|
Irrigation sodium chloride 0.9% Sol 500 mL Bottle [VDMC]
|
Facility
|
OP
|
$71.10
|
|
|
Service Code
|
NDC 00338-0048-03
|
| Hospital Charge Code |
10438413
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$63.99 |
| Rate for Payer: Aetna of IA Commercial |
$63.99
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.99
|
| Rate for Payer: Aetna of IA Medicare |
$40.53
|
| Rate for Payer: Amerigroup Medicaid |
$41.01
|
| Rate for Payer: Amerigroup Medicare |
$32.31
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.33
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.61
|
| Rate for Payer: Medical Associates Commercial |
$53.33
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.00
|
| Rate for Payer: Midlands Choice Commercial |
$49.77
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$36.79
|
| Rate for Payer: United Healthcare Commercial |
$63.99
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.95
|
|
|
Irrigation sodium chloride 0.9% Sol 500 mL Bottle [VDMC]
|
Facility
|
IP
|
$71.10
|
|
|
Service Code
|
NDC 00338-0048-03
|
| Hospital Charge Code |
10438413
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$49.77 |
| Max. Negotiated Rate |
$63.99 |
| Rate for Payer: Aetna of IA Commercial |
$63.99
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.99
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.33
|
| Rate for Payer: Medical Associates Commercial |
$53.33
|
| Rate for Payer: Midlands Choice Commercial |
$49.77
|
| Rate for Payer: United Healthcare Commercial |
$63.99
|
|
|
IRRIG DRUG DELIVERY DEVICE
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
8398094
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$70.65 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Aetna of IA Medicare |
$89.49
|
| Rate for Payer: Amerigroup Medicaid |
$90.56
|
| Rate for Payer: Amerigroup Medicare |
$71.36
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.68
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.65
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.25
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.63
|
|
|
IRRIG DRUG DELIVERY DEVICE
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
4866826
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
|
|
IRRIG DRUG DELIVERY DEVICE
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
8398094
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
|
|
IRRIG DRUG DELIVERY DEVICE
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
4866826
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$70.65 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Aetna of IA Medicare |
$89.49
|
| Rate for Payer: Amerigroup Medicaid |
$90.56
|
| Rate for Payer: Amerigroup Medicare |
$71.36
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.68
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.65
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.25
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.63
|
|
|
Isolation
|
Facility
|
IP
|
$230.00
|
|
| Hospital Charge Code |
7861839
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$2,580.60 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,258.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,580.60
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,306.00
|
|
|
isoniazid 100 mg Tab [VDMC]
|
Facility
|
OP
|
$1.29
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10397637
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of IA Commercial |
$1.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.16
|
| Rate for Payer: Aetna of IA Medicare |
$0.74
|
| Rate for Payer: Amerigroup Medicaid |
$0.75
|
| Rate for Payer: Amerigroup Medicare |
$0.59
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.74
|
| Rate for Payer: Medical Associates Commercial |
$0.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.58
|
| Rate for Payer: Midlands Choice Commercial |
$0.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.67
|
| Rate for Payer: United Healthcare Commercial |
$1.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.76
|
|
|
isoniazid 100 mg Tab [VDMC]
|
Facility
|
IP
|
$1.29
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10397637
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of IA Commercial |
$1.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.16
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.97
|
| Rate for Payer: Medical Associates Commercial |
$0.97
|
| Rate for Payer: Midlands Choice Commercial |
$0.91
|
| Rate for Payer: United Healthcare Commercial |
$1.16
|
|
|
isosorbide mononitrate 20 mg Tab [VDMC]
|
Facility
|
OP
|
$1.53
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10397848
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna of IA Commercial |
$1.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.38
|
| Rate for Payer: Aetna of IA Medicare |
$0.87
|
| Rate for Payer: Amerigroup Medicaid |
$0.88
|
| Rate for Payer: Amerigroup Medicare |
$0.70
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.15
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.69
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.88
|
| Rate for Payer: Medical Associates Commercial |
$1.15
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.69
|
| Rate for Payer: Midlands Choice Commercial |
$1.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.38
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.90
|
|
|
isosorbide mononitrate 20 mg Tab [VDMC]
|
Facility
|
IP
|
$1.53
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10397848
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna of IA Commercial |
$1.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.38
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.15
|
| Rate for Payer: Medical Associates Commercial |
$1.15
|
| Rate for Payer: Midlands Choice Commercial |
$1.07
|
| Rate for Payer: United Healthcare Commercial |
$1.38
|
|
|
isosorbide mononitrate 30 mg ER Tab [VDMC]
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10397917
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna of IA Commercial |
$1.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.73
|
| Rate for Payer: Aetna of IA Medicare |
$1.10
|
| Rate for Payer: Amerigroup Medicaid |
$1.11
|
| Rate for Payer: Amerigroup Medicare |
$0.87
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.87
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.10
|
| Rate for Payer: Medical Associates Commercial |
$1.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.87
|
| Rate for Payer: Midlands Choice Commercial |
$1.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$1.73
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.14
|
|
|
isosorbide mononitrate 30 mg ER Tab [VDMC]
|
Facility
|
IP
|
$1.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10397917
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna of IA Commercial |
$1.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.73
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.44
|
| Rate for Payer: Medical Associates Commercial |
