|
rivaroxaban 10 mg Tab UD [VDMC]
|
Facility
|
OP
|
$50.91
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419491
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$45.82 |
| Rate for Payer: Aetna of IA Commercial |
$45.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.82
|
| Rate for Payer: Aetna of IA Medicare |
$29.02
|
| Rate for Payer: Amerigroup Medicaid |
$29.36
|
| Rate for Payer: Amerigroup Medicare |
$23.14
|
| Rate for Payer: Cash Price |
$40.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.18
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.08
|
| Rate for Payer: Medical Associates Commercial |
$38.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.91
|
| Rate for Payer: Midlands Choice Commercial |
$35.63
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.34
|
| Rate for Payer: United Healthcare Commercial |
$45.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.03
|
|
|
rivaroxaban 10 mg Tab UD [VDMC]
|
Facility
|
IP
|
$50.91
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419491
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.63 |
| Max. Negotiated Rate |
$45.82 |
| Rate for Payer: Aetna of IA Commercial |
$45.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.82
|
| Rate for Payer: Cash Price |
$40.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.18
|
| Rate for Payer: Medical Associates Commercial |
$38.18
|
| Rate for Payer: Midlands Choice Commercial |
$35.63
|
| Rate for Payer: United Healthcare Commercial |
$45.82
|
|
|
rivaroxaban 15 mg Tab [VDMC]
|
Facility
|
IP
|
$53.39
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419562
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.37 |
| Max. Negotiated Rate |
$48.05 |
| Rate for Payer: Aetna of IA Commercial |
$48.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$48.05
|
| Rate for Payer: Cash Price |
$42.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$40.04
|
| Rate for Payer: Medical Associates Commercial |
$40.04
|
| Rate for Payer: Midlands Choice Commercial |
$37.37
|
| Rate for Payer: United Healthcare Commercial |
$48.05
|
|
|
rivaroxaban 15 mg Tab [VDMC]
|
Facility
|
OP
|
$53.39
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419562
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.03 |
| Max. Negotiated Rate |
$48.05 |
| Rate for Payer: Aetna of IA Commercial |
$48.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$48.05
|
| Rate for Payer: Aetna of IA Medicare |
$30.43
|
| Rate for Payer: Amerigroup Medicaid |
$30.80
|
| Rate for Payer: Amerigroup Medicare |
$24.27
|
| Rate for Payer: Cash Price |
$42.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$40.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$24.03
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.50
|
| Rate for Payer: Medical Associates Commercial |
$40.04
|
| Rate for Payer: Medical Associates Managed Medicare |
$24.03
|
| Rate for Payer: Midlands Choice Commercial |
$37.37
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.63
|
| Rate for Payer: United Healthcare Commercial |
$48.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$31.50
|
|
|
rivastiGMine 1.5 mg Cap [VDMC]
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419631
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna of IA Commercial |
$2.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.45
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.05
|
| Rate for Payer: Medical Associates Commercial |
$2.05
|
| Rate for Payer: Midlands Choice Commercial |
$1.91
|
| Rate for Payer: United Healthcare Commercial |
$2.45
|
|
|
rivastiGMine 1.5 mg Cap [VDMC]
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419631
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna of IA Commercial |
$2.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.45
|
| Rate for Payer: Aetna of IA Medicare |
$1.55
|
| Rate for Payer: Amerigroup Medicaid |
$1.57
|
| Rate for Payer: Amerigroup Medicare |
$1.24
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.05
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.23
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.56
|
| Rate for Payer: Medical Associates Commercial |
$2.05
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.23
|
| Rate for Payer: Midlands Choice Commercial |
$1.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.41
|
| Rate for Payer: United Healthcare Commercial |
$2.45
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.61
|
|
|
rivastiGMine 4.6 mg/24 hr TD film, ER [VDMC]
|
Facility
|
IP
|
$14.13
|
|
|
Service Code
|
NDC 00378-9070-93
|
| Hospital Charge Code |
10430381
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Aetna of IA Commercial |
$12.72
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.72
|
| Rate for Payer: Cash Price |
$11.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.60
|
| Rate for Payer: Medical Associates Commercial |
$10.60
|
| Rate for Payer: Midlands Choice Commercial |
$9.89
|
| Rate for Payer: United Healthcare Commercial |
$12.72
|
|
|
rivastiGMine 4.6 mg/24 hr TD film, ER [VDMC]
|
Facility
|
OP
|
$14.13
|
|
|
Service Code
|
NDC 00378-9070-93
|
| Hospital Charge Code |
10430381
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Aetna of IA Commercial |
$12.72
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.72
|
| Rate for Payer: Aetna of IA Medicare |
$8.06
|
| Rate for Payer: Amerigroup Medicaid |
$8.15
|
| Rate for Payer: Amerigroup Medicare |
$6.42
|
| Rate for Payer: Cash Price |
$11.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.07
|
| Rate for Payer: Medical Associates Commercial |
$10.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.36
|
