|
albuterol 1.25mg Inh Sol 3 mL [VDMC]
|
Facility
|
OP
|
$6.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10364304
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.78 |
| 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: Aetna of IA Medicare |
$3.52
|
| Rate for Payer: Amerigroup Medicaid |
$3.56
|
| Rate for Payer: Amerigroup Medicare |
$2.80
|
| Rate for Payer: Cash Price |
$4.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.63
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.52
|
| Rate for Payer: Medical Associates Commercial |
$4.63
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.78
|
| Rate for Payer: Midlands Choice Commercial |
$4.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.19
|
| Rate for Payer: United Healthcare Commercial |
$5.55
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.64
|
|
|
albuterol CFC free 90 mcg/inh Inh Aer w/Adapt [VDMC]
|
Facility
|
OP
|
$66.98
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10364515
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.14 |
| Max. Negotiated Rate |
$60.28 |
| Rate for Payer: Aetna of IA Commercial |
$60.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.28
|
| Rate for Payer: Aetna of IA Medicare |
$38.18
|
| Rate for Payer: Amerigroup Medicaid |
$38.63
|
| Rate for Payer: Amerigroup Medicare |
$30.44
|
| Rate for Payer: Cash Price |
$53.58
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.23
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.14
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.26
|
| Rate for Payer: Medical Associates Commercial |
$50.23
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.14
|
| Rate for Payer: Midlands Choice Commercial |
$46.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.66
|
| Rate for Payer: United Healthcare Commercial |
$60.28
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.52
|
|
|
albuterol CFC free 90 mcg/inh Inh Aer w/Adapt [VDMC]
|
Facility
|
IP
|
$66.98
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10364515
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$46.89 |
| Max. Negotiated Rate |
$60.28 |
| Rate for Payer: Aetna of IA Commercial |
$60.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.28
|
| Rate for Payer: Cash Price |
$53.58
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.23
|
| Rate for Payer: Medical Associates Commercial |
$50.23
|
| Rate for Payer: Midlands Choice Commercial |
$46.89
|
| Rate for Payer: United Healthcare Commercial |
$60.28
|
|
|
albuterol-ipratropium 0.5mg/3mg neb Sol 3 mL SDV [VDMC]
|
Facility
|
IP
|
$5.84
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10364653
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$5.26 |
| Rate for Payer: Aetna of IA Commercial |
$5.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.26
|
| Rate for Payer: Cash Price |
$4.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.38
|
| Rate for Payer: Medical Associates Commercial |
$4.38
|
| Rate for Payer: Midlands Choice Commercial |
$4.09
|
| Rate for Payer: United Healthcare Commercial |
$5.26
|
|
|
albuterol-ipratropium 0.5mg/3mg neb Sol 3 mL SDV [VDMC]
|
Facility
|
OP
|
$5.84
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10364653
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$5.26 |
| Rate for Payer: Aetna of IA Commercial |
$5.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.26
|
| Rate for Payer: Aetna of IA Medicare |
$3.33
|
| Rate for Payer: Amerigroup Medicaid |
$3.37
|
| Rate for Payer: Amerigroup Medicare |
$2.65
|
| Rate for Payer: Cash Price |
$4.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.63
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.34
|
| Rate for Payer: Medical Associates Commercial |
$4.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.63
|
| Rate for Payer: Midlands Choice Commercial |
$4.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.02
|
| Rate for Payer: United Healthcare Commercial |
$5.26
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.45
|
|
|
albuterol-ipratropium CFC free 100 mcg-20 mcg/inh Aer[VDMC]
|
Facility
|
OP
|
$1,549.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11449831
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$697.12 |
| Max. Negotiated Rate |
$1,394.24 |
| Rate for Payer: Aetna of IA Commercial |
$1,394.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,394.24
|
| Rate for Payer: Aetna of IA Medicare |
$883.02
|
| Rate for Payer: Amerigroup Medicaid |
$893.56
|
| Rate for Payer: Amerigroup Medicare |
$704.09
|
| Rate for Payer: Cash Price |
$1,239.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,161.87
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$697.12
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$884.88
|
| Rate for Payer: Medical Associates Commercial |
$1,161.87
|
| Rate for Payer: Medical Associates Managed Medicare |
$697.12
|
| Rate for Payer: Midlands Choice Commercial |
$1,084.41
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$897.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$801.69
|
| Rate for Payer: United Healthcare Commercial |
$1,394.24
|
| Rate for Payer: United Healthcare Managed Medicare |
$914.00
|
|
|
albuterol-ipratropium CFC free 100 mcg-20 mcg/inh Aer[VDMC]
|
Facility
|
IP
|
$1,549.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11449831
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,084.41 |