$1.44
|
| Rate for Payer: Midlands Choice Commercial |
$1.35
|
| Rate for Payer: United Healthcare Commercial |
$1.73
|
|
|
ITM
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
7984738
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$238.95 |
| Max. Negotiated Rate |
$477.90 |
| Rate for Payer: Aetna of IA Commercial |
$477.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$477.90
|
| Rate for Payer: Aetna of IA Medicare |
$302.67
|
| Rate for Payer: Amerigroup Medicaid |
$306.28
|
| Rate for Payer: Amerigroup Medicare |
$241.34
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$398.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$238.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$303.31
|
| Rate for Payer: Medical Associates Commercial |
$398.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$238.95
|
| Rate for Payer: Midlands Choice Commercial |
$371.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$307.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$274.79
|
| Rate for Payer: United Healthcare Commercial |
$477.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$313.29
|
|
|
ITM
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
7984738
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$371.70 |
| Max. Negotiated Rate |
$477.90 |
| Rate for Payer: Aetna of IA Commercial |
$477.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$477.90
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$398.25
|
| Rate for Payer: Medical Associates Commercial |
$398.25
|
| Rate for Payer: Midlands Choice Commercial |
$371.70
|
| Rate for Payer: United Healthcare Commercial |
$477.90
|
|
|
itraconazole 100 mg Cap [VDMC]
|
Facility
|
OP
|
$5.34
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10398128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna of IA Commercial |
$4.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.80
|
| Rate for Payer: Aetna of IA Medicare |
$3.04
|
| Rate for Payer: Amerigroup Medicaid |
$3.08
|
| Rate for Payer: Amerigroup Medicare |
$2.43
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.05
|
| Rate for Payer: Medical Associates Commercial |
$4.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.40
|
| Rate for Payer: Midlands Choice Commercial |
$3.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.76
|
| Rate for Payer: United Healthcare Commercial |
$4.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.15
|
|
|
itraconazole 100 mg Cap [VDMC]
|
Facility
|
IP
|
$5.34
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10398128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna of IA Commercial |
$4.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.80
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.00
|
| Rate for Payer: Medical Associates Commercial |
$4.00
|
| Rate for Payer: Midlands Choice Commercial |
$3.74
|
| Rate for Payer: United Healthcare Commercial |
$4.80
|
|
|
IUD REMOVAL CHARGE
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
8068939
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$153.92 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$236.25
|
| Rate for Payer: United Healthcare Commercial |
$153.92
|
|
|
IV CONSCIOUS SEDATION CHARGE
|
Professional
|
Both
|
$258.00
|
|
| Hospital Charge Code |
8084811
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$180.60 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Medical Associates Commercial |
$193.50
|
| Rate for Payer: Midlands Choice Commercial |
$180.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$193.50
|
|
|
IVP MED ADMIN EA ADDL SEQUENTL
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
7984747
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Aetna of IA Medicare |
$36.48
|
| Rate for Payer: Amerigroup Medicaid |
$36.92
|
| Rate for Payer: Amerigroup Medicare |
$29.09
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.56
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.80
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.12
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
|
|
IVP MED ADMIN EA ADDL SEQUENTL
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
7984747
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
|
|
IVP MEDICATION ADMIN
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
7984746
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of IA Commercial |
$97.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.20
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.00
|
| Rate for Payer: Medical Associates Commercial |
$81.00
|
| Rate for Payer: Midlands Choice Commercial |
$75.60
|
| Rate for Payer: United Healthcare Commercial |
$97.20
|
|
|
IVP MEDICATION ADMIN
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
7984746
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of IA Commercial |
$97.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.20
|
| Rate for Payer: Aetna of IA Medicare |
$61.56
|
| Rate for Payer: Amerigroup Medicaid |
$62.29
|
| Rate for Payer: Amerigroup Medicare |
$49.09
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$48.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.69
|
| Rate for Payer: Medical Associates Commercial |
$81.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$48.60
|
| Rate for Payer: Midlands Choice Commercial |
$75.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.89
|
| Rate for Payer: United Healthcare Commercial |
$97.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.72
|
|
|
JAK2 V617F Mutation Detection DMCL
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
8505649
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$281.25 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna of IA Commercial |
$562.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$562.50
|
| Rate for Payer: Aetna of IA Medicare |
$356.25
|
| Rate for Payer: Amerigroup Medicaid |
$360.50
|
| Rate for Payer: Amerigroup Medicare |
$284.06
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$468.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$281.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$357.00
|
| Rate for Payer: Medical Associates Commercial |
$468.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$281.25
|
| Rate for Payer: Midlands Choice Commercial |
$437.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$362.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$323.44
|
| Rate for Payer: United Healthcare Commercial |
$562.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$368.75
|
|
|
JAK2 V617F Mutation Detection DMCL
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
8505649
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna of IA Commercial |
$562.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$562.50
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$468.75
|
| Rate for Payer: Medical Associates Commercial |
$468.75
|
| Rate for Payer: Midlands Choice Commercial |
$437.50
|
| Rate for Payer: United Healthcare Commercial |
$562.50
|
|
