|
linaclotide 145 mcg Cap [VDMC]
|
Facility
|
IP
|
$64.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10400672
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$44.91 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna of IA Commercial |
$57.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.74
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.12
|
| Rate for Payer: Medical Associates Commercial |
$48.12
|
| Rate for Payer: Midlands Choice Commercial |
$44.91
|
| Rate for Payer: United Healthcare Commercial |
$57.74
|
|
|
linaclotide 145 mcg Cap [VDMC]
|
Facility
|
OP
|
$64.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10400672
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.07 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna of IA Commercial |
$57.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.74
|
| Rate for Payer: Aetna of IA Medicare |
$36.57
|
| Rate for Payer: Amerigroup Medicaid |
$32.38
|
| Rate for Payer: Amerigroup Medicare |
$32.40
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.07
|
| Rate for Payer: Medical Associates Commercial |
$48.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.08
|
| Rate for Payer: Midlands Choice Commercial |
$44.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.56
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$32.54
|
| Rate for Payer: Oscar Health of IA Commercial |
$48.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.12
|
| Rate for Payer: United Healthcare Commercial |
$57.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.85
|
|
|
linagliptin 5 mg Tab [VDMC]
|
Facility
|
IP
|
$62.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10400810
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$43.82 |
| Max. Negotiated Rate |
$56.34 |
| Rate for Payer: Aetna of IA Commercial |
$56.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$56.34
|
| Rate for Payer: Cash Price |
$50.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.95
|
| Rate for Payer: Medical Associates Commercial |
$46.95
|
| Rate for Payer: Midlands Choice Commercial |
$43.82
|
| Rate for Payer: United Healthcare Commercial |
$56.34
|
|
|
linagliptin 5 mg Tab [VDMC]
|
Facility
|
OP
|
$62.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10400810
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.29 |
| Max. Negotiated Rate |
$56.34 |
| Rate for Payer: Aetna of IA Commercial |
$56.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$56.34
|
| Rate for Payer: Aetna of IA Medicare |
$35.68
|
| Rate for Payer: Amerigroup Medicaid |
$31.59
|
| Rate for Payer: Amerigroup Medicare |
$31.61
|
| Rate for Payer: Cash Price |
$50.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.29
|
| Rate for Payer: Medical Associates Commercial |
$46.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.30
|
| Rate for Payer: Midlands Choice Commercial |
$43.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$31.77
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$31.75
|
| Rate for Payer: Oscar Health of IA Commercial |
$46.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$46.95
|
| Rate for Payer: United Healthcare Commercial |
$56.34
|
| Rate for Payer: United Healthcare Managed Medicare |
$36.93
|
|
|
linezolid 2 mg/mL-D5% 300ml [VDMC]
|
Facility
|
IP
|
$84.92
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
16670233
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$59.44 |
| Max. Negotiated Rate |
$76.43 |
| Rate for Payer: Aetna of IA Commercial |
$76.43
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.43
|
| Rate for Payer: Cash Price |
$67.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.69
|
| Rate for Payer: Medical Associates Commercial |
$63.69
|
| Rate for Payer: Midlands Choice Commercial |
$59.44
|
| Rate for Payer: United Healthcare Commercial |
$76.43
|
|
|
linezolid 2 mg/mL-D5% 300ml [VDMC]
|
Facility
|
OP
|
$84.92
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
16670233
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$42.44 |
| Max. Negotiated Rate |
$76.43 |
| Rate for Payer: Aetna of IA Commercial |
$76.43
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.43
|
| Rate for Payer: Aetna of IA Medicare |
$48.40
|
| Rate for Payer: Amerigroup Medicaid |
$42.86
|
| Rate for Payer: Amerigroup Medicare |
$42.88
|
| Rate for Payer: Cash Price |
$67.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.69
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.44
|
| Rate for Payer: Medical Associates Commercial |
$63.69
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.46
|
| Rate for Payer: Midlands Choice Commercial |
$59.44
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.10
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$43.07
|
| Rate for Payer: Oscar Health of IA Commercial |
$63.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$63.69
|
| Rate for Payer: United Healthcare Commercial |
$76.43
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.10
|
|
|
linezolid 600 mg Tab [VDMC]
|
Facility
|
OP
|
$7.96
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10400948
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Aetna of IA Commercial |
$7.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7.16
|
| Rate for Payer: Aetna of IA Medicare |
$4.54
|
| Rate for Payer: Amerigroup Medicaid |
$4.02
|
| Rate for Payer: Amerigroup Medicare |
$4.02
|
| Rate for Payer: Cash Price |
$6.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.98
|
| Rate for Payer: Medical Associates Commercial |
$5.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.98
|
| Rate for Payer: Midlands Choice Commercial |
$5.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4.04
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$4.04
|
| Rate for Payer: Oscar Health of IA Commercial |
$5.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$5.97
|
| Rate for Payer: United Healthcare Commercial |
