
| Rate for Payer: Medical Associates Commercial |
$27.26
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.36
|
| Rate for Payer: Midlands Choice Commercial |
$25.44
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.81
|
| Rate for Payer: United Healthcare Commercial |
$32.71
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.45
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
Enterovirus Detection PCR DMCL
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
8037855
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$86.50 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$114.21
|
| Rate for Payer: Amerigroup Medicare |
$89.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$89.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.10
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.10
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.46
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
| Rate for Payer: Wellmark IA HMO WHPI |
$86.50
|
| Rate for Payer: Wellmark IA PPO |
$95.28
|
|
|
Enterovirus Detection PCR DMCL
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
8037855
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
ePHEDrine 50 mg/mL 1ml SDV [VDMC]
|
Facility
|
OP
|
$46.49
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
15873673
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.92 |
| Max. Negotiated Rate |
$41.84 |
| Rate for Payer: Aetna of IA Commercial |
$41.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.84
|
| Rate for Payer: Aetna of IA Medicare |
$26.50
|
| Rate for Payer: Amerigroup Medicaid |
$26.82
|
| Rate for Payer: Amerigroup Medicare |
$21.13
|
| Rate for Payer: Cash Price |
$37.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.87
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$26.56
|
| Rate for Payer: Medical Associates Commercial |
$34.87
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.92
|
| Rate for Payer: Midlands Choice Commercial |
$32.54
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.06
|
| Rate for Payer: United Healthcare Commercial |
$41.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$27.43
|
|
|
ePHEDrine 50 mg/mL 1ml SDV [VDMC]
|
Facility
|
IP
|
$46.49
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
15873673
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.54 |
| Max. Negotiated Rate |
$41.84 |
| Rate for Payer: Aetna of IA Commercial |
$41.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.84
|
| Rate for Payer: Cash Price |
$37.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.87
|
| Rate for Payer: Medical Associates Commercial |
$34.87
|
| Rate for Payer: Midlands Choice Commercial |
$32.54
|
| Rate for Payer: United Healthcare Commercial |
$41.84
|
|
|
EPID INJECTION OF BLOOD PATCH
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
8059063
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,679.15 |
| Rate for Payer: Aetna of IA Commercial |
$397.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$397.80
|
| Rate for Payer: Aetna of IA Medicare |
$251.94
|
| Rate for Payer: Amerigroup Medicaid |
$254.95
|
| Rate for Payer: Amerigroup Medicare |
$200.89
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$331.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$198.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$252.47
|
| Rate for Payer: Medical Associates Commercial |
$331.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$198.90
|
| Rate for Payer: Midlands Choice Commercial |
$309.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$256.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$228.74
|
| Rate for Payer: United Healthcare Commercial |
$397.80
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,524.35
|
| Rate for Payer: Wellmark IA PPO |
$1,679.15
|
|
|
EPID INJECTION OF BLOOD PATCH
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
8059063
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$120.17 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Amerigroup Medicaid |
$121.34
|
| Rate for Payer: Cash Price |
$457.60
|
| Rate for Payer: Cash Price |
$457.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$120.17
|
| Rate for Payer: Medical Associates Commercial |
$429.00
|
| Rate for Payer: Midlands Choice Commercial |
$400.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$120.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$429.00
|
| Rate for Payer: United Healthcare Commercial |
$262.88
|
| Rate for Payer: Wellmark IA HMO WHPI |
$315.70
|
| Rate for Payer: Wellmark IA PPO |
$371.40
|
|
|
EPID INJECTION OF BLOOD PATCH
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
8059063
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$309.40 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna of IA Commercial |
$397.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$397.80
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$331.50
|
| Rate for Payer: Medical Associates Commercial |
$331.50
|
| Rate for Payer: Midlands Choice Commercial |
$309.40
|
| Rate for Payer: United Healthcare Commercial |
$397.80
|
|
|
EPIDRM A-GRFT FACE/NCK/HF/G
|
Facility
|
OP
|
$1,408.00
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
7982937
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$633.60 |
| Max. Negotiated Rate |
$3,434.06 |
| Rate for Payer: Aetna of IA Commercial |
$1,267.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,267.20
|
| Rate for Payer: Aetna of IA Medicare |
$802.56
|
| Rate for Payer: Amerigroup Medicaid |
$812.13
|
| Rate for Payer: Amerigroup Medicare |
$639.94
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,056.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$633.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$804.25