| Rate for Payer: Midlands Choice Commercial |
$9.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.31
|
| Rate for Payer: United Healthcare Commercial |
$12.72
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.34
|
|
|
RMVL DEVITAL TIS 20 CM/<
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
7855097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.75
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
|
|
RMVL DEVITAL TIS 20 CM/<
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
7855097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$657.60 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Aetna of IA Medicare |
$103.17
|
| Rate for Payer: Amerigroup Medicaid |
$104.40
|
| Rate for Payer: Amerigroup Medicare |
$82.26
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$103.39
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.45
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.67
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.79
|
| Rate for Payer: Wellmark IA HMO WHPI |
$596.98
|
| Rate for Payer: Wellmark IA PPO |
$657.60
|
|
|
RMVL DEVITAL TIS ADDL 20CM/<
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
7855098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of IA Commercial |
$108.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$108.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$90.00
|
| Rate for Payer: Medical Associates Commercial |
$90.00
|
| Rate for Payer: Midlands Choice Commercial |
$84.00
|
| Rate for Payer: United Healthcare Commercial |
$108.00
|
|
|
RMVL DEVITAL TIS ADDL 20CM/<
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
7855098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$4,090.88 |
| Rate for Payer: Aetna of IA Commercial |
$108.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$108.00
|
| Rate for Payer: Aetna of IA Medicare |
$68.40
|
| Rate for Payer: Amerigroup Medicaid |
$69.22
|
| Rate for Payer: Amerigroup Medicare |
$54.54
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$90.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$54.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$68.54
|
| Rate for Payer: Medical Associates Commercial |
$90.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$54.00
|
| Rate for Payer: Midlands Choice Commercial |
$84.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$69.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$62.10
|
| Rate for Payer: United Healthcare Commercial |
$108.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$70.80
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,713.74
|
| Rate for Payer: Wellmark IA PPO |
$4,090.88
|
|
|
rocuronium 10 mg/mL 5 ml MDV IV [VDMC]
|
Facility
|
IP
|
$26.44
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10419700
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.51 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Aetna of IA Commercial |
$23.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.80
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.83
|
| Rate for Payer: Medical Associates Commercial |
$19.83
|
| Rate for Payer: Midlands Choice Commercial |
$18.51
|
| Rate for Payer: United Healthcare Commercial |
$23.80
|
|
|
rocuronium 10 mg/mL 5 ml MDV IV [VDMC]
|
Facility
|
OP
|
$26.44
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10419700
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Aetna of IA Commercial |
$23.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.80
|
| Rate for Payer: Aetna of IA Medicare |
$15.07
|
| Rate for Payer: Amerigroup Medicaid |
$15.25
|
| Rate for Payer: Amerigroup Medicare |
$12.02
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.83
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.10
|
| Rate for Payer: Medical Associates Commercial |
$19.83
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.90
|
| Rate for Payer: Midlands Choice Commercial |
$18.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$13.68
|
| Rate for Payer: United Healthcare Commercial |
$23.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.60
|
|
|
romiPLOStim 125 mcg SQ Pow Inj [VDMC]
|
Facility
|
IP
|
$2,853.06
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
28899105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,997.14 |
| Max. Negotiated Rate |
$2,567.75 |
| Rate for Payer: Aetna of IA Commercial |
$2,567.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,567.75
|
| Rate for Payer: Cash Price |
$2,282.45
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,139.80
|
| Rate for Payer: Medical Associates Commercial |
$2,139.80
|
| Rate for Payer: Midlands Choice Commercial |
$1,997.14
|
| Rate for Payer: United Healthcare Commercial |
$2,567.75
|
|
|
romiPLOStim 125 mcg SQ Pow Inj [VDMC]
|
Facility
|
OP
|
$2,853.06
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
28899105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,283.88 |
| Max. Negotiated Rate |
$2,567.75 |
| Rate for Payer: Aetna of IA Commercial |
$2,567.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,567.75
|
| Rate for Payer: Aetna of IA Medicare |
$1,626.24
|
| Rate for Payer: Amerigroup Medicaid |
$1,645.65
|
| Rate for Payer: Amerigroup Medicare |
$1,296.72
|
| Rate for Payer: Cash Price |
$2,282.45
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,139.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,283.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,629.67
|
| Rate for Payer: Medical Associates Commercial |
$2,139.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,283.88
|
| Rate for Payer: Midlands Choice Commercial |
$1,997.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,653.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,476.46
