|
sodium hypochlorite 0.125% topical soln [VDMC]
|
Facility
|
OP
|
$64.41
|
|
|
Service Code
|
NDC 00436-0672-16
|
| Hospital Charge Code |
10439067
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.19 |
| Max. Negotiated Rate |
$57.97 |
| Rate for Payer: Aetna of IA Commercial |
$57.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.97
|
| Rate for Payer: Aetna of IA Medicare |
$36.71
|
| Rate for Payer: Amerigroup Medicaid |
$32.51
|
| Rate for Payer: Amerigroup Medicare |
$32.53
|
| Rate for Payer: Cash Price |
$51.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.31
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.19
|
| Rate for Payer: Medical Associates Commercial |
$48.31
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.20
|
| Rate for Payer: Midlands Choice Commercial |
$45.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.69
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$32.67
|
| Rate for Payer: Oscar Health of IA Commercial |
$48.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.31
|
| Rate for Payer: United Healthcare Commercial |
$57.97
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.00
|
|
|
Sodium-K+-Mag-CA-Chlor-Acetate IV Sol 20 mL [VDMC]
|
Facility
|
OP
|
$50.61
|
|
|
Service Code
|
NDC 00409-5779-01
|
| Hospital Charge Code |
10401994
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.29 |
| Max. Negotiated Rate |
$45.55 |
| Rate for Payer: Aetna of IA Commercial |
$45.55
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.55
|
| Rate for Payer: Aetna of IA Medicare |
$28.85
|
| Rate for Payer: Amerigroup Medicaid |
$25.54
|
| Rate for Payer: Amerigroup Medicare |
$25.56
|
| Rate for Payer: Cash Price |
$40.49
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.96
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.29
|
| Rate for Payer: Medical Associates Commercial |
$37.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.30
|
| Rate for Payer: Midlands Choice Commercial |
$35.43
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.68
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$25.67
|
| Rate for Payer: Oscar Health of IA Commercial |
$37.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$37.96
|
| Rate for Payer: United Healthcare Commercial |
$45.55
|
| Rate for Payer: United Healthcare Managed Medicare |
$29.86
|
|
|
Sodium-K+-Mag-CA-Chlor-Acetate IV Sol 20 mL [VDMC]
|
Facility
|
IP
|
$50.61
|
|
|
Service Code
|
NDC 00409-5779-01
|
| Hospital Charge Code |
10401994
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.43 |
| Max. Negotiated Rate |
$45.55 |
| Rate for Payer: Aetna of IA Commercial |
$45.55
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.55
|
| Rate for Payer: Cash Price |
$40.49
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.96
|
| Rate for Payer: Medical Associates Commercial |
$37.96
|
| Rate for Payer: Midlands Choice Commercial |
$35.43
|
| Rate for Payer: United Healthcare Commercial |
$45.55
|
|
|
Sodium Nitroprusside 25 mg/mL 2ml SDV [VDMC]
|
Facility
|
IP
|
$67.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10409275
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.32 |
| Max. Negotiated Rate |
$60.84 |
| Rate for Payer: Aetna of IA Commercial |
$60.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.84
|
| Rate for Payer: Cash Price |
$54.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.70
|
| Rate for Payer: Medical Associates Commercial |
$50.70
|
| Rate for Payer: Midlands Choice Commercial |
$47.32
|
| Rate for Payer: United Healthcare Commercial |
$60.84
|
|
|
Sodium Nitroprusside 25 mg/mL 2ml SDV [VDMC]
|
Facility
|
OP
|
$67.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10409275
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.79 |
| Max. Negotiated Rate |
$60.84 |
| Rate for Payer: Aetna of IA Commercial |
$60.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.84
|
| Rate for Payer: Aetna of IA Medicare |
$38.53
|
| Rate for Payer: Amerigroup Medicaid |
$34.12
|
| Rate for Payer: Amerigroup Medicare |
$34.14
|
| Rate for Payer: Cash Price |
$54.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.70
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.79
|
| Rate for Payer: Medical Associates Commercial |
$50.70
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.80
|
| Rate for Payer: Midlands Choice Commercial |
$47.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.31
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$34.29
|
| Rate for Payer: Oscar Health of IA Commercial |
$50.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.70
|
| Rate for Payer: United Healthcare Commercial |
$60.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.88
|
|
|
sodium phosphate-sodium biphosphate 18%-48% Oral Sol 45 mL [VDMC]
|
Facility
|
IP
|
$20.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10421497
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$18.11 |
| Rate for Payer: Aetna of IA Commercial |
$18.11
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.11
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.09
|
| Rate for Payer: Medical Associates Commercial |
$15.09
|
| Rate for Payer: Midlands Choice Commercial |
$14.08
|
| Rate for Payer: United Healthcare Commercial |
$18.11
|
|
|
sodium phosphate-sodium biphosphate 18%-48% Oral Sol 45 mL [VDMC]
|
Facility
|
OP
|
$20.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10421497
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$18.11 |
| Rate for Payer: Aetna of IA Commercial |
$18.11
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.11
|
| Rate for Payer: Aetna of IA Medicare |
$11.47
|
| Rate for Payer: Amerigroup Medicaid |
$10.15
|
| Rate for Payer: Amerigroup Medicare |
$10.16
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.09
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.06
|
| Rate for Payer: Medical Associates Commercial |
$15.09
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.06
|
| Rate for Payer: Midlands Choice Commercial |
$14.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.21
