|
riboflavin 100 mg Tab [VDMC]
|
Facility
|
IP
|
$1.22
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10418882
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna of IA Commercial |
$1.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.10
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.92
|
| Rate for Payer: Medical Associates Commercial |
$0.92
|
| Rate for Payer: Midlands Choice Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.10
|
|
|
rifampin 300mg cap [VDMC]
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna of IA Commercial |
$3.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.05
|
| Rate for Payer: Aetna of IA Medicare |
$1.93
|
| Rate for Payer: Amerigroup Medicaid |
$1.71
|
| Rate for Payer: Amerigroup Medicare |
$1.71
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.54
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.69
|
| Rate for Payer: Medical Associates Commercial |
$2.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.70
|
| Rate for Payer: Midlands Choice Commercial |
$2.37
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.72
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.54
|
| Rate for Payer: United Healthcare Commercial |
$3.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.00
|
|
|
rifampin 300mg cap [VDMC]
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna of IA Commercial |
$3.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.05
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.54
|
| Rate for Payer: Medical Associates Commercial |
$2.54
|
| Rate for Payer: Midlands Choice Commercial |
$2.37
|
| Rate for Payer: United Healthcare Commercial |
$3.05
|
|
|
rifampin 600 mg IV Inj [VDMC]
|
Facility
|
IP
|
$236.56
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10418951
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$165.59 |
| Max. Negotiated Rate |
$212.90 |
| Rate for Payer: Aetna of IA Commercial |
$212.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$212.90
|
| Rate for Payer: Cash Price |
$189.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$177.42
|
| Rate for Payer: Medical Associates Commercial |
$177.42
|
| Rate for Payer: Midlands Choice Commercial |
$165.59
|
| Rate for Payer: United Healthcare Commercial |
$212.90
|
|
|
rifampin 600 mg IV Inj [VDMC]
|
Facility
|
OP
|
$236.56
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10418951
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$118.23 |
| Max. Negotiated Rate |
$212.90 |
| Rate for Payer: Aetna of IA Commercial |
$212.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$212.90
|
| Rate for Payer: Aetna of IA Medicare |
$134.84
|
| Rate for Payer: Amerigroup Medicaid |
$119.39
|
| Rate for Payer: Amerigroup Medicare |
$119.46
|
| Rate for Payer: Cash Price |
$189.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$177.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$118.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$118.23
|
| Rate for Payer: Medical Associates Commercial |
$177.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$118.28
|
| Rate for Payer: Midlands Choice Commercial |
$165.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$120.05
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$119.98
|
| Rate for Payer: Oscar Health of IA Commercial |
$177.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$177.42
|
| Rate for Payer: United Healthcare Commercial |
$212.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$139.57
|
|
|
RING CAPSULAR TENSION 12MM
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna of IA Commercial |
$115.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$115.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.00
|
| Rate for Payer: Medical Associates Commercial |
$96.00
|
| Rate for Payer: Midlands Choice Commercial |
$89.60
|
| Rate for Payer: United Healthcare Commercial |
$115.20
|
|
|
RING CAPSULAR TENSION 12MM
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.97 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna of IA Commercial |
$115.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$115.20
|
| Rate for Payer: Aetna of IA Medicare |
$72.96
|
| Rate for Payer: Amerigroup Medicaid |
$64.60
|
| Rate for Payer: Amerigroup Medicare |
$64.64
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$63.97
|
| Rate for Payer: Medical Associates Commercial |
$96.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.00
|
| Rate for Payer: Midlands Choice Commercial |
$89.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$64.96
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$64.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$96.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$96.00
|
| Rate for Payer: United Healthcare Commercial |
$115.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$75.52
|
|
|
risperiDONE 0.25 mg Tab [VDMC]
|
Facility
|
IP
|
$1.43
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419221
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna of IA Commercial |
$1.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.29
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.07
|
| Rate for Payer: Medical Associates Commercial |
$1.07
|
| Rate for Payer: Midlands Choice Commercial |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
|
|
risperiDONE 0.25 mg Tab [VDMC]
|
Facility
|
OP
|
$1.43
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419221
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna of IA Commercial |
$1.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.29
|
| Rate for Payer: Aetna of IA Medicare |
$0.82
|
| Rate for Payer: Amerigroup Medicaid |
$0.72
|
| Rate for Payer: Amerigroup Medicare |
$0.72
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.07
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.71
|
| Rate for Payer: Medical Associates Commercial |
$1.07
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.72
|
| Rate for Payer: Midlands Choice Commercial |
$1.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.73
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.73
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.07
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.84
|
|
|
risperiDONE 1 mg Tab [VDMC]
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419292
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna of IA Commercial |
$1.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.94
|
| Rate for Payer: Aetna of IA Medicare |
