|
dexamethasone 0.5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.37
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10381637
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Aetna of IA Commercial |
$1.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.24
|
| Rate for Payer: Aetna of IA Medicare |
$0.78
|
| Rate for Payer: Amerigroup Medicaid |
$0.79
|
| Rate for Payer: Amerigroup Medicare |
$0.62
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.03
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.79
|
| Rate for Payer: Medical Associates Commercial |
$1.03
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.62
|
| Rate for Payer: Midlands Choice Commercial |
$0.96
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.71
|
| Rate for Payer: United Healthcare Commercial |
$1.24
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.81
|
|
|
dexamethasone 0.5 mg Tab [VDMC]
|
Facility
|
IP
|
$1.37
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10381637
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Aetna of IA Commercial |
$1.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.24
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.03
|
| Rate for Payer: Medical Associates Commercial |
$1.03
|
| Rate for Payer: Midlands Choice Commercial |
$0.96
|
| Rate for Payer: United Healthcare Commercial |
$1.24
|
|
|
dexamethasone 10 mg/mL 1 ml SDV PRESERVATIVE-FREE inj [VDMC]
|
Facility
|
IP
|
$25.37
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
12738943
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$22.84 |
| Rate for Payer: Aetna of IA Commercial |
$22.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.84
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.03
|
| Rate for Payer: Medical Associates Commercial |
$19.03
|
| Rate for Payer: Midlands Choice Commercial |
$17.76
|
| Rate for Payer: United Healthcare Commercial |
$22.84
|
|
|
dexamethasone 10 mg/mL 1 ml SDV PRESERVATIVE-FREE inj [VDMC]
|
Facility
|
OP
|
$25.37
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
12738943
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$22.84 |
| Rate for Payer: Aetna of IA Commercial |
$22.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.84
|
| Rate for Payer: Aetna of IA Medicare |
$14.46
|
| Rate for Payer: Amerigroup Medicaid |
$14.64
|
| Rate for Payer: Amerigroup Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.03
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.49
|
| Rate for Payer: Medical Associates Commercial |
$19.03
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.42
|
| Rate for Payer: Midlands Choice Commercial |
$17.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$13.13
|
| Rate for Payer: United Healthcare Commercial |
$22.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.97
|
|
|
dexamethasone 4 mg/mL 5 ml MDV inj [VDMC]
|
Facility
|
IP
|
$23.16
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
10381834
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$20.85 |
| Rate for Payer: Aetna of IA Commercial |
$20.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.85
|
| Rate for Payer: Cash Price |
$18.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.37
|
| Rate for Payer: Medical Associates Commercial |
$17.37
|
| Rate for Payer: Midlands Choice Commercial |
$16.22
|
| Rate for Payer: United Healthcare Commercial |
$20.85
|
|
|
dexamethasone 4 mg/mL 5 ml MDV inj [VDMC]
|
Facility
|
OP
|
$23.16
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
10381834
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$20.85 |
| Rate for Payer: Aetna of IA Commercial |
$20.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.85
|
| Rate for Payer: Aetna of IA Medicare |
$13.20
|
| Rate for Payer: Amerigroup Medicaid |
$13.36
|
| Rate for Payer: Amerigroup Medicare |
$10.53
|
| Rate for Payer: Cash Price |
$18.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.37
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.23
|
| Rate for Payer: Medical Associates Commercial |
$17.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.42
|
| Rate for Payer: Midlands Choice Commercial |
$16.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.99
|
| Rate for Payer: United Healthcare Commercial |
$20.85
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.67
|
|
|
dexamethasone 4 mg Tab [VDMC]
|
Facility
|
OP
|
$4.84
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10381765
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna of IA Commercial |
$4.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.36
|
| Rate for Payer: Aetna of IA Medicare |
$2.76
|
| Rate for Payer: Amerigroup Medicaid |
$2.79
|