$7.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$4.70
|
|
|
linezolid 600 mg Tab [VDMC]
|
Facility
|
IP
|
$7.96
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10400948
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Medical Associates Commercial |
$5.97
|
| Rate for Payer: Aetna of IA Commercial |
$7.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7.16
|
| Rate for Payer: Cash Price |
$6.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.97
|
| Rate for Payer: Midlands Choice Commercial |
$5.57
|
| Rate for Payer: United Healthcare Commercial |
$7.16
|
|
|
liothyronine 5 mcg Tab [VDMC]
|
Facility
|
IP
|
$2.63
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10401017
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$2.37 |
| Rate for Payer: Aetna of IA Commercial |
$2.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.37
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.97
|
| Rate for Payer: Medical Associates Commercial |
$1.97
|
| Rate for Payer: Midlands Choice Commercial |
$1.84
|
| Rate for Payer: United Healthcare Commercial |
$2.37
|
|
|
liothyronine 5 mcg Tab [VDMC]
|
Facility
|
OP
|
$2.63
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10401017
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$2.37 |
| Rate for Payer: Aetna of IA Commercial |
$2.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.37
|
| Rate for Payer: Aetna of IA Medicare |
$1.50
|
| Rate for Payer: Amerigroup Medicaid |
$1.33
|
| Rate for Payer: Amerigroup Medicare |
$1.33
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.31
|
| Rate for Payer: Medical Associates Commercial |
$1.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.32
|
| Rate for Payer: Midlands Choice Commercial |
$1.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.33
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.33
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.97
|
| Rate for Payer: United Healthcare Commercial |
$2.37
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.55
|
|
|
LIPASE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
633776
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of IA Commercial |
$64.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.80
|
| Rate for Payer: Aetna of IA Medicare |
$41.04
|
| Rate for Payer: Amerigroup Medicaid |
$36.34
|
| Rate for Payer: Amerigroup Medicare |
$36.36
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.99
|
| Rate for Payer: Medical Associates Commercial |
$54.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.00
|
| Rate for Payer: Midlands Choice Commercial |
$50.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$36.52
|
| Rate for Payer: Oscar Health of IA Commercial |
$54.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.00
|
| Rate for Payer: United Healthcare Commercial |
$64.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$42.48
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
LIPASE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
633776
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of IA Commercial |
$64.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.80
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.00
|
| Rate for Payer: Medical Associates Commercial |
$54.00
|
| Rate for Payer: Midlands Choice Commercial |
$50.40
|
| Rate for Payer: United Healthcare Commercial |
$64.80
|
|
|
lipase-protease-amylase 12000-38000-60000 units Cap [VDMC]
|
Facility
|
OP
|
$15.55
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10411455
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna of IA Commercial |
$14.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.00
|
| Rate for Payer: Aetna of IA Medicare |
$8.86
|
| Rate for Payer: Amerigroup Medicaid |
$7.85
|
| Rate for Payer: Amerigroup Medicare |
$7.85
|
| Rate for Payer: Cash Price |
$12.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.66
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.77
|
| Rate for Payer: Medical Associates Commercial |
$11.66
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.78
|
| Rate for Payer: Midlands Choice Commercial |
$10.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.89
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$7.89
|
| Rate for Payer: Oscar Health of IA Commercial |
$11.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.66
|
| Rate for Payer: United Healthcare Commercial |
$14.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$9.17
|
|
|
lipase-protease-amylase 12000-38000-60000 units Cap [VDMC]
|
Facility
|
IP
|
$15.55
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10411455
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna of IA Commercial |
$14.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.00
|
| Rate for Payer: Cash Price |
$12.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.66
|
| Rate for Payer: Medical Associates Commercial |
$11.66
|
| Rate for Payer: Midlands Choice Commercial |
$10.88
|
| Rate for Payer: United Healthcare Commercial |
$14.00
|
|
|
LIPECTOMY CHARGE
|
Professional
|
Both
|
$3,054.00
|
|
|
Service Code
|
CPT 15832
|
| Hospital Charge Code |
8068936
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$829.17 |
| Max. Negotiated Rate |
$2,137.80 |
| Rate for Payer: Aetna of IA Medicare |
$829.17
|
| Rate for Payer: Amerigroup Medicaid |
$857.36
|
| Rate for Payer: Cash Price |
$2,443.20
|
| Rate for Payer: Cash Price |
$2,443.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$995.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$845.75
|
| Rate for Payer: Medical Associates Commercial |
$1,575.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$829.17
|
| Rate for Payer: Midlands Choice Commercial |
$2,137.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,434.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,243.76
|
|
|
LIPID PROFILE
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