|
| Rate for Payer: United Healthcare Commercial |
$2,567.75
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,683.31
|
|
|
romosozumab-aqqg 210mg/2.34 mL Sol[VDMC]
|
Facility
|
IP
|
$5,357.84
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
28403926
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3,750.49 |
| Max. Negotiated Rate |
$4,822.06 |
| Rate for Payer: Aetna of IA Commercial |
$4,822.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,822.06
|
| Rate for Payer: Cash Price |
$4,286.27
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,018.38
|
| Rate for Payer: Medical Associates Commercial |
$4,018.38
|
| Rate for Payer: Midlands Choice Commercial |
$3,750.49
|
| Rate for Payer: United Healthcare Commercial |
$4,822.06
|
|
|
romosozumab-aqqg 210mg/2.34 mL Sol[VDMC]
|
Facility
|
OP
|
$5,357.84
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
28403926
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2,411.03 |
| Max. Negotiated Rate |
$4,822.06 |
| Rate for Payer: Aetna of IA Commercial |
$4,822.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,822.06
|
| Rate for Payer: Aetna of IA Medicare |
$3,053.97
|
| Rate for Payer: Amerigroup Medicaid |
$3,090.40
|
| Rate for Payer: Amerigroup Medicare |
$2,435.14
|
| Rate for Payer: Cash Price |
$4,286.27
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,018.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,411.03
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,060.40
|
| Rate for Payer: Medical Associates Commercial |
$4,018.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,411.03
|
| Rate for Payer: Midlands Choice Commercial |
$3,750.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,105.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,772.68
|
| Rate for Payer: United Healthcare Commercial |
$4,822.06
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,161.13
|
|
|
ROOM/BED: Observation: Per Hour
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
2120846
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$2,049.34 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,860.42
|
| Rate for Payer: Wellmark IA PPO |
$2,049.34
|
|
|
ROOM/BED: Observation: Per Hour
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
2120846
|
|
Hospital Revenue Code
|
762
|
| 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
|
|
|
ROOM/BED: Respite
|
Facility
|
IP
|
$400.00
|
|
| Hospital Charge Code |
8002762
|
|
Hospital Revenue Code
|
115
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$2,580.60 |
| Rate for Payer: Aetna of IA Commercial |
$360.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$360.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,258.00
|
| Rate for Payer: Amerigroup Medicare |
$2,266.44
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$300.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,244.00
|
| Rate for Payer: Medical Associates Commercial |
$300.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,244.00
|
| Rate for Payer: Midlands Choice Commercial |
$280.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,580.60
|
| Rate for Payer: United Healthcare Commercial |
$360.00
|
|
|
ROOM/BED: SCU Observation: Per Hour
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
8059713
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of IA Commercial |
$81.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$67.50
|
| Rate for Payer: Medical Associates Commercial |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$63.00
|
| Rate for Payer: United Healthcare Commercial |
$81.00
|
|
|
ROOM/BED: SCU Observation: Per Hour
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
8059713
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$2,049.34 |
| Rate for Payer: Aetna of IA Commercial |
$81.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.00
|
| Rate for Payer: Aetna of IA Medicare |
$51.30
|
| Rate for Payer: Amerigroup Medicaid |
$51.91
|
| Rate for Payer: Amerigroup Medicare |
$40.90
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$67.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$40.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.41
|
| Rate for Payer: Medical Associates Commercial |
$67.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.50
|
| Rate for Payer: Midlands Choice Commercial |
$63.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$46.58
|
| Rate for Payer: United Healthcare Commercial |
$81.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$53.10
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,860.42
|
| Rate for Payer: Wellmark IA PPO |
$2,049.34
|
|
|
rOPINIRole 0.5 mg Tab [VDMC]
|
Facility
|
OP
|
$2.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10608306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna of IA Commercial |
$1.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.95
|
| 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 |
$1.24
|
| Rate for Payer: Medical Associates Commercial |
$1.62
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.97
|
| Rate for Payer: Midlands Choice Commercial |
$1.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.12
|
| Rate for Payer: United Healthcare Commercial |
$1.95
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.28
|
|
|
rOPINIRole 0.5 mg Tab [VDMC]
|
Facility
|
IP
|
$2.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10608306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna of IA Commercial |
$1.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.95
|
| 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 |
$1.52
|
| Rate for Payer: United Healthcare Commercial |
$1.95
|
|