$1.23
|
| Rate for Payer: Amerigroup Medicaid |
$1.09
|
| Rate for Payer: Amerigroup Medicare |
$1.09
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.62
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.08
|
| Rate for Payer: Medical Associates Commercial |
$1.62
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.08
|
| Rate for Payer: Midlands Choice Commercial |
$1.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.10
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.10
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.62
|
| Rate for Payer: United Healthcare Commercial |
$1.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.27
|
|
|
risperiDONE 1 mg Tab [VDMC]
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419292
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna of IA Commercial |
$1.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.94
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.62
|
| Rate for Payer: Medical Associates Commercial |
$1.62
|
| Rate for Payer: Midlands Choice Commercial |
$1.51
|
| Rate for Payer: United Healthcare Commercial |
$1.94
|
|
|
riTUXimab-abbs 10mg/mL 50mL SDV [VDMC]
|
Facility
|
OP
|
$4,914.14
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
25843432
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2,456.09 |
| Max. Negotiated Rate |
$4,422.73 |
| Rate for Payer: Aetna of IA Commercial |
$4,422.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,422.73
|
| Rate for Payer: Aetna of IA Medicare |
$2,801.06
|
| Rate for Payer: Amerigroup Medicaid |
$2,480.17
|
| Rate for Payer: Amerigroup Medicare |
$2,481.64
|
| Rate for Payer: Cash Price |
$3,931.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,685.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,457.07
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,456.09
|
| Rate for Payer: Medical Associates Commercial |
$3,685.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,457.07
|
| Rate for Payer: Midlands Choice Commercial |
$3,439.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,493.93
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$2,492.45
|
| Rate for Payer: Oscar Health of IA Commercial |
$3,685.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,685.60
|
| Rate for Payer: United Healthcare Commercial |
$4,422.73
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,899.34
|
|
|
riTUXimab-abbs 10mg/mL 50mL SDV [VDMC]
|
Facility
|
IP
|
$4,914.14
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
25843432
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3,439.90 |
| Max. Negotiated Rate |
$4,422.73 |
| Rate for Payer: Aetna of IA Commercial |
$4,422.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,422.73
|
| Rate for Payer: Cash Price |
$3,931.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,685.60
|
| Rate for Payer: Medical Associates Commercial |
$3,685.60
|
| Rate for Payer: Midlands Choice Commercial |
$3,439.90
|
| Rate for Payer: United Healthcare Commercial |
$4,422.73
|
|
|
rivaroxaban 10 mg Tab UD [VDMC]
|
Facility
|
OP
|
$50.91
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419491
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$45.82 |
| Rate for Payer: Aetna of IA Commercial |
$45.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.82
|
| Rate for Payer: Aetna of IA Medicare |
$29.02
|
| Rate for Payer: Amerigroup Medicaid |
$25.69
|
| Rate for Payer: Amerigroup Medicare |
$25.71
|
| Rate for Payer: Cash Price |
$40.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.18
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.44
|
| Rate for Payer: Medical Associates Commercial |
$38.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.46
|
| Rate for Payer: Midlands Choice Commercial |
$35.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.84
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$25.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$38.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$38.18
|
| Rate for Payer: United Healthcare Commercial |
$45.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.04
|
|
|
rivaroxaban 10 mg Tab UD [VDMC]
|
Facility
|
IP
|
$50.91
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419491
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.64 |
| Max. Negotiated Rate |
$45.82 |
| Rate for Payer: Aetna of IA Commercial |
$45.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.82
|
| Rate for Payer: Cash Price |
$40.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.18
|
| Rate for Payer: Medical Associates Commercial |
$38.18
|
| Rate for Payer: Midlands Choice Commercial |
$35.64
|
| Rate for Payer: United Healthcare Commercial |
$45.82
|
|
|
rivaroxaban 15 mg Tab [VDMC]
|
Facility
|
IP
|
$67.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419562
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.35 |
| Max. Negotiated Rate |
$60.88 |
| Rate for Payer: Aetna of IA Commercial |
$60.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.88
|
| Rate for Payer: Cash Price |
$54.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.73
|
| Rate for Payer: Medical Associates Commercial |
$50.73
|
| Rate for Payer: Midlands Choice Commercial |
$47.35
|
| Rate for Payer: United Healthcare Commercial |
$60.88
|
|
|
rivaroxaban 15 mg Tab [VDMC]
|
Facility
|
OP
|
$67.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419562
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$60.88 |
| Rate for Payer: Aetna of IA Commercial |
$60.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.88
|
| Rate for Payer: Aetna of IA Medicare |
$38.55
|
| Rate for Payer: Amerigroup Medicaid |
$34.14
|
| Rate for Payer: Amerigroup Medicare |
$34.16
|
| Rate for Payer: Cash Price |
$54.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.81
|
| Rate for Payer: Medical Associates Commercial |
$50.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.82
|
| Rate for Payer: Midlands Choice Commercial |
$47.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.33
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$34.31
|
| Rate for Payer: Oscar Health of IA Commercial |
$50.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.73
|
| Rate for Payer: United Healthcare Commercial |
$60.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.91
|
|
|
rivastiGMine 1.5 mg Cap [VDMC]
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419631
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna of IA Commercial |
