|
oxcarbazepine 600mg Tab [VDMC]
|
Facility
|
OP
|
$2.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10609857
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna of IA Commercial |
$1.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.87
|
| Rate for Payer: Aetna of IA Medicare |
$1.19
|
| Rate for Payer: Amerigroup Medicaid |
$1.20
|
| Rate for Payer: Amerigroup Medicare |
$0.95
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.56
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.19
|
| Rate for Payer: Medical Associates Commercial |
$1.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.94
|
| Rate for Payer: Midlands Choice Commercial |
$1.46
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.87
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.23
|
|
|
Oxcarbazepine Trileptal DMCL
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
8037746
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.95 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Aetna of IA Commercial |
$117.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.90
|
| Rate for Payer: Aetna of IA Medicare |
$74.67
|
| Rate for Payer: Amerigroup Medicaid |
$75.56
|
| Rate for Payer: Amerigroup Medicare |
$59.54
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$98.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$58.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.83
|
| Rate for Payer: Medical Associates Commercial |
$98.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.95
|
| Rate for Payer: Midlands Choice Commercial |
$91.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$67.79
|
| Rate for Payer: United Healthcare Commercial |
$117.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$77.29
|
| Rate for Payer: Wellmark IA HMO WHPI |
$65.23
|
| Rate for Payer: Wellmark IA PPO |
$71.85
|
|
|
Oxcarbazepine Trileptal DMCL
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
8037746
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Aetna of IA Commercial |
$117.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.90
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$98.25
|
| Rate for Payer: Medical Associates Commercial |
$98.25
|
| Rate for Payer: Midlands Choice Commercial |
$91.70
|
| Rate for Payer: United Healthcare Commercial |
$117.90
|
|
|
OXIMETRY, PULSE CONTINUOUS OVERNIGHT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
6658828
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Aetna of IA Medicare |
$148.20
|
| Rate for Payer: Amerigroup Medicaid |
$149.97
|
| Rate for Payer: Amerigroup Medicare |
$118.17
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$117.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$148.51
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$117.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$150.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$134.55
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.40
|
| Rate for Payer: Wellmark IA HMO WHPI |
$185.05
|
| Rate for Payer: Wellmark IA PPO |
$203.84
|
|
|
OXIMETRY, PULSE CONTINUOUS OVERNIGHT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
6658828
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
|
|
oxybutynin 5 mg Tab[VDMC]
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11619058
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna of IA Commercial |
$1.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.94
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.62
|
| Rate for Payer: Medical Associates Commercial |
$1.62
|
| Rate for Payer: Midlands Choice Commercial |
$1.51
|
| Rate for Payer: United Healthcare Commercial |
$1.94
|
|
|
oxybutynin 5 mg Tab[VDMC]
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11619058
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna of IA Commercial |
$1.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.94
|
| Rate for Payer: Aetna of IA Medicare |
$1.23
|
| Rate for Payer: Amerigroup Medicaid |
$1.25
|
| Rate for Payer: Amerigroup Medicare |
$0.98
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.62
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.97
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.23
|
| Rate for Payer: Medical Associates Commercial |
$1.62
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.97
|
| Rate for Payer: Midlands Choice Commercial |
$1.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.12
|
| Rate for Payer: United Healthcare Commercial |
$1.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.27
|
|
|
oxybutynin ER 5 mg/24 hours Tab [VDMC]
|
Facility
|
OP
|
$1.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
17655078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Aetna of IA Commercial |
$1.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.15
|
| Rate for Payer: Aetna of IA Medicare |
$0.73
|
| Rate for Payer: Amerigroup Medicaid |
$0.74
|
| Rate for Payer: Amerigroup Medicare |
$0.58
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.96
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.73
|
| Rate for Payer: Medical Associates Commercial |
$0.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.57
|
| Rate for Payer: Midlands Choice Commercial |
$0.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.66
|
| Rate for Payer: United Healthcare Commercial |
$1.15
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.75
|
|
|
oxybutynin ER 5 mg/24 hours Tab [VDMC]
|
Facility
|
IP
|
$1.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
