|
iopamidol 41% Sol[VDMC]
|
Facility
|
IP
|
$57.58
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
12697970
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$40.31 |
| Max. Negotiated Rate |
$51.82 |
| Rate for Payer: Aetna of IA Commercial |
$51.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.82
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.18
|
| Rate for Payer: Medical Associates Commercial |
$43.18
|
| Rate for Payer: Midlands Choice Commercial |
$40.31
|
| Rate for Payer: United Healthcare Commercial |
$51.82
|
|
|
ipratropium 0.02% neb Sol 2.5 mL SDV [VDMC]
|
Facility
|
OP
|
$4.85
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
10397361
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna of IA Commercial |
$4.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.36
|
| Rate for Payer: Aetna of IA Medicare |
$2.76
|
| Rate for Payer: Amerigroup Medicaid |
$2.45
|
| Rate for Payer: Amerigroup Medicare |
$2.45
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.42
|
| Rate for Payer: Medical Associates Commercial |
$3.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.42
|
| Rate for Payer: Midlands Choice Commercial |
$3.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.46
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$2.46
|
| Rate for Payer: Oscar Health of IA Commercial |
$3.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.64
|
| Rate for Payer: United Healthcare Commercial |
$4.36
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.86
|
|
|
ipratropium 0.02% neb Sol 2.5 mL SDV [VDMC]
|
Facility
|
IP
|
$4.85
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
10397361
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna of IA Commercial |
$4.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.36
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.64
|
| Rate for Payer: Medical Associates Commercial |
$3.64
|
| Rate for Payer: Midlands Choice Commercial |
$3.40
|
| Rate for Payer: United Healthcare Commercial |
$4.36
|
|
|
ipratropium Nasal 0.06% Spry [VDMC]
|
Facility
|
IP
|
$113.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10397432
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$101.95 |
| Rate for Payer: Aetna of IA Commercial |
$101.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$101.95
|
| Rate for Payer: Cash Price |
$90.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$84.96
|
| Rate for Payer: Medical Associates Commercial |
$84.96
|
| Rate for Payer: Midlands Choice Commercial |
$79.30
|
| Rate for Payer: United Healthcare Commercial |
$101.95
|
|
|
ipratropium Nasal 0.06% Spry [VDMC]
|
Facility
|
OP
|
$113.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10397432
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$56.62 |
| Max. Negotiated Rate |
$101.95 |
| Rate for Payer: Aetna of IA Commercial |
$101.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$101.95
|
| Rate for Payer: Aetna of IA Medicare |
$64.57
|
| Rate for Payer: Amerigroup Medicaid |
$57.17
|
| Rate for Payer: Amerigroup Medicare |
$57.21
|
| Rate for Payer: Cash Price |
$90.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$84.96
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$56.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.62
|
| Rate for Payer: Medical Associates Commercial |
$84.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.64
|
| Rate for Payer: Midlands Choice Commercial |
$79.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.49
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$57.46
|
| Rate for Payer: Oscar Health of IA Commercial |
$84.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$84.96
|
| Rate for Payer: United Healthcare Commercial |
$101.95
|
| Rate for Payer: United Healthcare Managed Medicare |
$66.84
|
|
|
irbesartan 150 mg Tab [VDMC]
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10397497
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna of IA Commercial |
$1.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.78
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.48
|
| Rate for Payer: Medical Associates Commercial |
$1.48
|
| Rate for Payer: Midlands Choice Commercial |
$1.39
|
| Rate for Payer: United Healthcare Commercial |
$1.78
|
|
|
irbesartan 150 mg Tab [VDMC]
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10397497
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna of IA Commercial |
$1.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.78
|
| Rate for Payer: Aetna of IA Medicare |
$1.13
|
| Rate for Payer: Amerigroup Medicaid |
$1.00
|
| Rate for Payer: Amerigroup Medicare |
$1.00
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.48
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.99
|
| Rate for Payer: Medical Associates Commercial |