| Rate for Payer: Amerigroup Medicare |
$2.20
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.63
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.18
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.77
|
| Rate for Payer: Medical Associates Commercial |
$3.63
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.18
|
| Rate for Payer: Midlands Choice Commercial |
$3.39
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.51
|
| Rate for Payer: United Healthcare Commercial |
$4.36
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.86
|
|
|
dexamethasone 4 mg Tab [VDMC]
|
Facility
|
IP
|
$4.84
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10381765
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna of IA Commercial |
$4.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.36
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.63
|
| Rate for Payer: Medical Associates Commercial |
$3.63
|
| Rate for Payer: Midlands Choice Commercial |
$3.39
|
| Rate for Payer: United Healthcare Commercial |
$4.36
|
|
|
dexlansoprazole 60 mg Oral DR Cap [VDMC]
|
Facility
|
IP
|
$20.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27357838
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$18.08 |
| Rate for Payer: Aetna of IA Commercial |
$18.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.08
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.06
|
| Rate for Payer: Medical Associates Commercial |
$15.06
|
| Rate for Payer: Midlands Choice Commercial |
$14.06
|
| Rate for Payer: United Healthcare Commercial |
$18.08
|
|
|
dexlansoprazole 60 mg Oral DR Cap [VDMC]
|
Facility
|
OP
|
$20.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27357838
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$18.08 |
| Rate for Payer: Aetna of IA Commercial |
$18.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.08
|
| Rate for Payer: Aetna of IA Medicare |
$11.45
|
| Rate for Payer: Amerigroup Medicaid |
$11.58
|
| Rate for Payer: Amerigroup Medicare |
$9.13
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.06
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.47
|
| Rate for Payer: Medical Associates Commercial |
$15.06
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.04
|
| Rate for Payer: Midlands Choice Commercial |
$14.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$10.39
|
| Rate for Payer: United Healthcare Commercial |
$18.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.85
|
|
|
dexmedetomidine 100 mcg/mL 2 ml SDV inj [VDMC]
|
Facility
|
OP
|
$26.71
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
11219809
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$24.04 |
| Rate for Payer: Aetna of IA Commercial |
$24.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.04
|
| Rate for Payer: Aetna of IA Medicare |
$15.22
|
| Rate for Payer: Amerigroup Medicaid |
$15.41
|
| Rate for Payer: Amerigroup Medicare |
$12.14
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.03
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.26
|
| Rate for Payer: Medical Associates Commercial |
$20.03
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.02
|
| Rate for Payer: Midlands Choice Commercial |
$18.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$13.82
|
| Rate for Payer: United Healthcare Commercial |
$24.04
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.76
|
|
|
dexmedetomidine 100 mcg/mL 2 ml SDV inj [VDMC]
|
Facility
|
IP
|
$26.71
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
11219809
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$24.04 |
| Rate for Payer: Aetna of IA Commercial |
$24.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.04
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.03
|
| Rate for Payer: Medical Associates Commercial |
$20.03
|
| Rate for Payer: Midlands Choice Commercial |
$18.70
|
| Rate for Payer: United Healthcare Commercial |
$24.04
|
|
|
Dextrose 10% in Water intravenous solution 500 mL [VDMC]
|
Facility
|
OP
|
$69.40
|
|
|
Service Code
|
HCPCS J7799
|
| Hospital Charge Code |
10440241
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.23 |
| Max. Negotiated Rate |
$62.46 |
| Rate for Payer: Aetna of IA Commercial |
$62.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$62.46
|
| Rate for Payer: Aetna of IA Medicare |
$39.56
|
| Rate for Payer: Amerigroup Medicaid |
$40.03
|
| Rate for Payer: Amerigroup Medicare |
$31.54
|
| Rate for Payer: Cash Price |
$55.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.05
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.23
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$39.64
|
| Rate for Payer: Medical Associates Commercial |
$52.05
