|
brimonidine Ophth 0.2% Sol 5 ml [VDMC]
|
Facility
|
IP
|
$27.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433542
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna of IA Commercial |
$24.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.88
|
| Rate for Payer: Cash Price |
$22.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.73
|
| Rate for Payer: Medical Associates Commercial |
$20.73
|
| Rate for Payer: Midlands Choice Commercial |
$19.35
|
| Rate for Payer: United Healthcare Commercial |
$24.88
|
|
|
brimonidine Ophth 0.2% Sol 5 ml [VDMC]
|
Facility
|
OP
|
$27.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433542
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: United Healthcare Commercial |
$24.88
|
| Rate for Payer: Aetna of IA Commercial |
$24.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.88
|
| Rate for Payer: Aetna of IA Medicare |
$15.75
|
| Rate for Payer: Amerigroup Medicaid |
$13.95
|
| Rate for Payer: Amerigroup Medicare |
$13.96
|
| Rate for Payer: Cash Price |
$22.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.81
|
| Rate for Payer: Medical Associates Commercial |
$20.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.82
|
| Rate for Payer: Midlands Choice Commercial |
$19.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.03
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$14.02
|
| Rate for Payer: Oscar Health of IA Commercial |
$20.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.73
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.31
|
|
|
brinzolamide Ophth 1% Susp 10 ml[VDMC]
|
Facility
|
OP
|
$1,212.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433607
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$606.00 |
| Max. Negotiated Rate |
$1,091.23 |
| Rate for Payer: Aetna of IA Commercial |
$1,091.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,091.23
|
| Rate for Payer: Aetna of IA Medicare |
$691.11
|
| Rate for Payer: Amerigroup Medicaid |
$611.94
|
| Rate for Payer: Amerigroup Medicare |
$612.30
|
| Rate for Payer: Cash Price |
$969.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$909.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$606.24
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$606.00
|
| Rate for Payer: Medical Associates Commercial |
$909.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$606.24
|
| Rate for Payer: Midlands Choice Commercial |
$848.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$615.33
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$614.97
|
| Rate for Payer: Oscar Health of IA Commercial |
$909.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$909.36
|
| Rate for Payer: United Healthcare Commercial |
$1,091.23
|
| Rate for Payer: United Healthcare Managed Medicare |
$715.36
|
|
|
brinzolamide Ophth 1% Susp 10 ml[VDMC]
|
Facility
|
IP
|
$1,212.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433607
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$848.74 |
| Max. Negotiated Rate |
$1,091.23 |
| Rate for Payer: Aetna of IA Commercial |
$1,091.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,091.23
|
| Rate for Payer: Cash Price |
$969.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$909.36
|
| Rate for Payer: Medical Associates Commercial |
$909.36
|
| Rate for Payer: Midlands Choice Commercial |
$848.74
|
| Rate for Payer: United Healthcare Commercial |
$1,091.23
|
|
|
BRNCDILAT RSPSE SPMTRY PREPOST BRNCDILA
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
5338944
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
|
|
BRNCDILAT RSPSE SPMTRY PREPOST BRNCDILA
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
5338944
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$166.43 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Aetna of IA Medicare |
$189.81
|
| Rate for Payer: Amerigroup Medicaid |
$168.07
|
| Rate for Payer: Amerigroup Medicare |
$168.16
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$166.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$166.43
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$166.50
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$169.00
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$168.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$249.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$249.75
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
| Rate for Payer: Wellmark IA HMO |
$256.68
|
| Rate for Payer: Wellmark IA PPO |
$282.35
|
|
|
Bronchitis and Asthma With CC/MCC
|
Facility
|
IP
|
$6,520.60
|
|
|
Service Code
|
MS-DRG 202
|
| Hospital Charge Code |
73
|
| Min. Negotiated Rate |
$6,426.10 |
| Max. Negotiated Rate |
$6,520.60 |
| Rate for Payer: Amerigroup Medicaid |
$6,489.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,426.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,520.60
|
|
|
Bronchitis and Asthma Without CC/MCC
|
Facility
|
IP
|
$4,740.10
|
|
|
Service Code
|
MS-DRG 203
|
| Hospital Charge Code |
74
|
| Min. Negotiated Rate |
$4,671.41 |
| Max. Negotiated Rate |
$4,740.10 |
| Rate for Payer: Amerigroup Medicaid |
$4,717.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,671.41
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,740.10
|
|
|
BRONCHOSCOPY DX
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
8059061
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$395.34 |
| Max. Negotiated Rate |
$2,981.02 |
| Rate for Payer: Aetna of IA Commercial |
$711.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$711.90
|
| Rate for Payer: Aetna of IA Medicare |
$450.87
|
| Rate for Payer: Amerigroup Medicaid |
$399.22
|
| Rate for Payer: Amerigroup Medicare |
$399.46
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$593.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$395.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$395.34
|
| Rate for Payer: Medical Associates Commercial |
$593.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$395.50
|
| Rate for Payer: Midlands Choice Commercial |