$1.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.99
|
| Rate for Payer: Midlands Choice Commercial |
$1.39
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.48
|
| Rate for Payer: United Healthcare Commercial |
$1.78
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.17
|
|
|
IREM F.B. COMPLICATED
|
Professional
|
Both
|
$1,527.00
|
|
|
Service Code
|
CPT 54115
|
| Hospital Charge Code |
7982862
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$391.26 |
| Max. Negotiated Rate |
$1,068.90 |
| Rate for Payer: Aetna of IA Medicare |
$391.26
|
| Rate for Payer: Amerigroup Medicaid |
$404.56
|
| Rate for Payer: Cash Price |
$1,221.60
|
| Rate for Payer: Cash Price |
$1,221.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$469.51
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$399.09
|
| Rate for Payer: Medical Associates Commercial |
$704.27
|
| Rate for Payer: Medical Associates Managed Medicare |
$391.26
|
| Rate for Payer: Midlands Choice Commercial |
$1,068.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$676.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$586.89
|
|
|
irinotecan 20 mg/mL 2ml vial [VDMC]
|
Facility
|
OP
|
$71.72
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
16794539
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$64.55 |
| Rate for Payer: Aetna of IA Commercial |
$64.55
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.55
|
| Rate for Payer: Aetna of IA Medicare |
$40.88
|
| Rate for Payer: Amerigroup Medicaid |
$36.20
|
| Rate for Payer: Amerigroup Medicare |
$36.22
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.79
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.85
|
| Rate for Payer: Medical Associates Commercial |
$53.79
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.86
|
| Rate for Payer: Midlands Choice Commercial |
$50.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.40
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$36.38
|
| Rate for Payer: Oscar Health of IA Commercial |
$53.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.79
|
| Rate for Payer: United Healthcare Commercial |
$64.55
|
| Rate for Payer: United Healthcare Managed Medicare |
$42.31
|
|
|
irinotecan 20 mg/mL 2ml vial [VDMC]
|
Facility
|
IP
|
$71.72
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
16794539
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$64.55 |
| Rate for Payer: Aetna of IA Commercial |
$64.55
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.55
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.79
|
| Rate for Payer: Medical Associates Commercial |
$53.79
|
| Rate for Payer: Midlands Choice Commercial |
$50.20
|
| Rate for Payer: United Healthcare Commercial |
$64.55
|
|
|
irinotecan 20 mg/mL 5ml vial [VDMC]
|
Facility
|
IP
|
$100.20
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
16794383
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$70.14 |
| Max. Negotiated Rate |
$90.18 |
| Rate for Payer: Aetna of IA Commercial |
$90.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.18
|
| Rate for Payer: Cash Price |
$80.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.15
|
| Rate for Payer: Medical Associates Commercial |
$75.15
|
| Rate for Payer: Midlands Choice Commercial |
$70.14
|
| Rate for Payer: United Healthcare Commercial |
$90.18
|
|
|
irinotecan 20 mg/mL 5ml vial [VDMC]
|
Facility
|
OP
|
$100.20
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
16794383
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.08 |
| Max. Negotiated Rate |
$90.18 |
| Rate for Payer: Aetna of IA Commercial |
$90.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.18
|
| Rate for Payer: Aetna of IA Medicare |
$57.11
|
| Rate for Payer: Amerigroup Medicaid |
$50.57
|
| Rate for Payer: Amerigroup Medicare |
$50.60
|
| Rate for Payer: Cash Price |
$80.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.15
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$50.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$50.08
|
| Rate for Payer: Medical Associates Commercial |
$75.15
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.10
|
| Rate for Payer: Midlands Choice Commercial |
$70.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.85
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$50.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$75.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.15
|
| Rate for Payer: United Healthcare Commercial |
$90.18
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.12
|
|
|
IRIS RETRACTOR
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8026386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.98 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna of IA Commercial |
$111.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$111.60
|
| Rate for Payer: Aetna of IA Medicare |