$2.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.46
|
| Rate for Payer: Aetna of IA Medicare |
$1.56
|
| Rate for Payer: Amerigroup Medicaid |
$1.38
|
| Rate for Payer: Amerigroup Medicare |
$1.38
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.05
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.36
|
| Rate for Payer: Medical Associates Commercial |
$2.05
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.36
|
| Rate for Payer: Midlands Choice Commercial |
$1.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.39
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.38
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.05
|
| Rate for Payer: United Healthcare Commercial |
$2.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.61
|
|
|
rivastiGMine 1.5 mg Cap [VDMC]
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419631
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna of IA Commercial |
$2.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.46
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.05
|
| Rate for Payer: Medical Associates Commercial |
$2.05
|
| Rate for Payer: Midlands Choice Commercial |
$1.91
|
| Rate for Payer: United Healthcare Commercial |
$2.46
|
|
|
rivastiGMine 4.6 mg/24 hr TD film, ER [VDMC]
|
Facility
|
IP
|
$14.13
|
|
|
Service Code
|
NDC 00378-9070-93
|
| Hospital Charge Code |
10430381
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Aetna of IA Commercial |
$12.72
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.72
|
| Rate for Payer: Cash Price |
$11.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.60
|
| Rate for Payer: Medical Associates Commercial |
$10.60
|
| Rate for Payer: Midlands Choice Commercial |
$9.89
|
| Rate for Payer: United Healthcare Commercial |
$12.72
|
|
|
rivastiGMine 4.6 mg/24 hr TD film, ER [VDMC]
|
Facility
|
OP
|
$14.13
|
|
|
Service Code
|
NDC 00378-9070-93
|
| Hospital Charge Code |
10430381
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Aetna of IA Commercial |
$12.72
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.72
|
| Rate for Payer: Aetna of IA Medicare |
$8.05
|
| Rate for Payer: Amerigroup Medicaid |
$7.13
|
| Rate for Payer: Amerigroup Medicare |
$7.14
|
| Rate for Payer: Cash Price |
$11.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.06
|
| Rate for Payer: Medical Associates Commercial |
$10.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.06
|
| Rate for Payer: Midlands Choice Commercial |
$9.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.17
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$7.17
|
| Rate for Payer: Oscar Health of IA Commercial |
$10.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$10.60
|
| Rate for Payer: United Healthcare Commercial |
$12.72
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.34
|
|
|
rocuronium 10 mg/mL 5 ml MDV IV [VDMC]
|
Facility
|
IP
|
$47.69
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10419700
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$42.92 |
| Rate for Payer: Aetna of IA Commercial |
$42.92
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$42.92
|
| Rate for Payer: Cash Price |
$38.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.77
|
| Rate for Payer: Medical Associates Commercial |
$35.77
|
| Rate for Payer: Midlands Choice Commercial |
$33.38
|
| Rate for Payer: United Healthcare Commercial |
$42.92
|
|
|
rocuronium 10 mg/mL 5 ml MDV IV [VDMC]
|
Facility
|
OP
|
$47.69
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10419700
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.84 |
| Max. Negotiated Rate |
$42.92 |
| Rate for Payer: Aetna of IA Commercial |
$42.92
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$42.92
|
| Rate for Payer: Aetna of IA Medicare |
$27.18
|
| Rate for Payer: Amerigroup Medicaid |
$24.07
|
| Rate for Payer: Amerigroup Medicare |
$24.08
|
| Rate for Payer: Cash Price |
$38.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.77
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.84
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.84
|
| Rate for Payer: Medical Associates Commercial |
$35.77
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.84
|
| Rate for Payer: Midlands Choice Commercial |
$33.38
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24.20
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$24.19
|
| Rate for Payer: Oscar Health of IA Commercial |
$35.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$35.77
|
| Rate for Payer: United Healthcare Commercial |
$42.92
|
| Rate for Payer: United Healthcare Managed Medicare |
$28.14
|
|
|
ROOM/BED: Respite
|
Facility
|
IP
|
$400.00
|
|
| Hospital Charge Code |
8002762
|
|
Hospital Revenue Code
|
115
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$9,842.42 |
| Rate for Payer: Aetna of IA Commercial |
$360.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$360.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,258.00
|
| Rate for Payer: Amerigroup Medicare |
$2,054.34
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$300.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Medical Associates Commercial |
$300.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,034.00
|
| Rate for Payer: Midlands Choice Commercial |
$280.00
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$9,842.42
|
| Rate for Payer: Oscar Health of IA Commercial |
$3,051.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,339.10
|
| Rate for Payer: United Healthcare Commercial |
$360.00
|
|
|
rOPINIRole 0.5 mg Tab [VDMC]
|
Facility
|
OP
|
$2.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10608306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna of IA Commercial |
$1.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.95
|
| Rate for Payer: Aetna of IA Medicare |
$1.24
|
| Rate for Payer: Amerigroup Medicaid |
$1.10
|
| Rate for Payer: Amerigroup Medicare |
$1.10
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.63
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.08
|
| Rate for Payer: Medical Associates Commercial |
$1.63
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.08
|
| Rate for Payer: Midlands Choice Commercial |
$1.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.10
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.10
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.63
|
| Rate for Payer: United Healthcare Commercial |
$1.95
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.28
|
|
