|
NON-STRES TEST (COB)
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
4096783
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$207.45 |
| Max. Negotiated Rate |
$494.37 |
| Rate for Payer: Aetna of IA Commercial |
$414.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$414.90
|
| Rate for Payer: Aetna of IA Medicare |
$262.77
|
| Rate for Payer: Amerigroup Medicaid |
$265.90
|
| Rate for Payer: Amerigroup Medicare |
$209.52
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$345.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$207.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$263.32
|
| Rate for Payer: Medical Associates Commercial |
$345.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$207.45
|
| Rate for Payer: Midlands Choice Commercial |
$322.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$267.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$238.57
|
| Rate for Payer: United Healthcare Commercial |
$414.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$271.99
|
| Rate for Payer: Wellmark IA HMO WHPI |
$448.80
|
| Rate for Payer: Wellmark IA PPO |
$494.37
|
|
|
NON-STRES TEST (COB)
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
4096783
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$322.70 |
| Max. Negotiated Rate |
$414.90 |
| Rate for Payer: Aetna of IA Commercial |
$414.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$414.90
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$345.75
|
| Rate for Payer: Medical Associates Commercial |
$345.75
|
| Rate for Payer: Midlands Choice Commercial |
$322.70
|
| Rate for Payer: United Healthcare Commercial |
$414.90
|
|
|
NONTRAUMATIC STUPOR AND COMA WITH MCC
|
Facility
|
IP
|
$23,561.07
|
|
|
Service Code
|
MSDRG 080
|
| Min. Negotiated Rate |
$23,219.59 |
| Max. Negotiated Rate |
$23,561.07 |
| Rate for Payer: Amerigroup Medicaid |
$23,447.24
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23,219.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23,561.07
|
|
|
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC
|
Facility
|
IP
|
$6,170.35
|
|
|
Service Code
|
MSDRG 081
|
| Min. Negotiated Rate |
$6,080.93 |
| Max. Negotiated Rate |
$6,170.35 |
| Rate for Payer: Amerigroup Medicaid |
$6,140.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,080.93
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,170.35
|
|
|
norEPINEPHrine 1 mg/mL 4 ml SDV IV Sol [VDMC]
|
Facility
|
IP
|
$32.14
|
|
|
Service Code
|
NDC 43066-0997-10
|
| Hospital Charge Code |
10409340
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$28.93 |
| Rate for Payer: Aetna of IA Commercial |
$28.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.93
|
| Rate for Payer: Cash Price |
$25.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.11
|
| Rate for Payer: Medical Associates Commercial |
$24.11
|
| Rate for Payer: Midlands Choice Commercial |
$22.50
|
| Rate for Payer: United Healthcare Commercial |
$28.93
|
|
|
norEPINEPHrine 1 mg/mL 4 ml SDV IV Sol [VDMC]
|
Facility
|
OP
|
$32.14
|
|
|
Service Code
|
NDC 43066-0997-10
|
| Hospital Charge Code |
10409340
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$28.93 |
| Rate for Payer: Aetna of IA Commercial |
$28.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.93
|
| Rate for Payer: Aetna of IA Medicare |
$18.32
|
| Rate for Payer: Amerigroup Medicaid |
$18.54
|
| Rate for Payer: Amerigroup Medicare |
$14.61
|
| Rate for Payer: Cash Price |
$25.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.11
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.36
|
| Rate for Payer: Medical Associates Commercial |
$24.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.46
|
| Rate for Payer: Midlands Choice Commercial |
$22.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.63
|
| Rate for Payer: United Healthcare Commercial |
$28.93
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.96
|
|
|
NOREPINEPHRINE 4 MG/250 ML-D5W [VDMC]
|
Facility
|
IP
|
$123.58
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
23229588
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$86.51 |
| Max. Negotiated Rate |
$111.22 |
| Rate for Payer: Aetna of IA Commercial |
$111.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$111.22
|
| Rate for Payer: Cash Price |
$98.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.68
|
| Rate for Payer: Medical Associates Commercial |
$92.68
|
| Rate for Payer: Midlands Choice Commercial |
$86.51
|
| Rate for Payer: United Healthcare Commercial |
$111.22
|
|
|
NOREPINEPHRINE 4 MG/250 ML-D5W [VDMC]
|
Facility
|
OP
|
$123.58
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
23229588
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$55.61 |
| Max. Negotiated Rate |
$111.22 |
| Rate for Payer: Aetna of IA Commercial |
$111.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$111.22
|
| Rate for Payer: Aetna of IA Medicare |
$70.44
|
| Rate for Payer: Amerigroup Medicaid |
$71.28
|
| Rate for Payer: Amerigroup Medicare |
$56.17
|
| Rate for Payer: Cash Price |
$98.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.68
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.61
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$70.59
|
| Rate for Payer: Medical Associates Commercial |
$92.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.61
|
| Rate for Payer: Midlands Choice Commercial |
$86.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$63.95
|
| Rate for Payer: United Healthcare Commercial |
$111.22
|
| Rate for Payer: United Healthcare Managed Medicare |
$72.91
|
|
|
NORMAL NEWBORN
|
Facility
|
IP
|
$3,254.07
|
|
|
Service Code
|
MSDRG 795
|
| Min. Negotiated Rate |
$3,206.91 |
| Max. Negotiated Rate |
$3,254.07 |
| Rate for Payer: Amerigroup Medicaid |
$3,238.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,206.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,254.07
|
|
|