$70.68
|
| Rate for Payer: Amerigroup Medicaid |
$62.58
|
| Rate for Payer: Amerigroup Medicare |
$62.62
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$62.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.98
|
| Rate for Payer: Medical Associates Commercial |
$93.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.00
|
| Rate for Payer: Midlands Choice Commercial |
$86.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.93
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$62.89
|
| Rate for Payer: Oscar Health of IA Commercial |
$93.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.00
|
| Rate for Payer: United Healthcare Commercial |
$111.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$73.16
|
|
|
IRIS RETRACTOR
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
8026386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna of IA Commercial |
$111.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$111.60
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.00
|
| Rate for Payer: Medical Associates Commercial |
$93.00
|
| Rate for Payer: Midlands Choice Commercial |
$86.80
|
| Rate for Payer: United Healthcare Commercial |
$111.60
|
|
|
IRON
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
633765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Aetna of IA Medicare |
$40.47
|
| Rate for Payer: Amerigroup Medicaid |
$35.83
|
| Rate for Payer: Amerigroup Medicare |
$35.86
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.49
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.03
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$36.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$53.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.25
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.89
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
IRON
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
633765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
|
|
IRON IRON BINDING
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
4018195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of IA Commercial |
$64.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.80
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.00
|
| Rate for Payer: Medical Associates Commercial |
$54.00
|
| Rate for Payer: Midlands Choice Commercial |
$50.40
|
| Rate for Payer: United Healthcare Commercial |
$64.80
|
|
|
IRON IRON BINDING
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
4018195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of IA Commercial |
$64.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.80
|
| Rate for Payer: Aetna of IA Medicare |
$41.04
|
| Rate for Payer: Amerigroup Medicaid |
$36.34
|
| Rate for Payer: Amerigroup Medicare |
$36.36
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.99
|
| Rate for Payer: Medical Associates Commercial |
$54.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.00
|
| Rate for Payer: Midlands Choice Commercial |
$50.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$36.52
|
| Rate for Payer: Oscar Health of IA Commercial |
$54.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.00
|
| Rate for Payer: United Healthcare Commercial |
$64.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$42.48
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
iron sucrose 20 mg/mL IV 5 ml SDV Sol [VDMC]
|
Facility
|
OP
|
$140.90
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
10397566
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$70.42 |
| Max. Negotiated Rate |
$126.81 |
| Rate for Payer: Aetna of IA Commercial |
$126.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.81
|
| Rate for Payer: Aetna of IA Medicare |
$80.31
|
| Rate for Payer: Amerigroup Medicaid |
$71.11
|
| Rate for Payer: Amerigroup Medicare |
$71.15
|
| Rate for Payer: Cash Price |
$112.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.68
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$70.42
|
| Rate for Payer: Medical Associates Commercial |
$105.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.45
|
| Rate for Payer: Midlands Choice Commercial |
$98.63
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.51
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$71.46
|
| Rate for Payer: Oscar Health of IA Commercial |
$105.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$105.68
|
| Rate for Payer: United Healthcare Commercial |
$126.81
|
| Rate for Payer: United Healthcare Managed Medicare |
$83.13
|
|
|
iron sucrose 20 mg/mL IV 5 ml SDV Sol [VDMC]
|
Facility
|
IP
|
$140.90
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
10397566
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$98.63 |
| Max. Negotiated Rate |
$126.81 |
| Rate for Payer: Aetna of IA Commercial |
$126.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.81