17655078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Aetna of IA Commercial |
$1.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.15
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.96
|
| Rate for Payer: Medical Associates Commercial |
$0.96
|
| Rate for Payer: Midlands Choice Commercial |
$0.89
|
| Rate for Payer: United Healthcare Commercial |
$1.15
|
|
|
oxyCODONE 10 mg ER Tab [VDMC]
|
Facility
|
IP
|
$19.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10410964
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$17.93 |
| Rate for Payer: Aetna of IA Commercial |
$17.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.93
|
| Rate for Payer: Cash Price |
$15.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.94
|
| Rate for Payer: Medical Associates Commercial |
$14.94
|
| Rate for Payer: Midlands Choice Commercial |
$13.94
|
| Rate for Payer: United Healthcare Commercial |
$17.93
|
|
|
oxyCODONE 10 mg ER Tab [VDMC]
|
Facility
|
OP
|
$19.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10410964
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$17.93 |
| Rate for Payer: Aetna of IA Commercial |
$17.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.93
|
| Rate for Payer: Aetna of IA Medicare |
$11.35
|
| Rate for Payer: Amerigroup Medicaid |
$11.49
|
| Rate for Payer: Amerigroup Medicare |
$9.05
|
| Rate for Payer: Cash Price |
$15.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.94
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.38
|
| Rate for Payer: Medical Associates Commercial |
$14.94
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.96
|
| Rate for Payer: Midlands Choice Commercial |
$13.94
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$10.31
|
| Rate for Payer: United Healthcare Commercial |
$17.93
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.75
|
|
|
oxyCODONE 20 mg Tab [VDMC]
|
Facility
|
OP
|
$3.57
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23862626
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna of IA Commercial |
$3.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.21
|
| Rate for Payer: Aetna of IA Medicare |
$2.04
|
| Rate for Payer: Amerigroup Medicaid |
$2.06
|
| Rate for Payer: Amerigroup Medicare |
$1.62
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.68
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.61
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.04
|
| Rate for Payer: Medical Associates Commercial |
$2.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.61
|
| Rate for Payer: Midlands Choice Commercial |
$2.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.85
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.11
|
|
|
oxyCODONE 20 mg Tab [VDMC]
|
Facility
|
IP
|
$3.57
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23862626
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna of IA Commercial |
$3.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.21
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.68
|
| Rate for Payer: Medical Associates Commercial |
$2.68
|
| Rate for Payer: Midlands Choice Commercial |
$2.50
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
|
|
oxyCODONE 5 mg Tab [VDMC]
|
Facility
|
OP
|
$3.96
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10411246
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna of IA Commercial |
$3.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.56
|
| Rate for Payer: Aetna of IA Medicare |
$2.26
|
| Rate for Payer: Amerigroup Medicaid |
$2.28
|
| Rate for Payer: Amerigroup Medicare |
$1.80
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.26
|
| Rate for Payer: Medical Associates Commercial |
$2.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.78
|
| Rate for Payer: Midlands Choice Commercial |
$2.77
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.05
|
| Rate for Payer: United Healthcare Commercial |
$3.56
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.33
|
|
|
oxyCODONE 5 mg Tab [VDMC]
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10411246
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna of IA Commercial |
$3.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.56
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.97
|
| Rate for Payer: Medical Associates Commercial |
$2.97
|
| Rate for Payer: Midlands Choice Commercial |
$2.77
|
| Rate for Payer: United Healthcare Commercial |
$3.56
|
|
|
OXYGEN/DAY
|
Facility
|
IP
|
$130.00
|
|
| Hospital Charge Code |
7760561
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of IA Commercial |
$117.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$97.50
|
| Rate for Payer: Medical Associates Commercial |
$97.50
|
| Rate for Payer: Midlands Choice Commercial |
$91.00
|
| Rate for Payer: United Healthcare Commercial |
$117.00
|
|
|
OXYGEN/DAY
|
Facility
|
OP
|
$130.00
|
|
| Hospital Charge Code |
7760561
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of IA Commercial |
$117.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.00
|
| Rate for Payer: Aetna of IA Medicare |
$74.10
|
| Rate for Payer: Amerigroup Medicaid |
$74.98
|
| Rate for Payer: Amerigroup Medicare |
$59.08
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$97.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$58.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.26
|
| Rate for Payer: Medical Associates Commercial |
$97.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.50
|
