|
Sodium Chloride 0.9% 500 ml intravenous solution [VDMC]
|
Facility
|
OP
|
$66.70
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
10605618
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.02 |
| Max. Negotiated Rate |
$60.03 |
| Rate for Payer: Aetna of IA Commercial |
$60.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.03
|
| Rate for Payer: Aetna of IA Medicare |
$38.02
|
| Rate for Payer: Amerigroup Medicaid |
$38.47
|
| Rate for Payer: Amerigroup Medicare |
$30.32
|
| Rate for Payer: Cash Price |
$53.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.02
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.10
|
| Rate for Payer: Medical Associates Commercial |
$50.02
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.02
|
| Rate for Payer: Midlands Choice Commercial |
$46.69
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.52
|
| Rate for Payer: United Healthcare Commercial |
$60.03
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.35
|
|
|
sodium chloride 0.9% Inh Sol 3 mL [VDMC]
|
Facility
|
IP
|
$4.68
|
|
|
Service Code
|
NDC 76204-0300-03
|
| Hospital Charge Code |
10438086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna of IA Commercial |
$4.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.21
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.51
|
| Rate for Payer: Medical Associates Commercial |
$3.51
|
| Rate for Payer: Midlands Choice Commercial |
$3.27
|
| Rate for Payer: United Healthcare Commercial |
$4.21
|
|
|
sodium chloride 0.9% Inh Sol 3 mL [VDMC]
|
Facility
|
OP
|
$4.68
|
|
|
Service Code
|
NDC 76204-0300-03
|
| Hospital Charge Code |
10438086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna of IA Commercial |
$4.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.21
|
| Rate for Payer: Aetna of IA Medicare |
$2.67
|
| Rate for Payer: Amerigroup Medicaid |
$2.70
|
| Rate for Payer: Amerigroup Medicare |
$2.13
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.51
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.67
|
| Rate for Payer: Medical Associates Commercial |
$3.51
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.10
|
| Rate for Payer: Midlands Choice Commercial |
$3.27
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.42
|
| Rate for Payer: United Healthcare Commercial |
$4.21
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.76
|
|
|
Sodium Chloride 0.9% intravenous solution 25 mL [VDMC]
|
Facility
|
IP
|
$63.66
|
|
|
Service Code
|
NDC 00409-7984-20
|
| Hospital Charge Code |
11089158
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$44.56 |
| Max. Negotiated Rate |
$57.29 |
| Rate for Payer: Aetna of IA Commercial |
$57.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.29
|
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.74
|
| Rate for Payer: Medical Associates Commercial |
$47.74
|
| Rate for Payer: Midlands Choice Commercial |
$44.56
|
| Rate for Payer: United Healthcare Commercial |
$57.29
|
|
|
Sodium Chloride 0.9% intravenous solution 25 mL [VDMC]
|
Facility
|
OP
|
$63.66
|
|
|
Service Code
|
NDC 00409-7984-20
|
| Hospital Charge Code |
11089158
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.64 |
| Max. Negotiated Rate |
$57.29 |
| Rate for Payer: Aetna of IA Commercial |
$57.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.29
|
| Rate for Payer: Aetna of IA Medicare |
$36.28
|
| Rate for Payer: Amerigroup Medicaid |
$36.72
|
| Rate for Payer: Amerigroup Medicare |
$28.93
|
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.74
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.36
|
| Rate for Payer: Medical Associates Commercial |
$47.74
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.64
|
| Rate for Payer: Midlands Choice Commercial |
$44.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$32.94
|
| Rate for Payer: United Healthcare Commercial |
$57.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.56
|
|
|
Sodium Chloride 0.9% IV Sol 1000 mL [VDMC]
|
Facility
|
IP
|
$66.80
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
10441371
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$46.76 |
| Max. Negotiated Rate |
$60.12 |
| Rate for Payer: Aetna of IA Commercial |
$60.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.12
|
| Rate for Payer: Cash Price |
$53.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.10
|
| Rate for Payer: Medical Associates Commercial |
$50.10
|
| Rate for Payer: Midlands Choice Commercial |
$46.76
|
| Rate for Payer: United Healthcare Commercial |
$60.12
|
|
|
Sodium Chloride 0.9% IV Sol 1000 mL [VDMC]
|
Facility
|
OP
|
$66.80
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
10441371
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.06 |
| Max. Negotiated Rate |
