|
IOP Train and Educate
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS G0177
|
| Hospital Charge Code |
8300863
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of IA Commercial |
$198.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.90
|
| Rate for Payer: Aetna of IA Medicare |
$125.97
|
| Rate for Payer: Amerigroup Medicaid |
$127.47
|
| Rate for Payer: Amerigroup Medicare |
$100.44
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.24
|
| Rate for Payer: Medical Associates Commercial |
$165.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.45
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$114.37
|
| Rate for Payer: United Healthcare Commercial |
$198.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$130.39
|
|
|
IOP Train and Educate
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
HCPCS G0177
|
| Hospital Charge Code |
8300863
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of IA Commercial |
$198.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.90
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.75
|
| Rate for Payer: Medical Associates Commercial |
$165.75
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: United Healthcare Commercial |
$198.90
|
|
|
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 |
$4.37 |
| Rate for Payer: Aetna of IA Commercial |
$4.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.37
|
| 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 |
$4.37
|
|
|
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 |
$2.18 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna of IA Commercial |
$4.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.37
|
| Rate for Payer: Aetna of IA Medicare |
$2.77
|
| Rate for Payer: Amerigroup Medicaid |
$2.80
|
| Rate for Payer: Amerigroup Medicare |
$2.21
|
| 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 |
$2.18
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.77
|
| Rate for Payer: Medical Associates Commercial |
$3.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.18
|
| Rate for Payer: Midlands Choice Commercial |
$3.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.51
|
| Rate for Payer: United Healthcare Commercial |
$4.37
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.86
|
|
|
ipratropium Nasal 0.06% Spry [VDMC]
|
Facility
|
IP
|
$68.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10397432
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$61.63 |
| Rate for Payer: Aetna of IA Commercial |
$61.63
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$61.63
|
| Rate for Payer: Cash Price |
$54.79
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.36
|
| Rate for Payer: Medical Associates Commercial |
$51.36
|
| Rate for Payer: Midlands Choice Commercial |
$47.94
|
| Rate for Payer: United Healthcare Commercial |
$61.63
|
|
|
ipratropium Nasal 0.06% Spry [VDMC]
|
Facility
|
OP
|
$68.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10397432
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.82 |
| Max. Negotiated Rate |
$61.63 |
| Rate for Payer: Aetna of IA Commercial |
$61.63
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$61.63
|
| Rate for Payer: Aetna of IA Medicare |
$39.03
|
| Rate for Payer: Amerigroup Medicaid |
$39.50
|
| Rate for Payer: Amerigroup Medicare |
$31.13
|
| Rate for Payer: Cash Price |
$54.79
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$39.12
|
| Rate for Payer: Medical Associates Commercial |
$51.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.82
|
| Rate for Payer: Midlands Choice Commercial |
$47.94
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$35.44
|
| Rate for Payer: United Healthcare Commercial |
$61.63
|
| Rate for Payer: United Healthcare Managed Medicare |
$40.40
|
|
|
irbesartan 150 mg Tab [VDMC]
|
Facility
|
OP
|
$1.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10397497
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| 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 |
$1.08
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Cash Price |
$1.50
|
| 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 |
$0.84
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.07
|
| Rate for Payer: Medical Associates Commercial |
$1.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.84
|
| Rate for Payer: Midlands Choice Commercial |
$1.31
|
| 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
|
|
|
irbesartan 150 mg Tab [VDMC]
|
Facility
|
IP
|
$1.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10397497
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.31 |
| 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 |
$1.50
|
| 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 |
$1.31
|
| Rate for Payer: United Healthcare Commercial |
$1.69
|
|
|
IREM F.B. COMPLICATED
|
Professional
|
Both
|
$1,527.00
|
|
|
Service Code
|
CPT 54115
|
| Hospital Charge Code |
7982862
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$700.34 |
| Max. Negotiated Rate |
$1,145.25 |
| Rate for Payer: Cash Price |
$1,221.60
|
| Rate for Payer: Cash Price |
$1,221.60
|
| Rate for Payer: Medical Associates Commercial |
$1,145.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,068.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,145.25
|
| Rate for Payer: United Healthcare Commercial |
$700.34
|
|
|
IRIS RETRACTOR
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 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
|
|
|
IRIS RETRACTOR
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
8026386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.80 |
| 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: Aetna of IA Medicare |
$70.68
|
| Rate for Payer: Amerigroup Medicaid |
$71.52
|
| Rate for Payer: Amerigroup Medicare |
$56.36
|
| 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 |
$55.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$70.83
|
| Rate for Payer: Medical Associates Commercial |
$93.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.80
|
| Rate for Payer: Midlands Choice Commercial |
$86.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.17
|
| Rate for Payer: United Healthcare Commercial |
$111.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$73.16
|
|
|
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
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
633765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.95 |
| 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 |
$40.95
|
| Rate for Payer: Amerigroup Medicare |
$32.27
|
| 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 |
$31.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.56
