|
fluconazole 400 mg (200 mL) NaCl 0.9% Bag [VDMC]
|
Facility
|
OP
|
$67.46
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
22669081
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.72 |
| Max. Negotiated Rate |
$60.71 |
| Rate for Payer: Aetna of IA Commercial |
$60.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.71
|
| Rate for Payer: Aetna of IA Medicare |
$38.45
|
| Rate for Payer: Amerigroup Medicaid |
$34.05
|
| Rate for Payer: Amerigroup Medicare |
$34.07
|
| Rate for Payer: Cash Price |
$53.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.72
|
| Rate for Payer: Medical Associates Commercial |
$50.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.73
|
| Rate for Payer: Midlands Choice Commercial |
$47.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.24
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$34.22
|
| Rate for Payer: Oscar Health of IA Commercial |
$50.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.60
|
| Rate for Payer: United Healthcare Commercial |
$60.71
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.80
|
|
|
fluconazole 400 mg (200 mL) NaCl 0.9% Bag [VDMC]
|
Facility
|
IP
|
$67.46
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
22669081
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.22 |
| Max. Negotiated Rate |
$60.71 |
| Rate for Payer: Aetna of IA Commercial |
$60.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.71
|
| Rate for Payer: Cash Price |
$53.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.60
|
| Rate for Payer: Medical Associates Commercial |
$50.60
|
| Rate for Payer: Midlands Choice Commercial |
$47.22
|
| Rate for Payer: United Healthcare Commercial |
$60.71
|
|
|
fludrocortisone 0.1 mg Tab [VDMC]
|
Facility
|
OP
|
$2.69
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389657
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna of IA Commercial |
$2.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.42
|
| Rate for Payer: Aetna of IA Medicare |
$1.53
|
| Rate for Payer: Amerigroup Medicaid |
$1.36
|
| Rate for Payer: Amerigroup Medicare |
$1.36
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.02
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.34
|
| Rate for Payer: Medical Associates Commercial |
$2.02
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.34
|
| Rate for Payer: Midlands Choice Commercial |
$1.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.37
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.36
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.02
|
| Rate for Payer: United Healthcare Commercial |
$2.42
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.59
|
|
|
fludrocortisone 0.1 mg Tab [VDMC]
|
Facility
|
IP
|
$2.69
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389657
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna of IA Commercial |
$2.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.42
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.02
|
| Rate for Payer: Medical Associates Commercial |
$2.02
|
| Rate for Payer: Midlands Choice Commercial |
$1.88
|
| Rate for Payer: United Healthcare Commercial |
$2.42
|
|
|
flumazenil 0.1 mg/mL 10ml MDV [VDMC]
|
Facility
|
OP
|
$54.76
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
22847357
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$49.28 |
| Rate for Payer: Aetna of IA Commercial |
$49.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.28
|
| Rate for Payer: Aetna of IA Medicare |
$31.21
|
| Rate for Payer: Amerigroup Medicaid |
$27.64
|
| Rate for Payer: Amerigroup Medicare |
$27.65
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.07
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.38
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.37
|
| Rate for Payer: Medical Associates Commercial |
$41.07
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.38
|
| Rate for Payer: Midlands Choice Commercial |
$38.33
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27.79
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$27.77
|
| Rate for Payer: Oscar Health of IA Commercial |
$41.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$41.07
|
| Rate for Payer: United Healthcare Commercial |
$49.28
|
| Rate for Payer: United Healthcare Managed Medicare |
$32.31
|
|
|
flumazenil 0.1 mg/mL 10ml MDV [VDMC]
|
Facility
|
IP
|
$54.76
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
22847357
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.33 |
| Max. Negotiated Rate |
$49.28 |
| Rate for Payer: Aetna of IA Commercial |
$49.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.28
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.07
|
| Rate for Payer: Medical Associates Commercial |
$41.07
|
| Rate for Payer: Midlands Choice Commercial |
$38.33
|
| Rate for Payer: United Healthcare Commercial |
$49.28
|
|
|
flumazenil 0.1 mg/mL 5ml MDV [VDMC]
|
Facility
|
OP
|
$30.31
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10389728
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$27.28 |
| Rate for Payer: Aetna of IA Commercial |
$27.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.28
|
| Rate for Payer: Aetna of IA Medicare |
$17.28
|
| Rate for Payer: Amerigroup Medicaid |
$15.30
|
| Rate for Payer: Amerigroup Medicare |
$15.31
|
| Rate for Payer: Cash Price |
