|
FIBERWIRE 2-0 LOOP 60'' W/DIAMOND NEEDLE
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Aetna of IA Medicare |
$29.64
|
| Rate for Payer: Amerigroup Medicaid |
$29.99
|
| Rate for Payer: Amerigroup Medicare |
$23.63
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.70
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.40
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.91
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.68
|
|
|
FIBERWIRE 2-0 LOOP 60'' W/DIAMOND NEEDLE
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
|
|
FIBER WIRE BLUE W/TPR 1/2 CIR NEEDLE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8860533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.00 |
| 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: Aetna of IA Medicare |
$22.80
|
| Rate for Payer: Amerigroup Medicaid |
$23.07
|
| Rate for Payer: Amerigroup Medicare |
$18.18
|
| 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 |
$18.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.85
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.70
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.60
|
|
|
FIBER WIRE BLUE W/TPR 1/2 CIR NEEDLE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8860533
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
Fibrinogen DMCL
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
8037846
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna of IA Commercial |
$72.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$72.90
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$60.75
|
| Rate for Payer: Medical Associates Commercial |
$60.75
|
| Rate for Payer: Midlands Choice Commercial |
$56.70
|
| Rate for Payer: United Healthcare Commercial |
$72.90
|
|
|
Fibrinogen DMCL
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
8037846
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.07 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna of IA Commercial |
$72.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$72.90
|
| Rate for Payer: Aetna of IA Medicare |
$46.17
|
| Rate for Payer: Amerigroup Medicaid |
$46.72
|
| Rate for Payer: Amerigroup Medicare |
$36.81
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$60.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$46.27
|
| Rate for Payer: Medical Associates Commercial |
$60.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.45
|
| Rate for Payer: Midlands Choice Commercial |
$56.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$46.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$41.92
|
| Rate for Payer: United Healthcare Commercial |
$72.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$47.79
|
| Rate for Payer: Wellmark IA HMO WHPI |
$29.07
|
| Rate for Payer: Wellmark IA PPO |
$32.02
|
|
|
finasteride 5 mg Tab [VDMC]
|
Facility
|
IP
|
$2.37
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389109
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Aetna of IA Commercial |
$2.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.14
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.78
|
| Rate for Payer: Medical Associates Commercial |
$1.78
|
| Rate for Payer: Midlands Choice Commercial |
$1.66
|
| Rate for Payer: United Healthcare Commercial |
$2.14
|
|
|
finasteride 5 mg Tab [VDMC]
|
Facility
|
OP
|
$2.37
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389109
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Aetna of IA Commercial |
$2.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.14
|
| Rate for Payer: Aetna of IA Medicare |
$1.35
|
| Rate for Payer: Amerigroup Medicaid |
$1.37
|
| Rate for Payer: Amerigroup Medicare |
$1.08
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.07
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.36
|
| Rate for Payer: Medical Associates Commercial |
$1.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.07
|
| Rate for Payer: Midlands Choice Commercial |
$1.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.23
|
| Rate for Payer: United Healthcare Commercial |
$2.14
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.40
|
|
|
FIXATION DEVICE DERMASORB FASTENER
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$208.60 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Aetna of IA Commercial |
$268.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$268.20
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$223.50
|
| Rate for Payer: Medical Associates Commercial |
$223.50
|
| Rate for Payer: Midlands Choice Commercial |
$208.60
|
| Rate for Payer: United Healthcare Commercial |
$268.20
|
|
|
FIXATION DEVICE DERMASORB FASTENER
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.10 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Aetna of IA Commercial |
$268.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$268.20
|
| Rate for Payer: Aetna of IA Medicare |
$169.86
|
| Rate for Payer: Amerigroup Medicaid |
$171.89
|
| Rate for Payer: Amerigroup Medicare |
$135.44
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$223.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$134.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$170.22
|
| Rate for Payer: Medical Associates Commercial |
$223.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$134.10
|
| Rate for Payer: Midlands Choice Commercial |
$208.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$172.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$154.22
|
| Rate for Payer: United Healthcare Commercial |
$268.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$175.82
|
|
|
flecainide 100 mg Tab [VDMC]
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna of IA Commercial |
$1.35
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.35
|
| Rate for Payer: Aetna of IA Medicare |
$0.85
|
| Rate for Payer: Amerigroup Medicaid |
$0.86
|
| Rate for Payer: Amerigroup Medicare |
$0.68
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.67
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.86
|
| Rate for Payer: Medical Associates Commercial |
$1.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.67
|
| Rate for Payer: Midlands Choice Commercial |
$1.05
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.78
|
| Rate for Payer: United Healthcare Commercial |
$1.35
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.88
|
|
|
flecainide 100 mg Tab [VDMC]
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna of IA Commercial |
$1.35
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.35