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.95
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$36.74
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.89
|
|
|
iron dextran 50 mg/mL 2 ml Inj Sol [VDMC]
|
Facility
|
IP
|
$87.43
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
29045726
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$78.69 |
| Rate for Payer: Aetna of IA Commercial |
$78.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$78.69
|
| Rate for Payer: Cash Price |
$69.95
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$65.57
|
| Rate for Payer: Medical Associates Commercial |
$65.57
|
| Rate for Payer: Midlands Choice Commercial |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$78.69
|
|
|
iron dextran 50 mg/mL 2 ml Inj Sol [VDMC]
|
Facility
|
OP
|
$87.43
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
29045726
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.34 |
| Max. Negotiated Rate |
$78.69 |
| Rate for Payer: Aetna of IA Commercial |
$78.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$78.69
|
| Rate for Payer: Aetna of IA Medicare |
$49.84
|
| Rate for Payer: Amerigroup Medicaid |
$50.43
|
| Rate for Payer: Amerigroup Medicare |
$39.74
|
| Rate for Payer: Cash Price |
$69.95
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$65.57
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$39.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.94
|
| Rate for Payer: Medical Associates Commercial |
$65.57
|
| Rate for Payer: Medical Associates Managed Medicare |
$39.34
|
| Rate for Payer: Midlands Choice Commercial |
$61.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.25
|
| Rate for Payer: United Healthcare Commercial |
$78.69
|
| Rate for Payer: United Healthcare Managed Medicare |
$51.58
|
|
|
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 |
$32.40 |
| 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: Aetna of IA Medicare |
$41.04
|
| Rate for Payer: Amerigroup Medicaid |
$41.53
|
| Rate for Payer: Amerigroup Medicare |
$32.72
|
| 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 |
$32.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.13
|
| Rate for Payer: Medical Associates Commercial |
$54.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.40
|
| Rate for Payer: Midlands Choice Commercial |
$50.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$37.26
|
| Rate for Payer: United Healthcare Commercial |
$64.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$42.48
|
|
|
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 |
$63.41 |
| 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 |
$81.27
|
| Rate for Payer: Amerigroup Medicare |
$64.04
|
| Rate for Payer: Cash Price |
$112.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.67
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$63.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.48
|
| Rate for Payer: Medical Associates Commercial |
$105.67
|
| Rate for Payer: Medical Associates Managed Medicare |
$63.41
|
| Rate for Payer: Midlands Choice Commercial |
$98.63
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$72.92
|
| 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 |
$105.67
|
| Rate for Payer: Medical Associates Commercial |
$105.67
|
| 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 |
$30.22 |
| 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 |
$38.74
|
| Rate for Payer: Amerigroup Medicare |
$30.52
|
| 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 |
$30.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.36
|
| Rate for Payer: Medical Associates Commercial |
$50.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.22
|
| Rate for Payer: Midlands Choice Commercial |
$47.01
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.76
|
| 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
|
$76.72
|
|
|
Service Code
|
NDC 00338-0048-02
|
| Hospital Charge Code |
10438279
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.52 |
| Max. Negotiated Rate |
$69.05 |
| Rate for Payer: Aetna of IA Commercial |
$69.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.05
|
| Rate for Payer: Aetna of IA Medicare |
$43.73
|
| Rate for Payer: Amerigroup Medicaid |
$44.25
|
| Rate for Payer: Amerigroup Medicare |
$34.87
|
| Rate for Payer: Cash Price |
$61.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.54
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.82
|
| Rate for Payer: Medical Associates Commercial |
$57.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.52
|
| Rate for Payer: Midlands Choice Commercial |
$53.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.70
|
| Rate for Payer: United Healthcare Commercial |
$69.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.26
|
|
|
Irrigation sodium chloride 0.9% Sol 250 mL Bottle [VDMC]
|
Facility
|
IP
|
$76.72
|
|
|
Service Code
|
NDC 00338-0048-02
|
| Hospital Charge Code |
10438279
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$69.05 |
| Rate for Payer: Aetna of IA Commercial |
$69.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.05
|
| Rate for Payer: Cash Price |
$61.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.54
|
| Rate for Payer: Medical Associates Commercial |
$57.54
|
| Rate for Payer: Midlands Choice Commercial |
$53.70
|
| Rate for Payer: United Healthcare Commercial |
$69.05
|
|
|
Irrigation sodium chloride 0.9% Sol 3000 mL [VDMC]
|
Facility
|
IP
|
$77.88
|
|
|
Service Code
|
NDC 00990-7972-08
|
| Hospital Charge Code |
10438346
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$54.52 |
| 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: Cash Price |
$62.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.41
|
| Rate for Payer: Medical Associates Commercial |
$58.41
|
| Rate for Payer: Midlands Choice Commercial |
$54.52
|
| Rate for Payer: United Healthcare Commercial |
$70.09
|
|
|
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 |
$35.05 |
| 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 |
$44.92
|
| Rate for Payer: Amerigroup Medicare |
$35.40
|
| 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 |
$35.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$44.49
|
| Rate for Payer: Medical Associates Commercial |
$58.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.05
|
| Rate for Payer: Midlands Choice Commercial |
$54.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$45.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$40.30
|
| Rate for Payer: United Healthcare Commercial |
$70.09
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.95
|
|