$553.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$401.43
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$401.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$593.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$593.25
|
| Rate for Payer: United Healthcare Commercial |
$711.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$466.69
|
| Rate for Payer: Wellmark IA HMO |
$2,710.02
|
| Rate for Payer: Wellmark IA PPO |
$2,981.02
|
|
|
BRONCHOSCOPY DX
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
8059061
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$553.70 |
| Max. Negotiated Rate |
$711.90 |
| Rate for Payer: Aetna of IA Commercial |
$711.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$711.90
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$593.25
|
| Rate for Payer: Medical Associates Commercial |
$593.25
|
| Rate for Payer: Midlands Choice Commercial |
$553.70
|
| Rate for Payer: United Healthcare Commercial |
$711.90
|
|
|
budesonide 0.25 mg/2 mL neb Sol SDV [VDMC]
|
Facility
|
IP
|
$19.96
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10370896
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna of IA Commercial |
$17.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.96
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.97
|
| Rate for Payer: Medical Associates Commercial |
$14.97
|
| Rate for Payer: Midlands Choice Commercial |
$13.97
|
| Rate for Payer: United Healthcare Commercial |
$17.96
|
|
|
budesonide 0.25 mg/2 mL neb Sol SDV [VDMC]
|
Facility
|
OP
|
$19.96
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10370896
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna of IA Commercial |
$17.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.96
|
| Rate for Payer: Aetna of IA Medicare |
$11.38
|
| Rate for Payer: Amerigroup Medicaid |
$10.07
|
| Rate for Payer: Amerigroup Medicare |
$10.08
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9.98
|
| Rate for Payer: Medical Associates Commercial |
$14.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.98
|
| Rate for Payer: Midlands Choice Commercial |
$13.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.13
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$10.12
|
| Rate for Payer: Oscar Health of IA Commercial |
$14.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.97
|
| Rate for Payer: United Healthcare Commercial |
$17.96
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.78
|
|
|
budesonide 0.5 mg/2 mL neb Sol SDV [VDMC]
|
Facility
|
OP
|
$14.99
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
10370967
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$13.49 |
| Rate for Payer: Aetna of IA Commercial |
$13.49
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.49
|
| Rate for Payer: Aetna of IA Medicare |
$8.54
|
| Rate for Payer: Amerigroup Medicaid |
$7.57
|
| Rate for Payer: Amerigroup Medicare |
$7.57
|
| Rate for Payer: Cash Price |
$11.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.49
|
| Rate for Payer: Medical Associates Commercial |
$11.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.50
|
| Rate for Payer: Midlands Choice Commercial |
$10.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.61
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$7.60
|
| Rate for Payer: Oscar Health of IA Commercial |
$11.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.24
|
| Rate for Payer: United Healthcare Commercial |
$13.49
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.84
|
|
|
budesonide 0.5 mg/2 mL neb Sol SDV [VDMC]
|
Facility
|
IP
|
$14.99
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
10370967
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$13.49 |
| Rate for Payer: Aetna of IA Commercial |
$13.49
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.49
|
| Rate for Payer: Cash Price |
$11.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.24
|
| Rate for Payer: Medical Associates Commercial |
$11.24
|
| Rate for Payer: Midlands Choice Commercial |
$10.49
|
| Rate for Payer: United Healthcare Commercial |
$13.49
|
|
|
budesonide 3 mg DR Cap [VDMC]
|
Facility
|
IP
|
$2.94
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10371038
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna of IA Commercial |
$2.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.65
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.20
|
| Rate for Payer: Medical Associates Commercial |
$2.20
|
| Rate for Payer: Midlands Choice Commercial |
$2.06
|
| Rate for Payer: United Healthcare Commercial |
$2.65
|
|
|
budesonide 3 mg DR Cap [VDMC]
|
Facility
|
OP
|
$2.94
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10371038
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna of IA Commercial |
$2.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.65
|
| Rate for Payer: Aetna of IA Medicare |
$1.68
|
| Rate for Payer: Amerigroup Medicaid |
$1.48
|
| Rate for Payer: Amerigroup Medicare |
$1.48
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.20
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.47
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.47
|
| Rate for Payer: Medical Associates Commercial |
$2.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.47
|
| Rate for Payer: Midlands Choice Commercial |
$2.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.49
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.49
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.20
|
| Rate for Payer: United Healthcare Commercial |
$2.65
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.73
|
|
|
budesonide-formoterol 160 mcg-4.5 mcg/inh 6gm HFA Inhaler [VDMC]
|
Facility
|
OP
|
$651.76
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
20466680
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$325.75 |
| Max. Negotiated Rate |
$586.58 |
| Rate for Payer: Aetna of IA Commercial |
$586.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$586.58
|
| Rate for Payer: Aetna of IA Medicare |