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.12
|
| Rate for Payer: Medical Associates Commercial |
$1.12
|
| Rate for Payer: Midlands Choice Commercial |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$1.35
|
|
|
fluconazole 100 mg Tab [VDMC]
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389377
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna of IA Commercial |
$2.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.54
|
| Rate for Payer: Aetna of IA Medicare |
$1.61
|
| Rate for Payer: Amerigroup Medicaid |
$1.63
|
| Rate for Payer: Amerigroup Medicare |
$1.28
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.27
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.61
|
| Rate for Payer: Medical Associates Commercial |
$2.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.27
|
| Rate for Payer: Midlands Choice Commercial |
$1.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.46
|
| Rate for Payer: United Healthcare Commercial |
$2.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.66
|
|
|
fluconazole 100 mg Tab [VDMC]
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389377
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna of IA Commercial |
$2.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.54
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.12
|
| Rate for Payer: Medical Associates Commercial |
$2.12
|
| Rate for Payer: Midlands Choice Commercial |
$1.97
|
| Rate for Payer: United Healthcare Commercial |
$2.54
|
|
|
fluconazole 10 mg/mL 35ml Oral Liq [VDMC]
|
Facility
|
IP
|
$39.80
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389316
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$35.82 |
| Rate for Payer: Aetna of IA Commercial |
$35.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$35.82
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$29.85
|
| Rate for Payer: Medical Associates Commercial |
$29.85
|
| Rate for Payer: Midlands Choice Commercial |
$27.86
|
| Rate for Payer: United Healthcare Commercial |
$35.82
|
|
|
fluconazole 10 mg/mL 35ml Oral Liq [VDMC]
|
Facility
|
OP
|
$39.80
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389316
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.91 |
| Max. Negotiated Rate |
$35.82 |
| Rate for Payer: Aetna of IA Commercial |
$35.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$35.82
|
| Rate for Payer: Aetna of IA Medicare |
$22.69
|
| Rate for Payer: Amerigroup Medicaid |
$22.96
|
| Rate for Payer: Amerigroup Medicare |
$18.09
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$29.85
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.73
|
| Rate for Payer: Medical Associates Commercial |
$29.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.91
|
| Rate for Payer: Midlands Choice Commercial |
$27.86
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.60
|
| Rate for Payer: United Healthcare Commercial |
$35.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.48
|
|
|
fluconazole 150 mg Tab [VDMC]
|
Facility
|
IP
|
$5.14
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389446
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Aetna of IA Commercial |
$4.63
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.63
|
| Rate for Payer: Cash Price |
$4.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.86
|
| Rate for Payer: Medical Associates Commercial |
$3.86
|
| Rate for Payer: Midlands Choice Commercial |
$3.60
|
| Rate for Payer: United Healthcare Commercial |
$4.63
|
|
|
fluconazole 150 mg Tab [VDMC]
|
Facility
|
OP
|
$5.14
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10389446
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Aetna of IA Commercial |
$4.63
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.63
|
| Rate for Payer: Aetna of IA Medicare |
$2.93
|
| Rate for Payer: Amerigroup Medicaid |
$2.96
|
| Rate for Payer: Amerigroup Medicare |
$2.34
|
| Rate for Payer: Cash Price |
$4.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.86
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.31
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.94
|
| Rate for Payer: Medical Associates Commercial |
$3.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.31
|
| Rate for Payer: Midlands Choice Commercial |
$3.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.66
|
| Rate for Payer: United Healthcare Commercial |
$4.63
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.03
|
|
|
fluconazole 200 mg/100 mL-NS IV Sol [VDMC]
|
Facility
|
OP
|
$65.92
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
10389586
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.66 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$59.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.33
|
| Rate for Payer: Aetna of IA Medicare |
$37.57
|
| Rate for Payer: Amerigroup Medicaid |
$38.02
|
| Rate for Payer: Amerigroup Medicare |
$29.96
|
| Rate for Payer: Cash Price |
$52.74
|
| Rate for Payer: Cash Price |
$52.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.65
|
| Rate for Payer: Medical Associates Commercial |
$49.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.66
|
| Rate for Payer: Midlands Choice Commercial |
$46.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.11
|
| Rate for Payer: United Healthcare Commercial |
$59.33
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.89
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
fluconazole 200 mg/100 mL-NS IV Sol [VDMC]
|
Facility
|
IP
|
$65.92
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
10389586
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$59.33 |
| Rate for Payer: Aetna of IA Commercial |
$59.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.33
|
| Rate for Payer: Cash Price |
$52.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.44
|
| Rate for Payer: Medical Associates Commercial |
$49.44
|
| Rate for Payer: Midlands Choice Commercial |
$46.14
|
| Rate for Payer: United Healthcare Commercial |
$59.33
|
|
|
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 |
$221.80 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
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 |
$50.59
|
| Rate for Payer: Medical Associates Commercial |
$50.59
|
| Rate for Payer: Midlands Choice Commercial |
$47.22
|
| Rate for Payer: United Healthcare Commercial |
$60.71
|
|
|
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
|
|
|
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
|
|
|
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
|
|