| Rate for Payer: Midlands Choice Commercial |
$91.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$67.28
|
| Rate for Payer: United Healthcare Commercial |
$117.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.70
|
|
|
oxymetazoline Nasal 0.05% Spry [VDMC]
|
Facility
|
IP
|
$24.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10436644
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$21.82 |
| Rate for Payer: Aetna of IA Commercial |
$21.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.82
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.18
|
| Rate for Payer: Medical Associates Commercial |
$18.18
|
| Rate for Payer: Midlands Choice Commercial |
$16.97
|
| Rate for Payer: United Healthcare Commercial |
$21.82
|
|
|
oxymetazoline Nasal 0.05% Spry [VDMC]
|
Facility
|
OP
|
$24.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10436644
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$21.82 |
| Rate for Payer: Aetna of IA Commercial |
$21.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.82
|
| Rate for Payer: Aetna of IA Medicare |
$13.82
|
| Rate for Payer: Amerigroup Medicaid |
$13.98
|
| Rate for Payer: Amerigroup Medicare |
$11.02
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.18
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.85
|
| Rate for Payer: Medical Associates Commercial |
$18.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.91
|
| Rate for Payer: Midlands Choice Commercial |
$16.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.54
|
| Rate for Payer: United Healthcare Commercial |
$21.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.30
|
|
|
oxytocin 10 units/mL 1 ml Sol [VDMC]
|
Facility
|
OP
|
$25.42
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
10431955
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$22.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.88
|
| Rate for Payer: Aetna of IA Medicare |
$14.49
|
| Rate for Payer: Amerigroup Medicaid |
$14.66
|
| Rate for Payer: Amerigroup Medicare |
$11.55
|
| Rate for Payer: Cash Price |
$20.33
|
| Rate for Payer: Cash Price |
$20.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.06
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.52
|
| Rate for Payer: Medical Associates Commercial |
$19.06
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.44
|
| Rate for Payer: Midlands Choice Commercial |
$17.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$13.15
|
| Rate for Payer: United Healthcare Commercial |
$22.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.00
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
oxytocin 10 units/mL 1 ml Sol [VDMC]
|
Facility
|
IP
|
$25.42
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
10431955
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.79 |
| Max. Negotiated Rate |
$22.88 |
| Rate for Payer: Aetna of IA Commercial |
$22.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.88
|
| Rate for Payer: Cash Price |
$20.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.06
|
| Rate for Payer: Medical Associates Commercial |
$19.06
|
| Rate for Payer: Midlands Choice Commercial |
$17.79
|
| Rate for Payer: United Healthcare Commercial |
$22.88
|
|
|
Pain Clinic Survey Urine DMCL
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
8539276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.55 |
| Max. Negotiated Rate |
$129.65 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$80.18
|
| Rate for Payer: Amerigroup Medicare |
$63.18
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$62.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.40
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.55
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.93
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO WHPI |
$117.69
|
| Rate for Payer: Wellmark IA PPO |
$129.65
|
|
|
Pain Clinic Survey Urine DMCL
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 80364
|
| Hospital Charge Code |
8539461
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of IA Commercial |
$84.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$84.60
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$70.50
|
| Rate for Payer: Medical Associates Commercial |
$70.50
|
| Rate for Payer: Midlands Choice Commercial |
$65.80
|
| Rate for Payer: United Healthcare Commercial |
$84.60
|
|
|
Pain Clinic Survey Urine DMCL
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
8539276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
Pain Clinic Survey Urine DMCL
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 80364
|
| Hospital Charge Code |
8539461
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of IA Commercial |
$84.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$84.60
|
| Rate for Payer: Aetna of IA Medicare |
$53.58
|
| Rate for Payer: Amerigroup Medicaid |
$54.22
|
| Rate for Payer: Amerigroup Medicare |
$42.72
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$70.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$53.69
|
| Rate for Payer: Medical Associates Commercial |
$70.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.30
|
| Rate for Payer: Midlands Choice Commercial |
$65.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$54.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.64
|
| Rate for Payer: United Healthcare Commercial |
$84.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$55.46
|
| Rate for Payer: Wellmark IA HMO WHPI |
$43.25
|
| Rate for Payer: Wellmark IA PPO |
$47.64
|
|
