|
ADM IVP TX, SCHEDULED EA ADD'L
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
8012941
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Aetna of IA Medicare |
$36.48
|
| Rate for Payer: Amerigroup Medicaid |
$36.92
|
| Rate for Payer: Amerigroup Medicare |
$29.09
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.56
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.80
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.12
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
|
|
ADM IVP TX, SCHEDULED EA ADD'L
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
8012941
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
ADM IVP TX SCHED W/ OTHER PROC
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
8012939
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of IA Commercial |
$51.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.30
|
| Rate for Payer: Aetna of IA Medicare |
$32.49
|
| Rate for Payer: Amerigroup Medicaid |
$32.88
|
| Rate for Payer: Amerigroup Medicare |
$25.91
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.56
|
| Rate for Payer: Medical Associates Commercial |
$42.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.65
|
| Rate for Payer: Midlands Choice Commercial |
$39.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$29.50
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.63
|
|
|
ADM IVP TX SCHED W/ OTHER PROC
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
8012939
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of IA Commercial |
$51.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.30
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.75
|
| Rate for Payer: Medical Associates Commercial |
$42.75
|
| Rate for Payer: Midlands Choice Commercial |
$39.90
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
|
|
ADM VACC 1ST
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
4866871
|
|
Hospital Revenue Code
|
771
|
| 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 |
$13.63
|
| 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
|
|
|
ADM VACC 1ST
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
4866871
|
|
Hospital Revenue Code
|
771
|
| 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
|
|
|
ADM VACC EA ADDL VACCINE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
4866874
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.45 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Aetna of IA Medicare |
$23.37
|
| Rate for Payer: Amerigroup Medicaid |
$23.65
|
| Rate for Payer: Amerigroup Medicare |
$18.63
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.42
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.45
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.22
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.19
|
|
|
ADM VACC EA ADDL VACCINE
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
4866874
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
|
|
ADRENOCORTICOTROPHIC HORMONE
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
8037486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$118.35 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Aetna of IA Commercial |
$236.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$236.70
|
| Rate for Payer: Aetna of IA Medicare |
$149.91
|
| Rate for Payer: Amerigroup Medicaid |
$151.70
|
| Rate for Payer: Amerigroup Medicare |
$119.53
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$197.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$118.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$150.23
|
| Rate for Payer: Medical Associates Commercial |
$197.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$118.35
|
| Rate for Payer: Midlands Choice Commercial |
$184.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$152.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$136.10
|
| Rate for Payer: United Healthcare Commercial |
$236.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$155.17
|
|
|
ADRENOCORTICOTROPHIC HORMONE
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
8037486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$184.10 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Aetna of IA Commercial |
$236.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$236.70
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$197.25
|
| Rate for Payer: Medical Associates Commercial |
$197.25
|
| Rate for Payer: Midlands Choice Commercial |
$184.10
|
| Rate for Payer: United Healthcare Commercial |
$236.70
|
|
|
AIRWAY SUCTION-NASOTRACHEAL ONLY
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
5338782
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna of IA Commercial |
$158.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$158.40
|
| Rate for Payer: Aetna of IA Medicare |
$100.32
|
| Rate for Payer: Amerigroup Medicaid |
$101.52
|
| Rate for Payer: Amerigroup Medicare |
$79.99
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$79.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.53
|
| Rate for Payer: Medical Associates Commercial |
$132.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$79.20
|
| Rate for Payer: Midlands Choice Commercial |
$123.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$91.08
|
| Rate for Payer: United Healthcare Commercial |
$158.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.84
|
|
|
AIRWAY SUCTION-NASOTRACHEAL ONLY
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
5338782
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna of IA Commercial |
$158.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$158.40
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.00
|
| Rate for Payer: Medical Associates Commercial |
$132.00
|
| Rate for Payer: Midlands Choice Commercial |
$123.20
|
| Rate for Payer: United Healthcare Commercial |
$158.40
|
|
|
ALBUMIN
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
1620877
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna of IA Commercial |
$42.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$42.30
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.25
|
| Rate for Payer: Medical Associates Commercial |
$35.25
|
| Rate for Payer: Midlands Choice Commercial |
$32.90
|
| Rate for Payer: United Healthcare Commercial |
$42.30
|
|
|
ALBUMIN
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
8093923
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna of IA Commercial |
$42.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$42.30
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.25
|
| Rate for Payer: Medical Associates Commercial |
$35.25
|
| Rate for Payer: Midlands Choice Commercial |
$32.90
|
| Rate for Payer: United Healthcare Commercial |
$42.30
|
|
|
ALBUMIN
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
1620877
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.15 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna of IA Commercial |
$42.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$42.30
|
| Rate for Payer: Aetna of IA Medicare |
$26.79
|
| Rate for Payer: Amerigroup Medicaid |
$27.11
|
| Rate for Payer: Amerigroup Medicare |
$21.36
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$21.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$26.85
|
| Rate for Payer: Medical Associates Commercial |
$35.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$21.15
|
| Rate for Payer: Midlands Choice Commercial |
$32.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.32
|