| Max. Negotiated Rate |
$1,394.24 |
| Rate for Payer: Aetna of IA Commercial |
$1,394.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,394.24
|
| Rate for Payer: Cash Price |
$1,239.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,161.87
|
| Rate for Payer: Medical Associates Commercial |
$1,161.87
|
| Rate for Payer: Midlands Choice Commercial |
$1,084.41
|
| Rate for Payer: United Healthcare Commercial |
$1,394.24
|
|
|
ALCOHOL
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
1503765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.55 |
| 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: 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: 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
|
|
|
ALCOHOL
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
1503765
|
|
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
|
|
|
ALDL
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
6310783
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Aetna of IA Medicare |
$41.61
|
| Rate for Payer: Amerigroup Medicaid |
$42.11
|
| Rate for Payer: Amerigroup Medicare |
$33.18
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.70
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.85
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$37.78
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.07
|
|
|
ALDL
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
6310783
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
|
|
ALDOLASE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
8037487
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna of IA Commercial |
$59.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.40
|
| Rate for Payer: Aetna of IA Medicare |
$37.62
|
| Rate for Payer: Amerigroup Medicaid |
$38.07
|
| Rate for Payer: Amerigroup Medicare |
$30.00
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.70
|
| Rate for Payer: Medical Associates Commercial |
$49.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.70
|
| Rate for Payer: Midlands Choice Commercial |
$46.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.16
|
| Rate for Payer: United Healthcare Commercial |
$59.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.94
|
|
|
ALDOLASE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
8037487
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna of IA Commercial |
$59.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.50
|
| Rate for Payer: Medical Associates Commercial |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$59.40
|
|
|
ALDOSTERONE
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
8037488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$193.90 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: Aetna of IA Commercial |
$249.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$249.30
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$207.75
|
| Rate for Payer: Medical Associates Commercial |
$207.75
|
| Rate for Payer: Midlands Choice Commercial |
$193.90
|
| Rate for Payer: United Healthcare Commercial |
$249.30
|
|
|
ALDOSTERONE
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
8037488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$124.65 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: Aetna of IA Commercial |
$249.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$249.30
|
| Rate for Payer: Aetna of IA Medicare |
$157.89
|
| Rate for Payer: Amerigroup Medicaid |
$159.77
|
| Rate for Payer: Amerigroup Medicare |
$125.90
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$207.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$124.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$158.22
|
| Rate for Payer: Medical Associates Commercial |
$207.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$124.65
|
| Rate for Payer: Midlands Choice Commercial |
$193.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$160.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$143.35
|
| Rate for Payer: United Healthcare Commercial |
$249.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$163.43
|
|
|
al hydroxide/mg hydroxide/simethicone 400 mg-400 mg-40 mg/5 mL Oral Susp 30 mL [VDMC]
|
Facility
|
IP
|
$12.36
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10364164
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$11.13 |
| Rate for Payer: Aetna of IA Commercial |
$11.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.13
|
| Rate for Payer: Cash Price |
$9.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.27
|
| Rate for Payer: Medical Associates Commercial |
$9.27
|
| Rate for Payer: Midlands Choice Commercial |
$8.65
|
| Rate for Payer: United Healthcare Commercial |
$11.13
|
|
|
al hydroxide/mg hydroxide/simethicone 400 mg-400 mg-40 mg/5 mL Oral Susp 30 mL [VDMC]
|
Facility
|
OP
|
$12.36
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10364164
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$11.13 |
| Rate for Payer: Aetna of IA Commercial |
$11.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.13
|
| Rate for Payer: Aetna of IA Medicare |
$7.05
|
| Rate for Payer: Amerigroup Medicaid |
$7.13
|
| Rate for Payer: Amerigroup Medicare |
$5.62
|
| Rate for Payer: Cash Price |
$9.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.27
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.06
|
| Rate for Payer: Medical Associates Commercial |
$9.27
