|
Amino Acids 4.25% with 5% Dextrose and Electrolytes (Clinimix E Sulfite-Free)[VDMC]
|
Facility
|
IP
|
$219.60
|
|
|
Service Code
|
NDC 00338-1113-04
|
| Hospital Charge Code |
18808583
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$153.72 |
| Max. Negotiated Rate |
$197.64 |
| Rate for Payer: Aetna of IA Commercial |
$197.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$197.64
|
| Rate for Payer: Cash Price |
$175.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$164.70
|
| Rate for Payer: Medical Associates Commercial |
$164.70
|
| Rate for Payer: Midlands Choice Commercial |
$153.72
|
| Rate for Payer: United Healthcare Commercial |
$197.64
|
|
|
Amino Acids 5% with 20% Dextrose (Clinimix Sulfite-Free) intravenous solution Amino Acids 5% with 20% Dextrose (Clinimix Sulfite-Free) Sol
|
Facility
|
IP
|
$245.40
|
|
|
Service Code
|
NDC 00338-1138-03
|
| Hospital Charge Code |
26547466
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$171.78 |
| Max. Negotiated Rate |
$220.86 |
| Rate for Payer: Aetna of IA Commercial |
$220.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$220.86
|
| Rate for Payer: Cash Price |
$196.32
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$184.05
|
| Rate for Payer: Medical Associates Commercial |
$184.05
|
| Rate for Payer: Midlands Choice Commercial |
$171.78
|
| Rate for Payer: United Healthcare Commercial |
$220.86
|
|
|
Amino Acids 5% with 20% Dextrose (Clinimix Sulfite-Free) intravenous solution Amino Acids 5% with 20% Dextrose (Clinimix Sulfite-Free) Sol
|
Facility
|
OP
|
$245.40
|
|
|
Service Code
|
NDC 00338-1138-03
|
| Hospital Charge Code |
26547466
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$122.65 |
| Max. Negotiated Rate |
$220.86 |
| Rate for Payer: Aetna of IA Commercial |
$220.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$220.86
|
| Rate for Payer: Aetna of IA Medicare |
$139.88
|
| Rate for Payer: Amerigroup Medicaid |
$123.85
|
| Rate for Payer: Amerigroup Medicare |
$123.93
|
| Rate for Payer: Cash Price |
$196.32
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$184.05
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$122.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$122.65
|
| Rate for Payer: Medical Associates Commercial |
$184.05
|
| Rate for Payer: Medical Associates Managed Medicare |
$122.70
|
| Rate for Payer: Midlands Choice Commercial |
$171.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$124.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$124.47
|
| Rate for Payer: Oscar Health of IA Commercial |
$184.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$184.05
|
| Rate for Payer: United Healthcare Commercial |
$220.86
|
| Rate for Payer: United Healthcare Managed Medicare |
$144.79
|
|
|
amiodarone 200 mg Tab [VDMC]
|
Facility
|
OP
|
$1.69
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10365688
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna of IA Commercial |
$1.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.52
|
| Rate for Payer: Aetna of IA Medicare |
$0.96
|
| Rate for Payer: Amerigroup Medicaid |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.27
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.84
|
| Rate for Payer: Medical Associates Commercial |
$1.27
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.85
|
| Rate for Payer: Midlands Choice Commercial |
$1.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.86
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.86
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.27
|
| Rate for Payer: United Healthcare Commercial |
$1.52
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.00
|
|
|
amiodarone 200 mg Tab [VDMC]
|
Facility
|
IP
|
$1.69
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10365688
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna of IA Commercial |
$1.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.52
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.27
|
| Rate for Payer: Medical Associates Commercial |
$1.27
|
| Rate for Payer: Midlands Choice Commercial |
$1.18
|
| Rate for Payer: United Healthcare Commercial |
$1.52
|
|
|
amiodarone 400 mg Tab [VDMC]
|
Facility
|
IP
|
$5.91
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10365757
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna of IA Commercial |
$5.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.32
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.43
|
| Rate for Payer: Medical Associates Commercial |
$4.43
|
| Rate for Payer: Midlands Choice Commercial |
$4.14
|
| Rate for Payer: United Healthcare Commercial |
$5.32
|
|
|
amiodarone 400 mg Tab [VDMC]
|
Facility
|
OP
|
$5.91
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10365757
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna of IA Commercial |
$5.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.32
|
| Rate for Payer: Aetna of IA Medicare |
$3.37
|
| Rate for Payer: Amerigroup Medicaid |
$2.98
|
| Rate for Payer: Amerigroup Medicare |
$2.98
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.43
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.95
|
| Rate for Payer: Medical Associates Commercial |
$4.43
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.96
|
| Rate for Payer: Midlands Choice Commercial |
$4.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.00
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$3.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$4.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$4.43
|
| Rate for Payer: United Healthcare Commercial |
$5.32
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.49
|
|
|
amiodarone 50 mg/mL 18ml SDV [VDMC]
|
Facility
|
OP
|
$47.92
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
18208696
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.95 |
| Max. Negotiated Rate |
$43.13 |
| Rate for Payer: Aetna of IA Commercial |
$43.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$43.13
|
| Rate for Payer: Aetna of IA Medicare |
$27.31
|
| Rate for Payer: Amerigroup Medicaid |
$24.19
|
| Rate for Payer: Amerigroup Medicare |
$24.20
|
| Rate for Payer: Cash Price |
$38.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.94
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.95
|
| Rate for Payer: Medical Associates Commercial |
$35.94
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.96
|