| Rate for Payer: United Healthcare Commercial |
$42.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$27.73
|
|
|
ALBUMIN
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
8093923
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.15 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna of IA Commercial |
$42.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$42.30
|
| Rate for Payer: Aetna of IA Medicare |
$26.79
|
| Rate for Payer: Amerigroup Medicaid |
$27.11
|
| Rate for Payer: Amerigroup Medicare |
$21.36
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$21.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$26.85
|
| Rate for Payer: Medical Associates Commercial |
$35.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$21.15
|
| Rate for Payer: Midlands Choice Commercial |
$32.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.32
|
| Rate for Payer: United Healthcare Commercial |
$42.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$27.73
|
|
|
albumin human 25% IV Sol 50 mL SDV [VDMC]
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
10364235
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of IA Commercial |
$171.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$171.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$142.50
|
| Rate for Payer: Medical Associates Commercial |
$142.50
|
| Rate for Payer: Midlands Choice Commercial |
$133.00
|
| Rate for Payer: United Healthcare Commercial |
$171.00
|
|
|
albumin human 25% IV Sol 50 mL SDV [VDMC]
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
10364235
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of IA Commercial |
$171.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$171.00
|
| Rate for Payer: Aetna of IA Medicare |
$108.30
|
| Rate for Payer: Amerigroup Medicaid |
$109.59
|
| Rate for Payer: Amerigroup Medicare |
$86.36
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$142.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$85.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$108.53
|
| Rate for Payer: Medical Associates Commercial |
$142.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$133.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$110.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$98.33
|
| Rate for Payer: United Healthcare Commercial |
$171.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$112.10
|
|
|
albumin human 5% IV Sol 250 mL SDV [VDMC]
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
26134630
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$186.30 |
| Rate for Payer: Aetna of IA Commercial |
$186.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$186.30
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$155.25
|
| Rate for Payer: Medical Associates Commercial |
$155.25
|
| Rate for Payer: Midlands Choice Commercial |
$144.90
|
| Rate for Payer: United Healthcare Commercial |
$186.30
|
|
|
albumin human 5% IV Sol 250 mL SDV [VDMC]
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
26134630
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$93.15 |
| Max. Negotiated Rate |
$186.30 |
| Rate for Payer: Aetna of IA Commercial |
$186.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$186.30
|
| Rate for Payer: Aetna of IA Medicare |
$117.99
|
| Rate for Payer: Amerigroup Medicaid |
$119.40
|
| Rate for Payer: Amerigroup Medicare |
$94.08
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$155.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$93.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$118.24
|
| Rate for Payer: Medical Associates Commercial |
$155.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$93.15
|
| Rate for Payer: Midlands Choice Commercial |
$144.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$119.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$107.12
|
| Rate for Payer: United Healthcare Commercial |
$186.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$122.13
|
|
|
albuterol 0.083% 2.5mg neb Sol 3 mL SDV [VDMC]
|
Facility
|
OP
|
$5.10
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10364375
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna of IA Commercial |
$4.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.59
|
| Rate for Payer: Aetna of IA Medicare |
$2.91
|
| Rate for Payer: Amerigroup Medicaid |
$2.94
|
| Rate for Payer: Amerigroup Medicare |
$2.32
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.83
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.92
|
| Rate for Payer: Medical Associates Commercial |
$3.83
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.30
|
| Rate for Payer: Midlands Choice Commercial |
$3.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.64
|
| Rate for Payer: United Healthcare Commercial |
$4.59
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.01
|
|
|
albuterol 0.083% 2.5mg neb Sol 3 mL SDV [VDMC]
|
Facility
|
IP
|
$5.10
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10364375
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna of IA Commercial |
$4.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.59
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.83
|
| Rate for Payer: Medical Associates Commercial |
$3.83
|
| Rate for Payer: Midlands Choice Commercial |
$3.57
|
| Rate for Payer: United Healthcare Commercial |
$4.59
|
|
|
albuterol 0.5% 5mg/ml 20ml Inh Sol [VDMC]
|
Facility
|
OP
|
$180.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10364446
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$81.29 |
| Max. Negotiated Rate |
$162.58 |
| Rate for Payer: Aetna of IA Commercial |
$162.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.58
|
| Rate for Payer: Aetna of IA Medicare |
$102.96
|
| Rate for Payer: Amerigroup Medicaid |
$104.19
|
| Rate for Payer: Amerigroup Medicare |
$82.10
|
| Rate for Payer: Cash Price |
$144.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.48
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.29
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$103.18
|
| Rate for Payer: Medical Associates Commercial |
$135.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.29
|
| Rate for Payer: Midlands Choice Commercial |
$126.45
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.48
|
| Rate for Payer: United Healthcare Commercial |
$162.58
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.58
|
|
|
albuterol 0.5% 5mg/ml 20ml Inh Sol [VDMC]
|
Facility
|
IP
|
$180.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10364446
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$162.58 |
| Rate for Payer: Aetna of IA Commercial |
$162.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.58
|
| Rate for Payer: Cash Price |
$144.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.48
|
| Rate for Payer: Medical Associates Commercial |
$135.48
|
| Rate for Payer: Midlands Choice Commercial |
$126.45
|
| Rate for Payer: United Healthcare Commercial |
$162.58
|
|
|
albuterol 1.25mg Inh Sol 3 mL [VDMC]
|
Facility
|
IP
|
$6.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10364304
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$5.55 |
| Rate for Payer: Aetna of IA Commercial |
$5.55
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.55
|
| Rate for Payer: Cash Price |
$4.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.63
|
| Rate for Payer: Medical Associates Commercial |
$4.63
|
| Rate for Payer: Midlands Choice Commercial |
$4.32
|
| Rate for Payer: United Healthcare Commercial |
$5.55
|
|