nortriptyline 10 mg Cap [VDMC]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10409407
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna of IA Commercial |
$1.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.26
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.05
|
| Rate for Payer: Medical Associates Commercial |
$1.05
|
| Rate for Payer: Midlands Choice Commercial |
$0.98
|
| Rate for Payer: United Healthcare Commercial |
$1.26
|
|
|
nortriptyline 10 mg Cap [VDMC]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10409407
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna of IA Commercial |
$1.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.26
|
| Rate for Payer: Aetna of IA Medicare |
$0.80
|
| Rate for Payer: Amerigroup Medicaid |
$0.81
|
| Rate for Payer: Amerigroup Medicare |
$0.64
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.05
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.63
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.80
|
| Rate for Payer: Medical Associates Commercial |
$1.05
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.63
|
| Rate for Payer: Midlands Choice Commercial |
$0.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.73
|
| Rate for Payer: United Healthcare Commercial |
$1.26
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.83
|
|
|
nortriptyline 25 mg Cap [VDMC]
|
Facility
|
IP
|
$1.25
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10409478
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna of IA Commercial |
$1.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.12
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.94
|
| Rate for Payer: Medical Associates Commercial |
$0.94
|
| Rate for Payer: Midlands Choice Commercial |
$0.87
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
|
|
nortriptyline 25 mg Cap [VDMC]
|
Facility
|
OP
|
$1.25
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10409478
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna of IA Commercial |
$1.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.12
|
| Rate for Payer: Aetna of IA Medicare |
$0.71
|
| Rate for Payer: Amerigroup Medicaid |
$0.72
|
| Rate for Payer: Amerigroup Medicare |
$0.57
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.94
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.71
|
| Rate for Payer: Medical Associates Commercial |
$0.94
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.56
|
| Rate for Payer: Midlands Choice Commercial |
$0.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.65
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.74
|
|
|
NOVAFIXPATCH 4x4cm
|
Facility
|
IP
|
$3,960.00
|
|
|
Service Code
|
HCPCS Q4208
|
| Hospital Charge Code |
8822525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.00 |
| Max. Negotiated Rate |
$3,564.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,564.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,564.00
|
| Rate for Payer: Cash Price |
$3,168.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,970.00
|
| Rate for Payer: Medical Associates Commercial |
$2,970.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,772.00
|
| Rate for Payer: United Healthcare Commercial |
$3,564.00
|
|
|
NOVAFIXPATCH 4x4cm
|
Facility
|
OP
|
$3,960.00
|
|
|
Service Code
|
HCPCS Q4208
|
| Hospital Charge Code |
8822525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,782.00 |
| Max. Negotiated Rate |
$3,564.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,564.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,564.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,257.20
|
| Rate for Payer: Amerigroup Medicaid |
$2,284.13
|
| Rate for Payer: Amerigroup Medicare |
$1,799.82
|
| Rate for Payer: Cash Price |
$3,168.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,970.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,782.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,261.95
|
| Rate for Payer: Medical Associates Commercial |
$2,970.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,782.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,772.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,295.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,049.30
|
| Rate for Payer: United Healthcare Commercial |
$3,564.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,336.40
|
|
|
N-Terminal pro Brain Natriuretic Peptide
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
1503769
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.95 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna of IA Commercial |
$207.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.90
|
| Rate for Payer: Aetna of IA Medicare |
$131.67
|
| Rate for Payer: Amerigroup Medicaid |
$133.24
|
| Rate for Payer: Amerigroup Medicare |
$104.99
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$173.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$103.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$131.95
|
| Rate for Payer: Medical Associates Commercial |
$173.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$103.95
|
| Rate for Payer: Midlands Choice Commercial |
$161.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$133.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$119.54
|
| Rate for Payer: United Healthcare Commercial |
$207.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$136.29
|
| Rate for Payer: Wellmark IA HMO WHPI |
$121.95
|
| Rate for Payer: Wellmark IA PPO |
$134.33
|
|
|
N-Terminal pro Brain Natriuretic Peptide
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
1503769
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna of IA Commercial |
$207.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.90
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$173.25
|
| Rate for Payer: Medical Associates Commercial |
$173.25
|
| Rate for Payer: Midlands Choice Commercial |
$161.70
|
| Rate for Payer: United Healthcare Commercial |