$24.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.15
|
| Rate for Payer: Medical Associates Commercial |
$22.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.16
|
| Rate for Payer: Midlands Choice Commercial |
$21.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.38
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$15.37
|
| Rate for Payer: Oscar Health of IA Commercial |
$22.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.73
|
| Rate for Payer: United Healthcare Commercial |
$27.28
|
| Rate for Payer: United Healthcare Managed Medicare |
$17.88
|
|
|
flumazenil 0.1 mg/mL 5ml MDV [VDMC]
|
Facility
|
IP
|
$30.31
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10389728
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$27.28 |
| Rate for Payer: Aetna of IA Commercial |
$27.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.28
|
| Rate for Payer: Cash Price |
$24.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.73
|
| Rate for Payer: Medical Associates Commercial |
$22.73
|
| Rate for Payer: Midlands Choice Commercial |
$21.22
|
| Rate for Payer: United Healthcare Commercial |
$27.28
|
|
|
fluocinonide Top 0.05% Crm 30grams [VDMC]
|
Facility
|
OP
|
$111.76
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389799
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$100.58 |
| Rate for Payer: Aetna of IA Commercial |
$100.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$100.58
|
| Rate for Payer: Aetna of IA Medicare |
$63.70
|
| Rate for Payer: Amerigroup Medicaid |
$56.41
|
| Rate for Payer: Amerigroup Medicare |
$56.44
|
| Rate for Payer: Cash Price |
$89.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$83.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$55.86
|
| Rate for Payer: Medical Associates Commercial |
$83.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.88
|
| Rate for Payer: Midlands Choice Commercial |
$78.23
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$56.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$56.68
|
| Rate for Payer: Oscar Health of IA Commercial |
$83.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$83.82
|
| Rate for Payer: United Healthcare Commercial |
$100.58
|
| Rate for Payer: United Healthcare Managed Medicare |
$65.94
|
|
|
fluocinonide Top 0.05% Crm 30grams [VDMC]
|
Facility
|
IP
|
$111.76
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389799
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$78.23 |
| Max. Negotiated Rate |
$100.58 |
| Rate for Payer: Aetna of IA Commercial |
$100.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$100.58
|
| Rate for Payer: Cash Price |
$89.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$83.82
|
| Rate for Payer: Medical Associates Commercial |
$83.82
|
| Rate for Payer: Midlands Choice Commercial |
$78.23
|
| Rate for Payer: United Healthcare Commercial |
$100.58
|
|
|
fluocinonide Top 0.05% Oint 30gm [VDMC]
|
Facility
|
IP
|
$107.36
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389864
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$75.15 |
| Max. Negotiated Rate |
$96.62 |
| Rate for Payer: Aetna of IA Commercial |
$96.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$96.62
|
| Rate for Payer: Cash Price |
$85.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$80.52
|
| Rate for Payer: Medical Associates Commercial |
$80.52
|
| Rate for Payer: Midlands Choice Commercial |
$75.15
|
| Rate for Payer: United Healthcare Commercial |
$96.62
|
|
|
fluocinonide Top 0.05% Oint 30gm [VDMC]
|
Facility
|
OP
|
$107.36
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389864
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.66 |
| Max. Negotiated Rate |
$96.62 |
| Rate for Payer: Aetna of IA Commercial |
$96.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$96.62
|
| Rate for Payer: Aetna of IA Medicare |
$61.20
|
| Rate for Payer: Amerigroup Medicaid |
$54.18
|
| Rate for Payer: Amerigroup Medicare |
$54.22
|
| Rate for Payer: Cash Price |
$85.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$80.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$53.68
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$53.66
|
| Rate for Payer: Medical Associates Commercial |
$80.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$53.68
|
| Rate for Payer: Midlands Choice Commercial |
$75.15
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$54.49
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$54.45
|
| Rate for Payer: Oscar Health of IA Commercial |
$80.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$80.52
|
| Rate for Payer: United Healthcare Commercial |
$96.62
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.34
|
|
|
fluorouracil 50 mg/mL 100ml [VDMC]
|
Facility
|
IP
|
$253.92
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
14142753
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$177.74 |
| Max. Negotiated Rate |
$228.53 |
| Rate for Payer: Aetna of IA Commercial |
$228.53
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$228.53
|
| Rate for Payer: Cash Price |
$203.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$190.44
|
| Rate for Payer: Medical Associates Commercial |
$190.44
|
| Rate for Payer: Midlands Choice Commercial |
$177.74
|
| Rate for Payer: United Healthcare Commercial |
$228.53