|
| Rate for Payer: Cash Price |
$112.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.68
|
| Rate for Payer: Medical Associates Commercial |
$105.68
|
| Rate for Payer: Midlands Choice Commercial |
$98.63
|
| Rate for Payer: United Healthcare Commercial |
$126.81
|
|
|
Irrigation sodium chloride 0.9% Sol 1000 mL Bottle [VDMC]
|
Facility
|
IP
|
$67.16
|
|
|
Service Code
|
NDC 00338-0048-04
|
| Hospital Charge Code |
10438212
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.01 |
| Max. Negotiated Rate |
$60.44 |
| Rate for Payer: Aetna of IA Commercial |
$60.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.44
|
| Rate for Payer: Cash Price |
$53.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.37
|
| Rate for Payer: Medical Associates Commercial |
$50.37
|
| Rate for Payer: Midlands Choice Commercial |
$47.01
|
| Rate for Payer: United Healthcare Commercial |
$60.44
|
|
|
Irrigation sodium chloride 0.9% Sol 1000 mL Bottle [VDMC]
|
Facility
|
OP
|
$67.16
|
|
|
Service Code
|
NDC 00338-0048-04
|
| Hospital Charge Code |
10438212
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$60.44 |
| Rate for Payer: Aetna of IA Commercial |
$60.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.44
|
| Rate for Payer: Aetna of IA Medicare |
$38.28
|
| Rate for Payer: Amerigroup Medicaid |
$33.90
|
| Rate for Payer: Amerigroup Medicare |
$33.92
|
| Rate for Payer: Cash Price |
$53.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.37
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.57
|
| Rate for Payer: Medical Associates Commercial |
$50.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.58
|
| Rate for Payer: Midlands Choice Commercial |
$47.01
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.08
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$34.06
|
| Rate for Payer: Oscar Health of IA Commercial |
$50.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.37
|
| Rate for Payer: United Healthcare Commercial |
$60.44
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.62
|
|
|
Irrigation sodium chloride 0.9% Sol 250 mL Bottle [VDMC]
|
Facility
|
OP
|
$67.70
|
|
|
Service Code
|
NDC 00338-0048-02
|
| Hospital Charge Code |
10438279
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.84 |
| Max. Negotiated Rate |
$60.93 |
| Rate for Payer: Aetna of IA Commercial |
$60.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.93
|
| Rate for Payer: Aetna of IA Medicare |
$38.59
|
| Rate for Payer: Amerigroup Medicaid |
$34.17
|
| Rate for Payer: Amerigroup Medicare |
$34.19
|
| Rate for Payer: Cash Price |
$54.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.84
|
| Rate for Payer: Medical Associates Commercial |
$50.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.85
|
| Rate for Payer: Midlands Choice Commercial |
$47.39
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.36
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$34.34
|
| Rate for Payer: Oscar Health of IA Commercial |
$50.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.78
|
| Rate for Payer: United Healthcare Commercial |
$60.93
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.94
|
|
|
Irrigation sodium chloride 0.9% Sol 250 mL Bottle [VDMC]
|
Facility
|
IP
|
$67.70
|
|
|
Service Code
|
NDC 00338-0048-02
|
| Hospital Charge Code |
10438279
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$60.93 |
| Rate for Payer: Aetna of IA Commercial |
$60.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.93
|
| Rate for Payer: Cash Price |
$54.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.78
|
| Rate for Payer: Medical Associates Commercial |
$50.78
|
| Rate for Payer: Midlands Choice Commercial |
$47.39
|
| Rate for Payer: United Healthcare Commercial |
$60.93
|
|
|
Irrigation sodium chloride 0.9% Sol 3000 mL [VDMC]
|
Facility
|
OP
|
$77.88
|
|
|
Service Code
|
NDC 00990-7972-08
|
| Hospital Charge Code |
10438346
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$70.09 |
| Rate for Payer: Aetna of IA Commercial |
$70.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$70.09
|
| Rate for Payer: Aetna of IA Medicare |
$44.39
|
| Rate for Payer: Amerigroup Medicaid |
$39.31
|
| Rate for Payer: Amerigroup Medicare |
$39.33
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.92
|
| Rate for Payer: Medical Associates Commercial |
$58.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.94
|
| Rate for Payer: Midlands Choice Commercial |
$54.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.52
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$39.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$58.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$58.41
|
| Rate for Payer: United Healthcare Commercial |
$70.09
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.95
|
|
