|
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 |
$50.59
|
| Rate for Payer: Medical Associates Commercial |
$50.59
|
| Rate for Payer: Midlands Choice Commercial |
$47.22
|
| Rate for Payer: United Healthcare Commercial |
$60.71
|
|
|
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 |
$30.36 |
| 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 |
$38.91
|
| Rate for Payer: Amerigroup Medicare |
$30.66
|
| Rate for Payer: Cash Price |
$53.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.59
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.53
|
| Rate for Payer: Medical Associates Commercial |
$50.59
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.36
|
| Rate for Payer: Midlands Choice Commercial |
$47.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.91
|
| Rate for Payer: United Healthcare Commercial |
$60.71
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.80
|
|
|
fludrocortisone 0.1 mg Tab [VDMC]
|
Facility
|
IP
|
$2.36
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389657
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$2.13 |
| Rate for Payer: Aetna of IA Commercial |
$2.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.13
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.77
|
| Rate for Payer: Medical Associates Commercial |
$1.77
|
| Rate for Payer: Midlands Choice Commercial |
$1.65
|
| Rate for Payer: United Healthcare Commercial |
$2.13
|
|
|
fludrocortisone 0.1 mg Tab [VDMC]
|
Facility
|
OP
|
$2.36
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389657
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.13 |
| Rate for Payer: Aetna of IA Commercial |
$2.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.13
|
| Rate for Payer: Aetna of IA Medicare |
$1.35
|
| Rate for Payer: Amerigroup Medicaid |
$1.36
|
| Rate for Payer: Amerigroup Medicare |
$1.07
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.77
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.35
|
| Rate for Payer: Medical Associates Commercial |
$1.77
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.06
|
| Rate for Payer: Midlands Choice Commercial |
$1.65
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$2.13
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.39
|
|
|
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 |
$24.64 |
| 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 |
$31.59
|
| Rate for Payer: Amerigroup Medicare |
$24.89
|
| 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 |
$24.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.28
|
| Rate for Payer: Medical Associates Commercial |
$41.07
|
| Rate for Payer: Medical Associates Managed Medicare |
$24.64
|
| Rate for Payer: Midlands Choice Commercial |
$38.33
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$31.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.34
|
| 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 |
$13.64 |
| 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 |
$17.48
|
| Rate for Payer: Amerigroup Medicare |
$13.78
|
| 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 |
$13.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.31
|
| Rate for Payer: Medical Associates Commercial |
$22.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.64
|
| Rate for Payer: Midlands Choice Commercial |
$21.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$15.69
|
| 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
|
$58.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389799
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.37 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna of IA Commercial |
$52.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.74
|
| Rate for Payer: Aetna of IA Medicare |
$33.40
|
| Rate for Payer: Amerigroup Medicaid |
$33.80
|
| Rate for Payer: Amerigroup Medicare |
$26.63
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.37
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.47
|
| Rate for Payer: Medical Associates Commercial |
$43.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.37
|
| Rate for Payer: Midlands Choice Commercial |
$41.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.33
|
| Rate for Payer: United Healthcare Commercial |
$52.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.57
|
|
|
fluocinonide Top 0.05% Crm 30grams [VDMC]
|
Facility
|
IP
|
$58.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389799
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$41.02 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna of IA Commercial |
$52.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.74
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.95
|
| Rate for Payer: Medical Associates Commercial |
$43.95
|
| Rate for Payer: Midlands Choice Commercial |
$41.02
|
| Rate for Payer: United Healthcare Commercial |
$52.74
|
|
|
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 |
$48.31 |
| 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 |
$61.93
|
| Rate for Payer: Amerigroup Medicare |
$48.80
|
| 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 |
$48.31
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.32
|
| Rate for Payer: Medical Associates Commercial |
$80.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$48.31
|
| Rate for Payer: Midlands Choice Commercial |
$75.15
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.56
|
| Rate for Payer: United Healthcare Commercial |
$96.62
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.34
|
|
|
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
|
|
|
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 |
$1.14 |
| Rate for Payer: Aetna of IA Commercial |
$1.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.14
|
| 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 |
$1.14
|
|
|
FLUoxetine 10 mg Cap(VDMC)
|
Facility
|
OP
|
$1.26
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389929
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna of IA Commercial |
$1.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.14
|
| Rate for Payer: Aetna of IA Medicare |
$0.72
|
| Rate for Payer: Amerigroup Medicaid |
$0.73
|
| Rate for Payer: Amerigroup Medicare |
$0.57
|
| 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 |
$0.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.72
|
| Rate for Payer: Medical Associates Commercial |
$0.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.57
|
| Rate for Payer: Midlands Choice Commercial |
$0.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.65
|
| Rate for Payer: United Healthcare Commercial |
$1.14
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.75
|
|
|
FLUoxetine 20 mg Cap [VDMC]
|
Facility
|
OP
|
$1.10
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389998
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| 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 |
$0.63
|
| Rate for Payer: Amerigroup Medicare |
$0.50
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.49
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.63
|
| Rate for Payer: Medical Associates Commercial |