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$10.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$15.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$15.09
|
| Rate for Payer: United Healthcare Commercial |
$18.11
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.87
|
|
|
sodium polystyrene sulfonate 15 g/60 mL Oral Susp [VDMC]
|
Facility
|
OP
|
$75.74
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10421822
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.85 |
| Max. Negotiated Rate |
$68.17 |
| Rate for Payer: Aetna of IA Commercial |
$68.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.17
|
| Rate for Payer: Aetna of IA Medicare |
$43.17
|
| Rate for Payer: Amerigroup Medicaid |
$38.23
|
| Rate for Payer: Amerigroup Medicare |
$38.25
|
| Rate for Payer: Cash Price |
$60.59
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$56.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$37.87
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.85
|
| Rate for Payer: Medical Associates Commercial |
$56.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.87
|
| Rate for Payer: Midlands Choice Commercial |
$53.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.44
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$38.42
|
| Rate for Payer: Oscar Health of IA Commercial |
$56.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.80
|
| Rate for Payer: United Healthcare Commercial |
$68.17
|
| Rate for Payer: United Healthcare Managed Medicare |
$44.69
|
|
|
sodium polystyrene sulfonate 15 g/60 mL Oral Susp [VDMC]
|
Facility
|
IP
|
$75.74
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10421822
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.02 |
| Max. Negotiated Rate |
$68.17 |
| Rate for Payer: Aetna of IA Commercial |
$68.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.17
|
| Rate for Payer: Cash Price |
$60.59
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$56.80
|
| Rate for Payer: Medical Associates Commercial |
$56.80
|
| Rate for Payer: Midlands Choice Commercial |
$53.02
|
| Rate for Payer: United Healthcare Commercial |
$68.17
|
|
|
sodium thiosulfate 25% SDV Sol[VDMC]
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
NDC 60267-0705-50
|
| Hospital Charge Code |
12817991
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Aetna of IA Commercial |
$365.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$365.40
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$304.50
|
| Rate for Payer: Medical Associates Commercial |
$304.50
|
| Rate for Payer: Midlands Choice Commercial |
$284.20
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
|
|
sodium thiosulfate 25% SDV Sol[VDMC]
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
NDC 60267-0705-50
|
| Hospital Charge Code |
12817991
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$202.92 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Aetna of IA Commercial |
$365.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$365.40
|
| Rate for Payer: Aetna of IA Medicare |
$231.42
|
| Rate for Payer: Amerigroup Medicaid |
$204.91
|
| Rate for Payer: Amerigroup Medicare |
$205.03
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$304.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$203.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.92
|
| Rate for Payer: Medical Associates Commercial |
$304.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$203.00
|
| Rate for Payer: Midlands Choice Commercial |
$284.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$206.04
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$205.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$304.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$304.50
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$239.54
|
|
|
Soft Tissue Procedures With CC
|
Facility
|
IP
|
$12,716.40
|
|
|
Service Code
|
MS-DRG 501
|
| Hospital Charge Code |
318
|
| Min. Negotiated Rate |
$12,532.11 |
| Max. Negotiated Rate |
$12,716.40 |
| Rate for Payer: Amerigroup Medicaid |
$12,654.97
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12,532.11
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,716.40
|
|
|
Soft Tissue Procedures With MCC
|
Facility
|
IP
|
$19,360.03
|
|
|
Service Code
|
MS-DRG 500
|
| Hospital Charge Code |
317
|
| Min. Negotiated Rate |
$19,079.45 |
| Max. Negotiated Rate |
$19,360.03 |
| Rate for Payer: Amerigroup Medicaid |
$19,266.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19,079.45
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19,360.03
|
|
|
Soft Tissue Procedures Without CC/MCC
|
Facility
|
IP
|
$10,835.52
|
|
|
Service Code
|
MS-DRG 502
|
| Hospital Charge Code |
319
|
| Min. Negotiated Rate |
$10,678.48 |
| Max. Negotiated Rate |
$10,835.52 |
| Rate for Payer: Amerigroup Medicaid |
$10,783.17
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10,678.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,835.52
|
|
|
solifenacin 5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.53
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10421889
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna of IA Commercial |
$1.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.38
|
| 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 |
$1.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.15
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.77
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.76
|
| Rate for Payer: Medical Associates Commercial |
$1.15
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.77
|
| Rate for Payer: Midlands Choice Commercial |
$1.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.78
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.78
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.15
|
| Rate for Payer: United Healthcare Commercial |
$1.38
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.90
|
|
|
solifenacin 5 mg Tab [VDMC]
|
Facility
|
IP
|
$1.53
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10421889
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna of IA Commercial |