633777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.08 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of IA Commercial |
$98.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$98.10
|
| Rate for Payer: Aetna of IA Medicare |
$62.13
|
| Rate for Payer: Amerigroup Medicaid |
$55.01
|
| Rate for Payer: Amerigroup Medicare |
$55.04
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$54.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.48
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$54.50
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.32
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$55.28
|
| Rate for Payer: Oscar Health of IA Commercial |
$81.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.75
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.31
|
| Rate for Payer: Wellmark IA HMO |
$52.08
|
| Rate for Payer: Wellmark IA PPO |
$57.29
|
|
|
LIPID PROFILE
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
633777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of IA Commercial |
$98.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$98.10
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.75
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
|
|
Lipoprotein A DMCL
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
8632496
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of IA Commercial |
$126.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.00
|
| Rate for Payer: Aetna of IA Medicare |
$79.80
|
| Rate for Payer: Amerigroup Medicaid |
$70.66
|
| Rate for Payer: Amerigroup Medicare |
$70.70
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.97
|
| Rate for Payer: Medical Associates Commercial |
$105.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.00
|
| Rate for Payer: Midlands Choice Commercial |
$98.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.05
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$71.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$105.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$105.00
|
| Rate for Payer: United Healthcare Commercial |
$126.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.60
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Lipoprotein A DMCL
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
8632496
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of IA Commercial |
$126.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.00
|
| Rate for Payer: Medical Associates Commercial |
$105.00
|
| Rate for Payer: Midlands Choice Commercial |
$98.00
|
| Rate for Payer: United Healthcare Commercial |
$126.00
|
|
|
liraglutide 18 mg/3 mL Sol [VDMC]
|
Facility
|
IP
|
$1,389.66
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10401086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$972.76 |
| Max. Negotiated Rate |
$1,250.69 |
| Rate for Payer: Aetna of IA Commercial |
$1,250.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,250.69
|
| Rate for Payer: Cash Price |
$1,111.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,042.24
|
| Rate for Payer: Medical Associates Commercial |
$1,042.24
|
| Rate for Payer: Midlands Choice Commercial |
$972.76
|
| Rate for Payer: United Healthcare Commercial |
$1,250.69
|
|
|
liraglutide 18 mg/3 mL Sol [VDMC]
|
Facility
|
OP
|
$1,389.66
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10401086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$694.55 |
| Max. Negotiated Rate |
$1,250.69 |
| Rate for Payer: Aetna of IA Commercial |
$1,250.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,250.69
|
| Rate for Payer: Aetna of IA Medicare |
$792.11
|
| Rate for Payer: Amerigroup Medicaid |
$701.36
|
| Rate for Payer: Amerigroup Medicare |
$701.78
|
| Rate for Payer: Cash Price |
$1,111.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,042.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$694.83
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$694.55
|
| Rate for Payer: Medical Associates Commercial |
$1,042.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$694.83
|
| Rate for Payer: Midlands Choice Commercial |
$972.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$705.25
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$704.84
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,042.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,042.24
|
| Rate for Payer: United Healthcare Commercial |
$1,250.69
|
| Rate for Payer: United Healthcare Managed Medicare |
$819.90
|
|
|
lisinopril 20 mg Tab [VDMC]
|
Facility
|
OP
|
$1.26
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10429571
|
|
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
|
|
|
lisinopril 20 mg Tab [VDMC]
|
Facility
|
IP
|
$1.26
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10429571
|
|
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
|
|
|
lisinopril 5 mg Tab [VDMC]
|
Facility
|
IP
|
$1.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10401226
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of IA Commercial |
$1.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.05
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.88
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.05
|
|
|
lisinopril 5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10401226
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of IA Commercial |
$1.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.05
|
| Rate for Payer: Aetna of IA Medicare |
$0.67
|
| Rate for Payer: Amerigroup Medicaid |
$0.59
|
| Rate for Payer: Amerigroup Medicare |
$0.59
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.88
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.59
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.58
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.59
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.59
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.59
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$1.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.69
|
|