| Rate for Payer: Midlands Choice Commercial |
$33.54
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24.32
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$24.31
|
| Rate for Payer: Oscar Health of IA Commercial |
$35.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$35.94
|
| Rate for Payer: United Healthcare Commercial |
$43.13
|
| Rate for Payer: United Healthcare Managed Medicare |
$28.27
|
|
|
amiodarone 50 mg/mL 18ml SDV [VDMC]
|
Facility
|
IP
|
$47.92
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
18208696
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.54 |
| Max. Negotiated Rate |
$43.13 |
| Rate for Payer: Aetna of IA Commercial |
$43.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$43.13
|
| Rate for Payer: Cash Price |
$38.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.94
|
| Rate for Payer: Medical Associates Commercial |
$35.94
|
| Rate for Payer: Midlands Choice Commercial |
$33.54
|
| Rate for Payer: United Healthcare Commercial |
$43.13
|
|
|
amiodarone 50 mg/mL 3 ml IV Sol SDV [VDMC]
|
Facility
|
OP
|
$23.06
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
10431244
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$20.75 |
| Rate for Payer: Aetna of IA Commercial |
$20.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.75
|
| Rate for Payer: Aetna of IA Medicare |
$13.14
|
| Rate for Payer: Amerigroup Medicaid |
$11.64
|
| Rate for Payer: Amerigroup Medicare |
$11.65
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.30
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.53
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.53
|
| Rate for Payer: Medical Associates Commercial |
$17.30
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.53
|
| Rate for Payer: Midlands Choice Commercial |
$16.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.70
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$11.70
|
| Rate for Payer: Oscar Health of IA Commercial |
$17.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$17.30
|
| Rate for Payer: United Healthcare Commercial |
$20.75
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.61
|
|
|
amiodarone 50 mg/mL 3 ml IV Sol SDV [VDMC]
|
Facility
|
IP
|
$23.06
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
10431244
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$20.75 |
| Rate for Payer: Aetna of IA Commercial |
$20.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.75
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.30
|
| Rate for Payer: Medical Associates Commercial |
$17.30
|
| Rate for Payer: Midlands Choice Commercial |
$16.14
|
| Rate for Payer: United Healthcare Commercial |
$20.75
|
|
|
amitriptyline 10 mg Tab [VDMC]
|
Facility
|
IP
|
$1.26
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10365826
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of IA Commercial |
$1.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.13
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.95
|
| Rate for Payer: Medical Associates Commercial |
$0.95
|
| Rate for Payer: Midlands Choice Commercial |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$1.13
|
|
|
amitriptyline 10 mg Tab [VDMC]
|
Facility
|
OP
|
$1.26
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10365826
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of IA Commercial |
$1.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.13
|
| Rate for Payer: Aetna of IA Medicare |
$0.72
|
| Rate for Payer: Amerigroup Medicaid |
$0.64
|
| Rate for Payer: Amerigroup Medicare |
$0.64
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.95
|
| 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 |
$0.63
|
| Rate for Payer: Medical Associates Commercial |
$0.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.63
|
| Rate for Payer: Midlands Choice Commercial |
$0.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.64
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.95
|
| Rate for Payer: United Healthcare Commercial |
$1.13
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.74
|
|
|
amitriptyline 25 mg Tab [VDMC]
|
Facility
|
IP
|
$1.31
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10365897
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Aetna of IA Commercial |
$1.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.18
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.98
|
| Rate for Payer: Medical Associates Commercial |
$0.98
|
| Rate for Payer: Midlands Choice Commercial |
$0.92
|
| Rate for Payer: United Healthcare Commercial |
$1.18
|
|
|
amitriptyline 25 mg Tab [VDMC]
|
Facility
|
OP
|
$1.31
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10365897
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Aetna of IA Commercial |
$1.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.18
|
| Rate for Payer: Aetna of IA Medicare |
$0.75
|
| Rate for Payer: Amerigroup Medicaid |
$0.66
|
| Rate for Payer: Amerigroup Medicare |
$0.66
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.98
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.65
|
| Rate for Payer: Medical Associates Commercial |
$0.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.66
|
| Rate for Payer: Midlands Choice Commercial |
$0.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.66
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.66
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.98
|
| Rate for Payer: United Healthcare Commercial |
$1.18
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.77
|
|
|
amLODIPine-benazepril 5 mg-20 mg Cap [VDMC]
|
Facility
|
IP
|
$1.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10366246
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Aetna of IA Commercial |
$1.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.37
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.14
|
| Rate for Payer: Medical Associates Commercial |
$1.14
|
| Rate for Payer: Midlands Choice Commercial |
$1.06
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
|
|
amLODIPine-benazepril 5 mg-20 mg Cap [VDMC]
|
Facility
|
OP
|
$1.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10366246
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Aetna of IA Commercial |
$1.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.37
|
| Rate for Payer: Aetna of IA Medicare |
$0.87
|
| Rate for Payer: Amerigroup Medicaid |
$0.77
|
| Rate for Payer: Amerigroup Medicare |