$60.12 |
| Rate for Payer: Aetna of IA Commercial |
$60.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.12
|
| Rate for Payer: Aetna of IA Medicare |
$38.08
|
| Rate for Payer: Amerigroup Medicaid |
$38.53
|
| Rate for Payer: Amerigroup Medicare |
$30.36
|
| Rate for Payer: Cash Price |
$53.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.10
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.16
|
| Rate for Payer: Medical Associates Commercial |
$50.10
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.06
|
| Rate for Payer: Midlands Choice Commercial |
$46.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.57
|
| Rate for Payer: United Healthcare Commercial |
$60.12
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.41
|
|
|
Sodium Chloride 0.9% IV Sol 250 mL [VDMC]
|
Facility
|
IP
|
$65.26
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
10441438
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$45.68 |
| Max. Negotiated Rate |
$58.73 |
| Rate for Payer: Aetna of IA Commercial |
$58.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.73
|
| Rate for Payer: Cash Price |
$52.21
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.95
|
| Rate for Payer: Medical Associates Commercial |
$48.95
|
| Rate for Payer: Midlands Choice Commercial |
$45.68
|
| Rate for Payer: United Healthcare Commercial |
$58.73
|
|
|
Sodium Chloride 0.9% IV Sol 250 mL [VDMC]
|
Facility
|
OP
|
$65.26
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
10441438
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.37 |
| Max. Negotiated Rate |
$58.73 |
| Rate for Payer: Aetna of IA Commercial |
$58.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.73
|
| Rate for Payer: Aetna of IA Medicare |
$37.20
|
| Rate for Payer: Amerigroup Medicaid |
$37.64
|
| Rate for Payer: Amerigroup Medicare |
$29.66
|
| Rate for Payer: Cash Price |
$52.21
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.37
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.28
|
| Rate for Payer: Medical Associates Commercial |
$48.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.37
|
| Rate for Payer: Midlands Choice Commercial |
$45.68
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.77
|
| Rate for Payer: United Healthcare Commercial |
$58.73
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.50
|
|
|
Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
|
Facility
|
IP
|
$66.80
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
10441505
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$46.76 |
| Max. Negotiated Rate |
$60.12 |
| Rate for Payer: Aetna of IA Commercial |
$60.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.12
|
| Rate for Payer: Cash Price |
$53.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.10
|
| Rate for Payer: Medical Associates Commercial |
$50.10
|
| Rate for Payer: Midlands Choice Commercial |
$46.76
|
| Rate for Payer: United Healthcare Commercial |
$60.12
|
|
|
Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
|
Facility
|
OP
|
$66.80
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
10441505
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.06 |
| Max. Negotiated Rate |
$60.12 |
| Rate for Payer: Aetna of IA Commercial |
$60.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.12
|
| Rate for Payer: Aetna of IA Medicare |
$38.07
|
| Rate for Payer: Amerigroup Medicaid |
$38.53
|
| Rate for Payer: Amerigroup Medicare |
$30.36
|
| Rate for Payer: Cash Price |
$53.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.10
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.15
|
| Rate for Payer: Medical Associates Commercial |
$50.10
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.06
|
| Rate for Payer: Midlands Choice Commercial |
$46.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.57
|
| Rate for Payer: United Healthcare Commercial |
$60.12
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.41
|
|
|
sodium chloride 1 g Tab [VDMC]
|
Facility
|
IP
|
$1.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10421562
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Aetna of IA Commercial |
$1.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.15
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.96
|
| Rate for Payer: Medical Associates Commercial |
$0.96
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.15
|
|
|
sodium chloride 1 g Tab [VDMC]
|
Facility
|
OP
|
$1.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10421562
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Aetna of IA Commercial |
$1.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.15
|
| Rate for Payer: Aetna of IA Medicare |
$0.73
|
| Rate for Payer: Amerigroup Medicaid |
$0.74
|
| Rate for Payer: Amerigroup Medicare |