$1.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.38
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.15
|
| Rate for Payer: Medical Associates Commercial |
$1.15
|
| Rate for Payer: Midlands Choice Commercial |
$1.07
|
| Rate for Payer: United Healthcare Commercial |
$1.38
|
|
|
Soluble Transferrin Receptor DMCL
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
8820558
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.47 |
| 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 |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| 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 |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$70.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$104.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$102.92
|
| Rate for Payer: Wellmark IA PPO |
$113.21
|
|
|
Soluble Transferrin Receptor DMCL
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
8820558
|
|
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
|
|
|
SONICANCHOR KIT 2.5X10MM/ FOREC FIBRE #0
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8470642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.36 |
| Max. Negotiated Rate |
$623.70 |
| Rate for Payer: Aetna of IA Commercial |
$623.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$623.70
|
| Rate for Payer: Aetna of IA Medicare |
$395.01
|
| Rate for Payer: Amerigroup Medicaid |
$349.76
|
| Rate for Payer: Amerigroup Medicare |
$349.96
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$519.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$346.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$346.36
|
| Rate for Payer: Medical Associates Commercial |
$519.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$346.50
|
| Rate for Payer: Midlands Choice Commercial |
$485.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$351.70
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$351.49
|
| Rate for Payer: Oscar Health of IA Commercial |
$519.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$519.75
|
| Rate for Payer: United Healthcare Commercial |
$623.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$408.87
|
|
|
SONICANCHOR KIT 2.5X10MM/ FOREC FIBRE #0
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8470642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$485.10 |
| Max. Negotiated Rate |
$623.70 |
| Rate for Payer: Aetna of IA Commercial |
$623.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$623.70
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$519.75
|
| Rate for Payer: Medical Associates Commercial |
$519.75
|
| Rate for Payer: Midlands Choice Commercial |
$485.10
|
| Rate for Payer: United Healthcare Commercial |
$623.70
|
|
|
SORBAFIX ABSORBABLE FIXATION SYSTEM
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8773701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.70 |
| Max. Negotiated Rate |
$639.90 |
| Rate for Payer: Aetna of IA Commercial |
$639.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$639.90
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$533.25
|
| Rate for Payer: Medical Associates Commercial |
$533.25
|
| Rate for Payer: Midlands Choice Commercial |
$497.70
|
| Rate for Payer: United Healthcare Commercial |
$639.90
|
|
|
SORBAFIX ABSORBABLE FIXATION SYSTEM
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8773701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.36 |
| Max. Negotiated Rate |
$639.90 |
| Rate for Payer: Aetna of IA Commercial |
$639.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$639.90
|
| Rate for Payer: Aetna of IA Medicare |
$405.27
|
| Rate for Payer: Amerigroup Medicaid |
$358.84
|
| Rate for Payer: Amerigroup Medicare |
$359.06
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$533.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$355.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$355.36
|
| Rate for Payer: Medical Associates Commercial |
$533.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$355.50
|
| Rate for Payer: Midlands Choice Commercial |
$497.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$360.83
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$360.62
|
| Rate for Payer: Oscar Health of IA Commercial |
$533.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$533.25
|
| Rate for Payer: United Healthcare Commercial |
$639.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$419.49
|
|
|
sotalol 120 mg Tab [VDMC]
|
Facility
|
OP
|
$1.29
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
17311425
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of IA Commercial |
$1.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.16
|
| Rate for Payer: Aetna of IA Medicare |
$0.74
|
| Rate for Payer: Amerigroup Medicaid |
$0.65
|
| Rate for Payer: Amerigroup Medicare |
$0.65
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.64
|
| Rate for Payer: Medical Associates Commercial |
$0.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.65
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.65
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.65
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.97
|
| Rate for Payer: United Healthcare Commercial |
$1.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.76
|
|
|
sotalol 120 mg Tab [VDMC]
|
Facility
|
IP
|
$1.29
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
17311425
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of IA Commercial |
$1.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.16
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.97
|
| Rate for Payer: Medical Associates Commercial |
$0.97
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.16
|
|
|
sotalol 80 mg Tab [VDMC]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10421958
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna of IA Commercial |
$1.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.08
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.90
|
| Rate for Payer: Medical Associates Commercial |
$0.90
|
| Rate for Payer: Midlands Choice Commercial |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.08
|
|