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.56
|
| Rate for Payer: Midlands Choice Commercial |
$8.65
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$6.40
|
| Rate for Payer: United Healthcare Commercial |
$11.13
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.29
|
|
|
ALK PHOSPHATASE
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
1620878
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna of IA Commercial |
$47.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$47.70
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.75
|
| Rate for Payer: Medical Associates Commercial |
$39.75
|
| Rate for Payer: Midlands Choice Commercial |
$37.10
|
| Rate for Payer: United Healthcare Commercial |
$47.70
|
|
|
ALK PHOSPHATASE
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
1620878
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.85 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna of IA Commercial |
$47.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$47.70
|
| Rate for Payer: Aetna of IA Medicare |
$30.21
|
| Rate for Payer: Amerigroup Medicaid |
$30.57
|
| Rate for Payer: Amerigroup Medicare |
$24.09
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.27
|
| Rate for Payer: Medical Associates Commercial |
$39.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.85
|
| Rate for Payer: Midlands Choice Commercial |
$37.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.43
|
| Rate for Payer: United Healthcare Commercial |
$47.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$31.27
|
|
|
ALLOGRAFT 30X40MM 722-TS
|
Facility
|
OP
|
$3,960.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8942325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,782.00 |
| Max. Negotiated Rate |
$3,564.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,564.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,564.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,257.20
|
| Rate for Payer: Amerigroup Medicaid |
$2,284.13
|
| Rate for Payer: Amerigroup Medicare |
$1,799.82
|
| Rate for Payer: Cash Price |
$3,168.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,970.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,782.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,261.95
|
| Rate for Payer: Medical Associates Commercial |
$2,970.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,782.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,772.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,295.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,049.30
|
| Rate for Payer: United Healthcare Commercial |
$3,564.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,336.40
|
|
|
ALLOGRAFT 30X40MM 722-TS
|
Facility
|
IP
|
$3,960.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8942325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.00 |
| Max. Negotiated Rate |
$3,564.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,564.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,564.00
|
| Rate for Payer: Cash Price |
$3,168.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,970.00
|
| Rate for Payer: Medical Associates Commercial |
$2,970.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,772.00
|
| Rate for Payer: United Healthcare Commercial |
$3,564.00
|
|
|
allopurinol 100 mg Tab [VDMC]
|
Facility
|
IP
|
$1.13
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10364795
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of IA Commercial |
$1.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.02
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.85
|
| Rate for Payer: Medical Associates Commercial |
$0.85
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
|
|
allopurinol 100 mg Tab [VDMC]
|
Facility
|
OP
|
$1.13
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10364795
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of IA Commercial |
$1.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.02
|
| Rate for Payer: Aetna of IA Medicare |
$0.64
|
| Rate for Payer: Amerigroup Medicaid |
$0.65
|
| Rate for Payer: Amerigroup Medicare |
$0.51
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.85
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.51
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.65
|
| Rate for Payer: Medical Associates Commercial |
$0.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.51
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.58
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.67
|
|
|
allopurinol 300 mg Tab [VDMC]
|
Facility
|
OP
|
$1.31
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11263409
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.59 |
| 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 |
$0.76
|
| Rate for Payer: Amerigroup Medicare |
$0.60
|
| 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 |
$0.59
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.75
|
| Rate for Payer: Medical Associates Commercial |
$0.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.59
|
| Rate for Payer: Midlands Choice Commercial |
$0.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.68
|
| Rate for Payer: United Healthcare Commercial |
$1.18
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.77
|
|
|
allopurinol 300 mg Tab [VDMC]
|
Facility
|
IP
|
$1.31
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11263409
|
|
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
|
|