$0.58
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.96
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.73
|
| Rate for Payer: Medical Associates Commercial |
$0.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.58
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.66
|
| Rate for Payer: United Healthcare Commercial |
$1.15
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.76
|
|
|
sodium chloride 3% neb Sol 4 ml SDV [VDMC]
|
Facility
|
IP
|
$5.13
|
|
|
Service Code
|
NDC 00487-9003-60
|
| Hospital Charge Code |
12710834
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna of IA Commercial |
$4.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.62
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.85
|
| Rate for Payer: Medical Associates Commercial |
$3.85
|
| Rate for Payer: Midlands Choice Commercial |
$3.59
|
| Rate for Payer: United Healthcare Commercial |
$4.62
|
|
|
sodium chloride 3% neb Sol 4 ml SDV [VDMC]
|
Facility
|
OP
|
$5.13
|
|
|
Service Code
|
NDC 00487-9003-60
|
| Hospital Charge Code |
12710834
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna of IA Commercial |
$4.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.62
|
| Rate for Payer: Aetna of IA Medicare |
$2.92
|
| Rate for Payer: Amerigroup Medicaid |
$2.96
|
| Rate for Payer: Amerigroup Medicare |
$2.33
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.85
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.31
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.93
|
| Rate for Payer: Medical Associates Commercial |
$3.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.31
|
| Rate for Payer: Midlands Choice Commercial |
$3.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.65
|
| Rate for Payer: United Healthcare Commercial |
$4.62
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.03
|
|
|
sodium chloride 7% UD neb sol 4ml SDV [VDMC]
|
Facility
|
OP
|
$6.33
|
|
|
Service Code
|
HCPCS A4216
|
| Hospital Charge Code |
17985180
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Aetna of IA Commercial |
$5.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.70
|
| Rate for Payer: Aetna of IA Medicare |
$3.61
|
| Rate for Payer: Amerigroup Medicaid |
$3.65
|
| Rate for Payer: Amerigroup Medicare |
$2.88
|
| Rate for Payer: Cash Price |
$5.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.62
|
| Rate for Payer: Medical Associates Commercial |
$4.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.85
|
| Rate for Payer: Midlands Choice Commercial |
$4.43
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.28
|
| Rate for Payer: United Healthcare Commercial |
$5.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.74
|
|
|
sodium chloride 7% UD neb sol 4ml SDV [VDMC]
|
Facility
|
IP
|
$6.33
|
|
|
Service Code
|
HCPCS A4216
|
| Hospital Charge Code |
17985180
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Aetna of IA Commercial |
$5.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.70
|
| Rate for Payer: Cash Price |
$5.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.75
|
| Rate for Payer: Medical Associates Commercial |
$4.75
|
| Rate for Payer: Midlands Choice Commercial |
$4.43
|
| Rate for Payer: United Healthcare Commercial |
$5.70
|
|
|
Sodium Chloride HYPERTONIC 3% IV Sol 500 mL [VDMC]
|
Facility
|
IP
|
$67.18
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
10441689
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.03 |
| Max. Negotiated Rate |
$60.46 |
| Rate for Payer: Aetna of IA Commercial |
$60.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.46
|
| Rate for Payer: Cash Price |
$53.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.38
|
| Rate for Payer: Medical Associates Commercial |
$50.38
|
| Rate for Payer: Midlands Choice Commercial |
$47.03
|
| Rate for Payer: United Healthcare Commercial |
$60.46
|
|
|
Sodium Chloride HYPERTONIC 3% IV Sol 500 mL [VDMC]
|
Facility
|
OP
|
$67.18
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
10441689
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$60.46 |
| Rate for Payer: Aetna of IA Commercial |
$60.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.46
|
| Rate for Payer: Aetna of IA Medicare |
$38.29
|
| Rate for Payer: Amerigroup Medicaid |
$38.75
|
| Rate for Payer: Amerigroup Medicare |
$30.53
|
| Rate for Payer: Cash Price |
$53.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.23
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.37
|
| Rate for Payer: Medical Associates Commercial |
$50.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.23
|
| Rate for Payer: Midlands Choice Commercial |
$47.03
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.77
|
| Rate for Payer: United Healthcare Commercial |