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.23
|
| Rate for Payer: Midlands Choice Commercial |
$48.58
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$40.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$35.91
|
| Rate for Payer: United Healthcare Commercial |
$62.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$40.95
|
|
|
Dextrose 10% in Water intravenous solution 500 mL [VDMC]
|
Facility
|
IP
|
$69.40
|
|
|
Service Code
|
HCPCS J7799
|
| Hospital Charge Code |
10440241
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$48.58 |
| Max. Negotiated Rate |
$62.46 |
| Rate for Payer: Aetna of IA Commercial |
$62.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$62.46
|
| Rate for Payer: Cash Price |
$55.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.05
|
| Rate for Payer: Medical Associates Commercial |
$52.05
|
| Rate for Payer: Midlands Choice Commercial |
$48.58
|
| Rate for Payer: United Healthcare Commercial |
$62.46
|
|
|
dextrose 40% Oral gel [VDMC]
|
Facility
|
OP
|
$13.31
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10392316
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$11.98 |
| Rate for Payer: Aetna of IA Commercial |
$11.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.98
|
| Rate for Payer: Aetna of IA Medicare |
$7.58
|
| Rate for Payer: Amerigroup Medicaid |
$7.68
|
| Rate for Payer: Amerigroup Medicare |
$6.05
|
| Rate for Payer: Cash Price |
$10.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.98
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.60
|
| Rate for Payer: Medical Associates Commercial |
$9.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.99
|
| Rate for Payer: Midlands Choice Commercial |
$9.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$6.89
|
| Rate for Payer: United Healthcare Commercial |
$11.98
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.85
|
|
|
dextrose 40% Oral gel [VDMC]
|
Facility
|
IP
|
$13.31
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10392316
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$11.98 |
| Rate for Payer: Aetna of IA Commercial |
$11.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.98
|
| Rate for Payer: Cash Price |
$10.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.98
|
| Rate for Payer: Medical Associates Commercial |
$9.98
|
| Rate for Payer: Midlands Choice Commercial |
$9.31
|
| Rate for Payer: United Healthcare Commercial |
$11.98
|
|
|
Dextrose 5% in Lactated Ringers 1000ml IV [VDMC]
|
Facility
|
OP
|
$68.20
|
|
|
Service Code
|
HCPCS J7121
|
| Hospital Charge Code |
10440304
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.69 |
| Max. Negotiated Rate |
$61.38 |
| Rate for Payer: Aetna of IA Commercial |
$61.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$61.38
|
| Rate for Payer: Aetna of IA Medicare |
$38.87
|
| Rate for Payer: Amerigroup Medicaid |
$39.34
|
| Rate for Payer: Amerigroup Medicare |
$31.00
|
| Rate for Payer: Cash Price |
$54.56
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.15
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.69
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.96
|
| Rate for Payer: Medical Associates Commercial |
$51.15
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.69
|
| Rate for Payer: Midlands Choice Commercial |
$47.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$35.29
|
| Rate for Payer: United Healthcare Commercial |
$61.38
|
| Rate for Payer: United Healthcare Managed Medicare |
$40.24
|
|
|
Dextrose 5% in Lactated Ringers 1000ml IV [VDMC]
|
Facility
|
IP
|
$68.20
|
|
|
Service Code
|
HCPCS J7121
|
| Hospital Charge Code |
10440304
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$61.38 |
| Rate for Payer: Aetna of IA Commercial |
$61.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$61.38
|
| Rate for Payer: Cash Price |
$54.56
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.15
|
| Rate for Payer: Medical Associates Commercial |
$51.15
|
| Rate for Payer: Midlands Choice Commercial |
$47.74
|
| Rate for Payer: United Healthcare Commercial |
$61.38
|
|
|
Dextrose 5% in Water IV 500ml Sol PVC FREE [VDMC]
|
Facility
|
OP
|
$71.36
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
13773598
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.11 |
| Max. Negotiated Rate |
$64.22 |
| Rate for Payer: Aetna of IA Commercial |
$64.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.22
|
| Rate for Payer: Aetna of IA Medicare |
$40.68
|
| Rate for Payer: Amerigroup Medicaid |
$41.16
|
| Rate for Payer: Amerigroup Medicare |
$32.43
|
| Rate for Payer: Cash Price |
$57.09
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.11