|
| Rate for Payer: Medical Associates Commercial |
$1,056.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$633.60
|
| Rate for Payer: Midlands Choice Commercial |
$985.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$816.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$728.64
|
| Rate for Payer: United Healthcare Commercial |
$1,267.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$830.72
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,117.47
|
| Rate for Payer: Wellmark IA PPO |
$3,434.06
|
|
|
EPIDRM A-GRFT FACE/NCK/HF/G
|
Facility
|
IP
|
$1,408.00
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
7982937
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$985.60 |
| Max. Negotiated Rate |
$1,267.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,267.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,267.20
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,056.00
|
| Rate for Payer: Medical Associates Commercial |
$1,056.00
|
| Rate for Payer: Midlands Choice Commercial |
$985.60
|
| Rate for Payer: United Healthcare Commercial |
$1,267.20
|
|
|
EPIDURAL BLOCK-CERVICAL/THORACIC SPINE
|
Professional
|
Both
|
$554.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
8101309
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$153.26 |
| Max. Negotiated Rate |
$415.50 |
| Rate for Payer: Amerigroup Medicaid |
$154.76
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$153.26
|
| Rate for Payer: Medical Associates Commercial |
$415.50
|
| Rate for Payer: Midlands Choice Commercial |
$387.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$154.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$415.50
|
| Rate for Payer: United Healthcare Commercial |
$249.23
|
| Rate for Payer: Wellmark IA HMO WHPI |
$308.20
|
| Rate for Payer: Wellmark IA PPO |
$362.60
|
|
|
EPINEPHrine 0.3 mg Kit [VDMC]
|
Facility
|
IP
|
$544.30
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
11223910
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$381.01 |
| Max. Negotiated Rate |
$489.87 |
| Rate for Payer: Aetna of IA Commercial |
$489.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$489.87
|
| Rate for Payer: Cash Price |
$435.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$408.22
|
| Rate for Payer: Medical Associates Commercial |
$408.22
|
| Rate for Payer: Midlands Choice Commercial |
$381.01
|
| Rate for Payer: United Healthcare Commercial |
$489.87
|
|
|
EPINEPHrine 0.3 mg Kit [VDMC]
|
Facility
|
OP
|
$544.30
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
11223910
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$201.36 |
| Max. Negotiated Rate |
$489.87 |
| Rate for Payer: Aetna of IA Commercial |
$489.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$489.87
|
| Rate for Payer: Aetna of IA Medicare |
$310.25
|
| Rate for Payer: Amerigroup Medicaid |
$313.95
|
| Rate for Payer: Amerigroup Medicare |
$247.38
|
| Rate for Payer: Cash Price |
$435.44
|
| Rate for Payer: Cash Price |
$435.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$408.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$244.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$310.90
|
| Rate for Payer: Medical Associates Commercial |
$408.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$244.94
|
| Rate for Payer: Midlands Choice Commercial |
$381.01
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$315.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$281.68
|
| Rate for Payer: United Healthcare Commercial |
$489.87
|
| Rate for Payer: United Healthcare Managed Medicare |
$321.14
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
EPINEPHrine 0.3mL Syringe SDV [VDMC]
|
Facility
|
OP
|
$71.79
|
|
|
Service Code
|
NDC 99999-9061-00
|
| Hospital Charge Code |
12362767
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$64.61 |
| Rate for Payer: Aetna of IA Commercial |
$64.61
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.61
|
| Rate for Payer: Aetna of IA Medicare |
$40.92
|
| Rate for Payer: Amerigroup Medicaid |
$41.41
|
| Rate for Payer: Amerigroup Medicare |
$32.63
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.84
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.01
|
| Rate for Payer: Medical Associates Commercial |
$53.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.30
|
| Rate for Payer: Midlands Choice Commercial |
$50.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$37.15
|
| Rate for Payer: United Healthcare Commercial |
$64.61
|
| Rate for Payer: United Healthcare Managed Medicare |
$42.36
|
|
|
EPINEPHrine 0.3mL Syringe SDV [VDMC]
|
Facility
|
IP
|
$71.79
|
|
|
Service Code
|
NDC 99999-9061-00
|
| Hospital Charge Code |
12362767
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.25 |
| Max. Negotiated Rate |
$64.61 |
| Rate for Payer: Aetna of IA Commercial |
$64.61
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.61
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.84
|
| Rate for Payer: Medical Associates Commercial |
$53.84
|
| Rate for Payer: Midlands Choice Commercial |
$50.25
|
| Rate for Payer: United Healthcare Commercial |
$64.61
|
|
|
EPINEPHrine 1 mg/mL 1ml vial SDV [VDMC]
|
Facility
|
IP
|
$108.27
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
11219984
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$75.79 |
| Max. Negotiated Rate |
$97.44 |
| Rate for Payer: Aetna of IA Commercial |
$97.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.44
|
| Rate for Payer: Cash Price |
$86.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.20
|
| Rate for Payer: Medical Associates Commercial |
$81.20
|
| Rate for Payer: Midlands Choice Commercial |
$75.79
|
| Rate for Payer: United Healthcare Commercial |