$207.90
|
|
|
NURSEMAIDS ELBOW CHILD
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
7982808
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$148.61 |
| Max. Negotiated Rate |
$291.00 |
| Rate for Payer: Amerigroup Medicaid |
$150.07
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$148.61
|
| Rate for Payer: Medical Associates Commercial |
$291.00
|
| Rate for Payer: Midlands Choice Commercial |
$271.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$149.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$291.00
|
| Rate for Payer: United Healthcare Commercial |
$155.57
|
| Rate for Payer: Wellmark IA HMO WHPI |
$198.80
|
| Rate for Payer: Wellmark IA PPO |
$233.80
|
|
|
nystatin 100000 units/mL Sus UD 5 mL [VDMC]
|
Facility
|
IP
|
$7.61
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10431892
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$6.85 |
| Rate for Payer: Aetna of IA Commercial |
$6.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.85
|
| Rate for Payer: Cash Price |
$6.09
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.71
|
| Rate for Payer: Medical Associates Commercial |
$5.71
|
| Rate for Payer: Midlands Choice Commercial |
$5.33
|
| Rate for Payer: United Healthcare Commercial |
$6.85
|
|
|
nystatin 100000 units/mL Sus UD 5 mL [VDMC]
|
Facility
|
OP
|
$7.61
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10431892
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$6.85 |
| Rate for Payer: Aetna of IA Commercial |
$6.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.85
|
| Rate for Payer: Aetna of IA Medicare |
$4.34
|
| Rate for Payer: Amerigroup Medicaid |
$4.39
|
| Rate for Payer: Amerigroup Medicare |
$3.46
|
| Rate for Payer: Cash Price |
$6.09
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.71
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.43
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4.35
|
| Rate for Payer: Medical Associates Commercial |
$5.71
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.43
|
| Rate for Payer: Midlands Choice Commercial |
$5.33
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.94
|
| Rate for Payer: United Healthcare Commercial |
$6.85
|
| Rate for Payer: United Healthcare Managed Medicare |
$4.49
|
|
|
nystatin Top 100,000 units/g Crm 15 gm [VDMC]
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10409549
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of IA Commercial |
$27.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.00
|
| Rate for Payer: Aetna of IA Medicare |
$17.10
|
| Rate for Payer: Amerigroup Medicaid |
$17.30
|
| Rate for Payer: Amerigroup Medicare |
$13.64
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.14
|
| Rate for Payer: Medical Associates Commercial |
$22.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.50
|
| Rate for Payer: Midlands Choice Commercial |
$21.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$15.53
|
| Rate for Payer: United Healthcare Commercial |
$27.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$17.70
|
|
|
nystatin Top 100,000 units/g Crm 15 gm [VDMC]
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10409549
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of IA Commercial |
$27.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.50
|
| Rate for Payer: Medical Associates Commercial |
$22.50
|
| Rate for Payer: Midlands Choice Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$27.00
|
|
|
nystatin Top 100,000 units/g Oint 15 gm [VDMC]
|
Facility
|
IP
|
$19.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10409679
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$17.64 |
| Rate for Payer: Aetna of IA Commercial |
$17.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.64
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.70
|
| Rate for Payer: Medical Associates Commercial |
$14.70
|
| Rate for Payer: Midlands Choice Commercial |
$13.72
|
| Rate for Payer: United Healthcare Commercial |
$17.64
|
|
|
nystatin Top 100,000 units/g Oint 15 gm [VDMC]
|
Facility
|
OP
|
$19.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10409679
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$17.64 |
| Rate for Payer: Aetna of IA Commercial |
$17.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.64
|
| Rate for Payer: Aetna of IA Medicare |
$11.17
|
| Rate for Payer: Amerigroup Medicaid |
$11.31
|
| Rate for Payer: Amerigroup Medicare |
$8.91
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.70
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.20
|
| Rate for Payer: Medical Associates Commercial |
$14.70
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.82
|
| Rate for Payer: Midlands Choice Commercial |
$13.72
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$10.14
|
| Rate for Payer: United Healthcare Commercial |
$17.64
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.56
|
|
|
nystatin Top 100,000 units/g Pwdr 15 gm [VDMC]
|
Facility
|
OP
|
$36.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10409744
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.49 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: Aetna of IA Commercial |
$32.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.98
|
| Rate for Payer: Aetna of IA Medicare |
$20.88
|
| Rate for Payer: Amerigroup Medicaid |
$21.13
|
| Rate for Payer: Amerigroup Medicare |
$16.65
|
| Rate for Payer: Cash Price |
$29.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.48
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.49
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.93
|
| Rate for Payer: Medical Associates Commercial |
$27.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.49
|
| Rate for Payer: Midlands Choice Commercial |
$25.65
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.96
|
| Rate for Payer: United Healthcare Commercial |
$32.98
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.62
|
|