$60.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.64
|
|
|
sodium chloride, hypertonic, Ophth 5% Sol [VDMC]
|
Facility
|
OP
|
$49.80
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10439002
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.41 |
| Max. Negotiated Rate |
$44.82 |
| Rate for Payer: Aetna of IA Commercial |
$44.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$44.82
|
| Rate for Payer: Aetna of IA Medicare |
$28.39
|
| Rate for Payer: Amerigroup Medicaid |
$28.72
|
| Rate for Payer: Amerigroup Medicare |
$22.63
|
| Rate for Payer: Cash Price |
$39.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.35
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.45
|
| Rate for Payer: Medical Associates Commercial |
$37.35
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.41
|
| Rate for Payer: Midlands Choice Commercial |
$34.86
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$25.77
|
| Rate for Payer: United Healthcare Commercial |
$44.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$29.38
|
|
|
sodium chloride, hypertonic, Ophth 5% Sol [VDMC]
|
Facility
|
IP
|
$49.80
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10439002
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.86 |
| Max. Negotiated Rate |
$44.82 |
| Rate for Payer: Aetna of IA Commercial |
$44.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$44.82
|
| Rate for Payer: Cash Price |
$39.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.35
|
| Rate for Payer: Medical Associates Commercial |
$37.35
|
| Rate for Payer: Midlands Choice Commercial |
$34.86
|
| Rate for Payer: United Healthcare Commercial |
$44.82
|
|
|
sodium chloride nasal 0.65% Gel [VDMC]
|
Facility
|
IP
|
$27.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10438811
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.07 |
| Max. Negotiated Rate |
$24.52 |
| Rate for Payer: Aetna of IA Commercial |
$24.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.52
|
| Rate for Payer: Cash Price |
$21.79
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.43
|
| Rate for Payer: Medical Associates Commercial |
$20.43
|
| Rate for Payer: Midlands Choice Commercial |
$19.07
|
| Rate for Payer: United Healthcare Commercial |
$24.52
|
|
|
sodium chloride nasal 0.65% Gel [VDMC]
|
Facility
|
OP
|
$27.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10438811
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$24.52 |
| Rate for Payer: Aetna of IA Commercial |
$24.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.52
|
| Rate for Payer: Aetna of IA Medicare |
$15.53
|
| Rate for Payer: Amerigroup Medicaid |
$15.71
|
| Rate for Payer: Amerigroup Medicare |
$12.38
|
| Rate for Payer: Cash Price |
$21.79
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.43
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.26
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.56
|
| Rate for Payer: Medical Associates Commercial |
$20.43
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.26
|
| Rate for Payer: Midlands Choice Commercial |
$19.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.10
|
| Rate for Payer: United Healthcare Commercial |
$24.52
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.07
|
|
|
sodium chloride Nasal 0.65% Spry [VDMC]
|
Facility
|
IP
|
$18.04
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10438876
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$16.24 |
| Rate for Payer: Aetna of IA Commercial |
$16.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.24
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.53
|
| Rate for Payer: Medical Associates Commercial |
$13.53
|
| Rate for Payer: Midlands Choice Commercial |
$12.63
|
| Rate for Payer: United Healthcare Commercial |
$16.24
|
|
|
sodium chloride Nasal 0.65% Spry [VDMC]
|
Facility
|
OP
|
$18.04
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10438876
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$16.24 |
| Rate for Payer: Aetna of IA Commercial |
$16.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.24
|
| Rate for Payer: Aetna of IA Medicare |
$10.28
|
| Rate for Payer: Amerigroup Medicaid |
$10.41
|
| Rate for Payer: Amerigroup Medicare |
$8.20
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.53
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.12
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.30
|
| Rate for Payer: Medical Associates Commercial |
$13.53
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.12
|
| Rate for Payer: Midlands Choice Commercial |
$12.63
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.34
|
| Rate for Payer: United Healthcare Commercial |
$16.24
|
| Rate for Payer: United Healthcare Managed Medicare |
$10.64
|
|