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.76
|
| Rate for Payer: Medical Associates Commercial |
$53.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.11
|
| Rate for Payer: Midlands Choice Commercial |
$49.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$36.93
|
| Rate for Payer: United Healthcare Commercial |
$64.22
|
| Rate for Payer: United Healthcare Managed Medicare |
$42.10
|
|
|
Dextrose 5% in Water IV 500ml Sol PVC FREE [VDMC]
|
Facility
|
IP
|
$71.36
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
13773598
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$49.95 |
| Max. Negotiated Rate |
$64.22 |
| Rate for Payer: Aetna of IA Commercial |
$64.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.22
|
| Rate for Payer: Cash Price |
$57.09
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.52
|
| Rate for Payer: Medical Associates Commercial |
$53.52
|
| Rate for Payer: Midlands Choice Commercial |
$49.95
|
| Rate for Payer: United Healthcare Commercial |
$64.22
|
|
|
Dextrose 5% in Water IV Sol 1000 mL [VDMC]
|
Facility
|
OP
|
$74.40
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
10440505
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$66.96 |
| Rate for Payer: Aetna of IA Commercial |
$66.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.96
|
| Rate for Payer: Aetna of IA Medicare |
$42.41
|
| Rate for Payer: Amerigroup Medicaid |
$42.91
|
| Rate for Payer: Amerigroup Medicare |
$33.81
|
| Rate for Payer: Cash Price |
$59.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.50
|
| Rate for Payer: Medical Associates Commercial |
$55.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.48
|
| Rate for Payer: Midlands Choice Commercial |
$52.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$38.50
|
| Rate for Payer: United Healthcare Commercial |
$66.96
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.90
|
|
|
Dextrose 5% in Water IV Sol 1000 mL [VDMC]
|
Facility
|
IP
|
$74.40
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
10440505
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$52.08 |
| Max. Negotiated Rate |
$66.96 |
| Rate for Payer: Aetna of IA Commercial |
$66.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.96
|
| Rate for Payer: Cash Price |
$59.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.80
|
| Rate for Payer: Medical Associates Commercial |
$55.80
|
| Rate for Payer: Midlands Choice Commercial |
$52.08
|
| Rate for Payer: United Healthcare Commercial |
$66.96
|
|
|
Dextrose 5% in Water IV Sol 100 mL [VDMC]
|
Facility
|
OP
|
$65.52
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
10440438
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.48 |
| Max. Negotiated Rate |
$58.97 |
| Rate for Payer: Aetna of IA Commercial |
$58.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.97
|
| Rate for Payer: Aetna of IA Medicare |
$37.35
|
| Rate for Payer: Amerigroup Medicaid |
$37.79
|
| Rate for Payer: Amerigroup Medicare |
$29.78
|
| Rate for Payer: Cash Price |
$52.42
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.14
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.43
|
| Rate for Payer: Medical Associates Commercial |
$49.14
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.48
|
| Rate for Payer: Midlands Choice Commercial |
$45.86
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.91
|
| Rate for Payer: United Healthcare Commercial |
$58.97
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.66
|
|
|
Dextrose 5% in Water IV Sol 100 mL [VDMC]
|
Facility
|
IP
|
$65.52
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
10440438
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$45.86 |
| Max. Negotiated Rate |
$58.97 |
| Rate for Payer: Aetna of IA Commercial |
$58.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.97
|
| Rate for Payer: Cash Price |
$52.42
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.14
|
| Rate for Payer: Medical Associates Commercial |
$49.14
|
| Rate for Payer: Midlands Choice Commercial |
$45.86
|
| Rate for Payer: United Healthcare Commercial |
$58.97
|
|
|
Dextrose 5% in Water IV Sol 250 mL PVC FREE [VDMC]
|
Facility
|
IP
|
$73.61
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
10440572
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$51.53 |
| Max. Negotiated Rate |
$66.25 |
| Rate for Payer: Aetna of IA Commercial |
$66.25
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.25
|
| Rate for Payer: Cash Price |
$58.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.21
|
| Rate for Payer: Medical Associates Commercial |
$55.21
|
| Rate for Payer: Midlands Choice Commercial |
$51.53
|
| Rate for Payer: United Healthcare Commercial |
$66.25
|
|