$371.50
|
| Rate for Payer: Amerigroup Medicaid |
$328.94
|
| Rate for Payer: Amerigroup Medicare |
$329.14
|
| Rate for Payer: Cash Price |
$521.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$488.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$325.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$325.75
|
| Rate for Payer: Medical Associates Commercial |
$488.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$325.88
|
| Rate for Payer: Midlands Choice Commercial |
$456.23
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$330.77
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$330.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$488.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$488.82
|
| Rate for Payer: United Healthcare Commercial |
$586.58
|
| Rate for Payer: United Healthcare Managed Medicare |
$384.54
|
|
|
budesonide-formoterol 160 mcg-4.5 mcg/inh 6gm HFA Inhaler [VDMC]
|
Facility
|
IP
|
$651.76
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
20466680
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$456.23 |
| Max. Negotiated Rate |
$586.58 |
| Rate for Payer: Aetna of IA Commercial |
$586.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$586.58
|
| Rate for Payer: Cash Price |
$521.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$488.82
|
| Rate for Payer: Medical Associates Commercial |
$488.82
|
| Rate for Payer: Midlands Choice Commercial |
$456.23
|
| Rate for Payer: United Healthcare Commercial |
$586.58
|
|
|
buffered lidocaine/epi 1:100,000/8.4% 5ml Syringe[VDMC]
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
NDC 99999-6625-02
|
| Hospital Charge Code |
15046134
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Aetna of IA Medicare |
$22.80
|
| Rate for Payer: Amerigroup Medicaid |
$20.19
|
| Rate for Payer: Amerigroup Medicare |
$20.20
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.99
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.30
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$20.29
|
| Rate for Payer: Oscar Health of IA Commercial |
$30.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.60
|
|
|
buffered lidocaine/epi 1:100,000/8.4% 5ml Syringe[VDMC]
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
NDC 99999-6625-02
|
| Hospital Charge Code |
15046134
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
|
|
bumetanide 0.25 mg/mL 10ml MDV Inj Sol [VDMC]
|
Facility
|
OP
|
$32.06
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10371107
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$28.85 |
| Rate for Payer: Aetna of IA Commercial |
$28.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.85
|
| Rate for Payer: Aetna of IA Medicare |
$18.27
|
| Rate for Payer: Amerigroup Medicaid |
$16.18
|
| Rate for Payer: Amerigroup Medicare |
$16.19
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.03
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.02
|
| Rate for Payer: Medical Associates Commercial |
$24.04
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.03
|
| Rate for Payer: Midlands Choice Commercial |
$22.44
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.27
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$16.26
|
| Rate for Payer: Oscar Health of IA Commercial |
$24.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.04
|
| Rate for Payer: United Healthcare Commercial |
$28.85
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.92
|
|
|
bumetanide 0.25 mg/mL 10ml MDV Inj Sol [VDMC]
|
Facility
|
IP
|
$32.06
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10371107
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$28.85 |
| Rate for Payer: Aetna of IA Commercial |
$28.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.85
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.04
|
| Rate for Payer: Medical Associates Commercial |
$24.04
|
| Rate for Payer: Midlands Choice Commercial |
$22.44
|
| Rate for Payer: United Healthcare Commercial |
$28.85
|
|
|
bumetanide 1 mg Tab [VDMC]
|
Facility
|
OP
|
$3.58
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10371247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: Aetna of IA Commercial |
$3.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.22
|
| Rate for Payer: Aetna of IA Medicare |
$2.04
|
| Rate for Payer: Amerigroup Medicaid |
$1.81
|
| Rate for Payer: Amerigroup Medicare |
$1.81
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.68
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.79
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.79
|
| Rate for Payer: Medical Associates Commercial |
$2.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.79
|
| Rate for Payer: Midlands Choice Commercial |
$2.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.82
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.68
|
| Rate for Payer: United Healthcare Commercial |
$3.22
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.11
|
|
|
bumetanide 1 mg Tab [VDMC]
|
Facility
|
IP
|
$3.58
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10371247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: Aetna of IA Commercial |
$3.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.22
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.68
|
| Rate for Payer: Medical Associates Commercial |
$2.68
|
| Rate for Payer: Midlands Choice Commercial |
$2.51
|
| Rate for Payer: United Healthcare Commercial |
$3.22
|
|
|
BUN
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
633605
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Aetna of IA Medicare |
$22.80
|
| Rate for Payer: Amerigroup Medicaid |
$20.19
|
| Rate for Payer: Amerigroup Medicare |
$20.20
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.99
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.30
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$20.29
|
| Rate for Payer: Oscar Health of IA Commercial |
$30.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.60
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