|
|
|
fluorouracil 50 mg/mL 100ml [VDMC]
|
Facility
|
OP
|
$253.92
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
14142753
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$126.91 |
| Max. Negotiated Rate |
$228.53 |
| Rate for Payer: Aetna of IA Commercial |
$228.53
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$228.53
|
| Rate for Payer: Aetna of IA Medicare |
$144.73
|
| Rate for Payer: Amerigroup Medicaid |
$128.15
|
| Rate for Payer: Amerigroup Medicare |
$128.23
|
| Rate for Payer: Cash Price |
$203.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$190.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$126.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.91
|
| Rate for Payer: Medical Associates Commercial |
$190.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$126.96
|
| Rate for Payer: Midlands Choice Commercial |
$177.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.86
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$128.79
|
| Rate for Payer: Oscar Health of IA Commercial |
$190.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$190.44
|
| Rate for Payer: United Healthcare Commercial |
$228.53
|
| Rate for Payer: United Healthcare Managed Medicare |
$149.81
|
|
|
fluorouracil 50 mg/mL 20ml vial [VDMC]
|
Facility
|
OP
|
$63.56
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
14720464
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.77 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Aetna of IA Commercial |
$57.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.20
|
| Rate for Payer: Aetna of IA Medicare |
$36.23
|
| Rate for Payer: Amerigroup Medicaid |
$32.08
|
| Rate for Payer: Amerigroup Medicare |
$32.10
|
| Rate for Payer: Cash Price |
$50.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.67
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.77
|
| Rate for Payer: Medical Associates Commercial |
$47.67
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.78
|
| Rate for Payer: Midlands Choice Commercial |
$44.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.26
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$32.24
|
| Rate for Payer: Oscar Health of IA Commercial |
$47.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$47.67
|
| Rate for Payer: United Healthcare Commercial |
$57.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.50
|
|
|
fluorouracil 50 mg/mL 20ml vial [VDMC]
|
Facility
|
IP
|
$63.56
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
14720464
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$44.49 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Aetna of IA Commercial |
$57.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.20
|
| Rate for Payer: Cash Price |
$50.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.67
|
| Rate for Payer: Medical Associates Commercial |
$47.67
|
| Rate for Payer: Midlands Choice Commercial |
$44.49
|
| Rate for Payer: United Healthcare Commercial |
$57.20
|
|
|
fluorouracil 50 mg/mL MDV 50ml [VDMC]
|
Facility
|
OP
|
$146.36
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
14142949
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$73.15 |
| Max. Negotiated Rate |
$131.72 |
| Rate for Payer: Aetna of IA Commercial |
$131.72
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.72
|
| Rate for Payer: Aetna of IA Medicare |
$83.43
|
| Rate for Payer: Amerigroup Medicaid |
$73.87
|
| Rate for Payer: Amerigroup Medicare |
$73.91
|
| Rate for Payer: Cash Price |
$117.09
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.77
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.18
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.15
|
| Rate for Payer: Medical Associates Commercial |
$109.77
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.18
|
| Rate for Payer: Midlands Choice Commercial |
$102.45
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.28
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$74.23
|
| Rate for Payer: Oscar Health of IA Commercial |
$109.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$109.77
|
| Rate for Payer: United Healthcare Commercial |
$131.72
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.35
|
|
|
fluorouracil 50 mg/mL MDV 50ml [VDMC]
|
Facility
|
IP
|
$146.36
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
14142949
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$102.45 |
| Max. Negotiated Rate |
$131.72 |
| Rate for Payer: Aetna of IA Commercial |
$131.72
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.72
|
| Rate for Payer: Cash Price |
$117.09
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.77
|
| Rate for Payer: Medical Associates Commercial |
$109.77
|
| Rate for Payer: Midlands Choice Commercial |
$102.45
|
| Rate for Payer: United Healthcare Commercial |
$131.72
|
|
|
FLUoxetine 10 mg Cap(VDMC)
|
Facility
|
OP
|
$1.26
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389929
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of IA Commercial |
$1.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.13
|
| Rate for Payer: Aetna of IA Medicare |
$0.72
|
| Rate for Payer: Amerigroup Medicaid |
$0.64
|
| Rate for Payer: Amerigroup Medicare |
$0.64
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.63
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.63
|