$0.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.49
|
| Rate for Payer: Midlands Choice Commercial |
$0.77
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.57
|
| 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 |
$0.82
|
| Rate for Payer: Medical Associates Commercial |
$0.82
|
| 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
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
11219929
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$138.15 |
| 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 |
$177.08
|
| Rate for Payer: Amerigroup Medicare |
$139.53
|
| 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 |
$138.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$175.36
|
| Rate for Payer: Medical Associates Commercial |
$230.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$138.15
|
| Rate for Payer: Midlands Choice Commercial |
$214.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$177.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$158.87
|
| Rate for Payer: United Healthcare Commercial |
$276.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$181.13
|
|
|
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
|
|
|
fluticasone CFC free 110 mcg/inh Inh Aer w/adapter [VDMC]
|
Facility
|
IP
|
$919.44
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10390205
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$643.61 |
| Max. Negotiated Rate |
$827.49 |
| Rate for Payer: Aetna of IA Commercial |
$827.49
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$827.49
|
| Rate for Payer: Cash Price |
$735.55
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$689.58
|
| Rate for Payer: Medical Associates Commercial |
$689.58
|
| Rate for Payer: Midlands Choice Commercial |
$643.61
|
| Rate for Payer: United Healthcare Commercial |
$827.49
|
|
|
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 |
$413.75 |
| Max. Negotiated Rate |
$827.49 |
| Rate for Payer: Aetna of IA Commercial |
$827.49
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$827.49
|
| Rate for Payer: Aetna of IA Medicare |
$524.08
|
| Rate for Payer: Amerigroup Medicaid |
$530.33
|
| Rate for Payer: Amerigroup Medicare |
$417.88
|
| 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 |
$413.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$525.18
|
| Rate for Payer: Medical Associates Commercial |
$689.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$413.75
|
| Rate for Payer: Midlands Choice Commercial |
$643.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$532.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$475.81
|
| Rate for Payer: United Healthcare Commercial |
$827.49
|
| Rate for Payer: United Healthcare Managed Medicare |
$542.47
|
|
|
fluticasone CFC free 44 mcg/inh Inh Aer w/adapter [VDMC]
|
Facility
|
OP
|
$447.40
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10390270
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$201.33 |
| Max. Negotiated Rate |
$402.66 |
| Rate for Payer: Aetna of IA Commercial |
$402.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$402.66
|
| Rate for Payer: Aetna of IA Medicare |
$255.02
|
| Rate for Payer: Amerigroup Medicaid |
$258.06
|
| Rate for Payer: Amerigroup Medicare |
$203.34
|
| Rate for Payer: Cash Price |
$357.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$335.55
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$201.33
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$255.55
|
| Rate for Payer: Medical Associates Commercial |
$335.55
|
| Rate for Payer: Medical Associates Managed Medicare |
$201.33
|
| Rate for Payer: Midlands Choice Commercial |
$313.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$259.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$231.53
|
| Rate for Payer: United Healthcare Commercial |
$402.66
|
| Rate for Payer: United Healthcare Managed Medicare |
$263.97
|
|
|
fluticasone CFC free 44 mcg/inh Inh Aer w/adapter [VDMC]
|
Facility
|
IP
|
$447.40
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10390270
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$313.18 |
| Max. Negotiated Rate |
$402.66 |
| Rate for Payer: Aetna of IA Commercial |
$402.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$402.66
|
| Rate for Payer: Cash Price |
$357.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$335.55
|
| Rate for Payer: Medical Associates Commercial |
$335.55
|
| Rate for Payer: Midlands Choice Commercial |
$313.18
|
| Rate for Payer: United Healthcare Commercial |
$402.66
|
|
|
fluticasone Nasal 0.05 mg/inh Spry [VDMC]
|
Facility
|
OP
|
$42.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10390335
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$38.38 |
| Rate for Payer: Aetna of IA Commercial |
$38.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.38
|
| Rate for Payer: Aetna of IA Medicare |
$24.30
|
| Rate for Payer: Amerigroup Medicaid |
$24.59
|
| Rate for Payer: Amerigroup Medicare |
$19.38
|
| Rate for Payer: Cash Price |
$34.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.98
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$19.19
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$24.36
|
| Rate for Payer: Medical Associates Commercial |
$31.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.19
|
| Rate for Payer: Midlands Choice Commercial |
$29.85
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.07
|
| Rate for Payer: United Healthcare Commercial |
$38.38
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.16
|
|
|
fluticasone Nasal 0.05 mg/inh Spry [VDMC]
|
Facility
|
IP
|
$42.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10390335
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$38.38 |
| Rate for Payer: Aetna of IA Commercial |
$38.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.38
|
| Rate for Payer: Cash Price |
$34.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.98
|
| Rate for Payer: Medical Associates Commercial |
$31.98
|
| Rate for Payer: Midlands Choice Commercial |
$29.85
|
| Rate for Payer: United Healthcare Commercial |
$38.38
|
|
|
fluticasone-salmeterol 100 mcg-50 mcg Inh Pwdr [VDMC]
|
Facility
|
OP
|
$76.86
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10390400
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.59 |
| Max. Negotiated Rate |
$69.18 |
| Rate for Payer: Aetna of IA Commercial |
$69.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.18
|
| Rate for Payer: Aetna of IA Medicare |
$43.81
|
| Rate for Payer: Amerigroup Medicaid |
$44.34
|
| Rate for Payer: Amerigroup Medicare |
$34.93
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.65
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.59
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.90
|
| Rate for Payer: Medical Associates Commercial |
$57.65
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.59
|
| Rate for Payer: Midlands Choice Commercial |
$53.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.78
|
| Rate for Payer: United Healthcare Commercial |
$69.18
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.35
|
|