$97.44
|
|
|
EPINEPHrine 1 mg/mL 1ml vial SDV [VDMC]
|
Facility
|
OP
|
$108.27
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
11219984
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$48.72 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$97.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.44
|
| Rate for Payer: Aetna of IA Medicare |
$61.71
|
| Rate for Payer: Amerigroup Medicaid |
$62.45
|
| Rate for Payer: Amerigroup Medicare |
$49.21
|
| Rate for Payer: Cash Price |
$86.62
|
| Rate for Payer: Cash Price |
$86.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.20
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$48.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.84
|
| Rate for Payer: Medical Associates Commercial |
$81.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$48.72
|
| Rate for Payer: Midlands Choice Commercial |
$75.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.03
|
| Rate for Payer: United Healthcare Commercial |
$97.44
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.88
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
EPINEPHrine 1 mg/mL 30ml Inj MDV [VDMC]
|
Facility
|
OP
|
$645.48
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
10386241
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$201.36 |
| Max. Negotiated Rate |
$580.93 |
| Rate for Payer: Aetna of IA Commercial |
$580.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$580.93
|
| Rate for Payer: Aetna of IA Medicare |
$367.92
|
| Rate for Payer: Amerigroup Medicaid |
$372.31
|
| Rate for Payer: Amerigroup Medicare |
$293.37
|
| Rate for Payer: Cash Price |
$516.38
|
| Rate for Payer: Cash Price |
$516.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$484.11
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$290.47
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$368.70
|
| Rate for Payer: Medical Associates Commercial |
$484.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$290.47
|
| Rate for Payer: Midlands Choice Commercial |
$451.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$374.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$334.04
|
| Rate for Payer: United Healthcare Commercial |
$580.93
|
| Rate for Payer: United Healthcare Managed Medicare |
$380.83
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
EPINEPHrine 1 mg/mL 30ml Inj MDV [VDMC]
|
Facility
|
IP
|
$645.48
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
10386241
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$451.84 |
| Max. Negotiated Rate |
$580.93 |
| Rate for Payer: Aetna of IA Commercial |
$580.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$580.93
|
| Rate for Payer: Cash Price |
$516.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$484.11
|
| Rate for Payer: Medical Associates Commercial |
$484.11
|
| Rate for Payer: Midlands Choice Commercial |
$451.84
|
| Rate for Payer: United Healthcare Commercial |
$580.93
|
|
|
EPINEPHrine Emergency syringe 0.1 mg/mL 10ml Inj SDV [VDMC]
|
Facility
|
IP
|
$54.96
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
10386040
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.47 |
| Max. Negotiated Rate |
$49.46 |
| Rate for Payer: Aetna of IA Commercial |
$49.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.46
|
| Rate for Payer: Cash Price |
$43.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.22
|
| Rate for Payer: Medical Associates Commercial |
$41.22
|
| Rate for Payer: Midlands Choice Commercial |
$38.47
|
| Rate for Payer: United Healthcare Commercial |
$49.46
|
|
|
EPINEPHrine Emergency syringe 0.1 mg/mL 10ml Inj SDV [VDMC]
|
Facility
|
OP
|
$54.96
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
10386040
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.73 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$49.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.46
|
| Rate for Payer: Aetna of IA Medicare |
$31.32
|
| Rate for Payer: Amerigroup Medicaid |
$31.70
|
| Rate for Payer: Amerigroup Medicare |
$24.98
|
| Rate for Payer: Cash Price |
$43.96
|
| Rate for Payer: Cash Price |
$43.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$24.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.39
|
| Rate for Payer: Medical Associates Commercial |
$41.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$24.73
|
| Rate for Payer: Midlands Choice Commercial |
$38.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$31.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.44
|
| Rate for Payer: United Healthcare Commercial |
$49.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$32.42
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
EPINEPHrine ( Eye Surgery )1 mg/mL 0.3ml Inj Sol [VDMC]
|
Facility
|
OP
|
$104.97
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
10607748
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.24 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$94.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$94.47
|
| Rate for Payer: Aetna of IA Medicare |
$59.83
|
| Rate for Payer: Amerigroup Medicaid |
$60.55
|
| Rate for Payer: Amerigroup Medicare |
$47.71
|
| Rate for Payer: Cash Price |
$83.97
|
| Rate for Payer: Cash Price |
$83.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$47.24
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.96
|
| Rate for Payer: Medical Associates Commercial |
$78.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.24
|
| Rate for Payer: Midlands Choice Commercial |
$73.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.32
|
| Rate for Payer: United Healthcare Commercial |
$94.47
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.93
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