| Rate for Payer: Medical Associates Commercial |
$0.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.63
|
| Rate for Payer: Midlands Choice Commercial |
$0.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.64
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.95
|
| Rate for Payer: United Healthcare Commercial |
$1.13
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.74
|
|
|
FLUoxetine 10 mg Cap(VDMC)
|
Facility
|
IP
|
$1.26
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389929
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of IA Commercial |
$1.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.13
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.95
|
| Rate for Payer: Medical Associates Commercial |
$0.95
|
| Rate for Payer: Midlands Choice Commercial |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$1.13
|
|
|
FLUoxetine 20 mg Cap [VDMC]
|
Facility
|
OP
|
$1.10
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389998
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna of IA Commercial |
$0.99
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.99
|
| Rate for Payer: Aetna of IA Medicare |
$0.63
|
| Rate for Payer: Amerigroup Medicaid |
$0.56
|
| Rate for Payer: Amerigroup Medicare |
$0.56
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.83
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.55
|
| Rate for Payer: Medical Associates Commercial |
$0.83
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.55
|
| Rate for Payer: Midlands Choice Commercial |
$0.77
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.56
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.56
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.83
|
| Rate for Payer: United Healthcare Commercial |
$0.99
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.65
|
|
|
FLUoxetine 20 mg Cap [VDMC]
|
Facility
|
IP
|
$1.10
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389998
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna of IA Commercial |
$0.99
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.99
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.83
|
| Rate for Payer: Medical Associates Commercial |
$0.83
|
| Rate for Payer: Midlands Choice Commercial |
$0.77
|
| Rate for Payer: United Healthcare Commercial |
$0.99
|
|
|
fluPHENAZine decanoate 25 mg/mL 5 ml MDV Sol [VDMC]
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
11219929
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$214.90 |
| Max. Negotiated Rate |
$276.30 |
| Rate for Payer: Aetna of IA Commercial |
$276.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$276.30
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$230.25
|
| Rate for Payer: Medical Associates Commercial |
$230.25
|
| Rate for Payer: Midlands Choice Commercial |
$214.90
|
| Rate for Payer: United Healthcare Commercial |
$276.30
|
|
|
fluPHENAZine decanoate 25 mg/mL 5 ml MDV Sol [VDMC]
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
11219929
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$153.44 |
| Max. Negotiated Rate |
$276.30 |
| Rate for Payer: Aetna of IA Commercial |
$276.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$276.30
|
| Rate for Payer: Aetna of IA Medicare |
$174.99
|
| Rate for Payer: Amerigroup Medicaid |
$154.94
|
| Rate for Payer: Amerigroup Medicare |
$155.04
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$230.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$153.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$153.44
|
| Rate for Payer: Medical Associates Commercial |
$230.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$153.50
|
| Rate for Payer: Midlands Choice Commercial |
$214.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$155.80
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$155.71
|
| Rate for Payer: Oscar Health of IA Commercial |
$230.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$230.25
|
| Rate for Payer: United Healthcare Commercial |
$276.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$181.13
|
|
|
fluticasone CFC free 110 mcg/inh Inh Aer w/adapter [VDMC]
|
Facility
|
OP
|
$919.44
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10390205
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$459.54 |
| Max. Negotiated Rate |
$827.50 |
| Rate for Payer: Aetna of IA Commercial |
$827.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$827.50
|
| Rate for Payer: Aetna of IA Medicare |
$524.08
|
| Rate for Payer: Amerigroup Medicaid |
$464.04
|
| Rate for Payer: Amerigroup Medicare |
$464.32
|
| Rate for Payer: Cash Price |
$735.55
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$689.58
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$459.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$459.54
|
| Rate for Payer: Medical Associates Commercial |
$689.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$459.72
|
| Rate for Payer: Midlands Choice Commercial |
$643.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$466.62
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$466.34
|
| Rate for Payer: Oscar Health of IA Commercial |
$689.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$689.58
|
| Rate for Payer: United Healthcare Commercial |
$827.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$542.47
|
|