$0.77
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.14
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.76
|
| Rate for Payer: Medical Associates Commercial |
$1.14
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.76
|
| Rate for Payer: Midlands Choice Commercial |
$1.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.77
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.77
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.14
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.90
|
|
|
amLODIPine besylate 5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10366106
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| 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 |
$0.63
|
| Rate for Payer: Amerigroup Medicare |
$0.63
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.93
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.62
|
| Rate for Payer: Medical Associates Commercial |
$0.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.62
|
| Rate for Payer: Midlands Choice Commercial |
$0.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.63
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.63
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.73
|
|
|
amLODIPine besylate 5 mg Tab [VDMC]
|
Facility
|
IP
|
$1.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10366106
|
|
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 |
$0.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.93
|
| Rate for Payer: Medical Associates Commercial |
$0.93
|
| Rate for Payer: Midlands Choice Commercial |
$0.87
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
|
|
AMMONIA
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
1628880
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Aetna of IA Commercial |
$109.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$109.80
|
| Rate for Payer: Aetna of IA Medicare |
$69.54
|
| Rate for Payer: Amerigroup Medicaid |
$61.57
|
| Rate for Payer: Amerigroup Medicare |
$61.61
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$91.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$61.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$60.98
|
| Rate for Payer: Medical Associates Commercial |
$91.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$61.00
|
| Rate for Payer: Midlands Choice Commercial |
$85.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$61.92
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$61.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$91.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$91.50
|
| Rate for Payer: United Healthcare Commercial |
$109.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$71.98
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
AMMONIA
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
1628880
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Aetna of IA Commercial |
$109.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$109.80
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$91.50
|
| Rate for Payer: Medical Associates Commercial |
$91.50
|
| Rate for Payer: Midlands Choice Commercial |
$85.40
|
| Rate for Payer: United Healthcare Commercial |
$109.80
|
|
|
ammonium lactate Top 12% Lotion [VDMC]
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433152
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna of IA Commercial |
$18.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.00
|
| Rate for Payer: Medical Associates Commercial |
$15.00
|
| Rate for Payer: Midlands Choice Commercial |
$14.00
|
| Rate for Payer: United Healthcare Commercial |
$18.00
|
|
|
ammonium lactate Top 12% Lotion [VDMC]
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433152
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna of IA Commercial |
$18.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.00
|
| Rate for Payer: Aetna of IA Medicare |
$11.40
|
| Rate for Payer: Amerigroup Medicaid |
$10.09
|
| Rate for Payer: Amerigroup Medicare |
$10.10
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.00
|
| Rate for Payer: Medical Associates Commercial |
$15.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.00
|
| Rate for Payer: Midlands Choice Commercial |
$14.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.15
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$10.14
|
| Rate for Payer: Oscar Health of IA Commercial |
$15.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$15.00
|
| Rate for Payer: United Healthcare Commercial |
$18.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.80
|
|
|
AMNIOCENTESIS DIAGNOSTIC
|
Facility
|
IP
|
$949.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
7984751
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$664.30 |
| Max. Negotiated Rate |
$854.10 |
| Rate for Payer: Aetna of IA Commercial |
$854.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$854.10
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$711.75
|
| Rate for Payer: Medical Associates Commercial |
$711.75
|
| Rate for Payer: Midlands Choice Commercial |
$664.30
|
| Rate for Payer: United Healthcare Commercial |
$854.10
|
|
|
AMNIOCENTESIS DIAGNOSTIC
|
Facility
|
OP
|
$949.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
7984751
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$474.31 |
| Max. Negotiated Rate |
$2,339.94 |
| Rate for Payer: Aetna of IA Commercial |
$854.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$854.10
|
| Rate for Payer: Aetna of IA Medicare |
$540.93
|
| Rate for Payer: Amerigroup Medicaid |
$478.96
|
| Rate for Payer: Amerigroup Medicare |
$479.24
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$711.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$474.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$474.31
|
| Rate for Payer: Medical Associates Commercial |
$711.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$474.50
|
| Rate for Payer: Midlands Choice Commercial |
$664.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$481.62
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$481.33
|
| Rate for Payer: Oscar Health of IA Commercial |
$711.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$711.75
|
| Rate for Payer: United Healthcare Commercial |
$854.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$559.91
|
| Rate for Payer: Wellmark IA HMO |
$2,127.22
|
| Rate for Payer: Wellmark IA PPO |
$2,339.94
|
|
