|
potassium phosphate-sodium phosphate 250 mg-280 mg-160 mg Pow UD [VDMC]
|
Facility
|
IP
|
$4.43
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10415085
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: Aetna of IA Commercial |
$3.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.98
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.32
|
| Rate for Payer: Medical Associates Commercial |
$3.32
|
| Rate for Payer: Midlands Choice Commercial |
$3.10
|
| Rate for Payer: United Healthcare Commercial |
$3.98
|
|
|
potassium phosphate-sodium phosphate 250 mg-280 mg-160 mg Pow UD [VDMC]
|
Facility
|
OP
|
$4.43
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10415085
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: Aetna of IA Commercial |
$3.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.98
|
| Rate for Payer: Aetna of IA Medicare |
$2.52
|
| Rate for Payer: Amerigroup Medicaid |
$2.55
|
| Rate for Payer: Amerigroup Medicare |
$2.01
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.53
|
| Rate for Payer: Medical Associates Commercial |
$3.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.99
|
| Rate for Payer: Midlands Choice Commercial |
$3.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.29
|
| Rate for Payer: United Healthcare Commercial |
$3.98
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.61
|
|
|
povidone iodine topical 10% Oin[VDMC]
|
Facility
|
IP
|
$12.89
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11336895
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$11.60 |
| Rate for Payer: Aetna of IA Commercial |
$11.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.60
|
| Rate for Payer: Cash Price |
$10.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.67
|
| Rate for Payer: Medical Associates Commercial |
$9.67
|
| Rate for Payer: Midlands Choice Commercial |
$9.02
|
| Rate for Payer: United Healthcare Commercial |
$11.60
|
|
|
povidone iodine topical 10% Oin[VDMC]
|
Facility
|
OP
|
$12.89
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11336895
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$11.60 |
| Rate for Payer: Aetna of IA Commercial |
$11.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.60
|
| Rate for Payer: Aetna of IA Medicare |
$7.35
|
| Rate for Payer: Amerigroup Medicaid |
$7.43
|
| Rate for Payer: Amerigroup Medicare |
$5.86
|
| Rate for Payer: Cash Price |
$10.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.67
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.36
|
| Rate for Payer: Medical Associates Commercial |
$9.67
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.80
|
| Rate for Payer: Midlands Choice Commercial |
$9.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$6.67
|
| Rate for Payer: United Healthcare Commercial |
$11.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.60
|
|
|
POWER PORT INFUSAPORT
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
8026269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$261.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of IA Commercial |
$522.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$522.00
|
| Rate for Payer: Aetna of IA Medicare |
$330.60
|
| Rate for Payer: Amerigroup Medicaid |
$334.54
|
| Rate for Payer: Amerigroup Medicare |
$263.61
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$435.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$261.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$331.30
|
| Rate for Payer: Medical Associates Commercial |
$435.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$261.00
|
| Rate for Payer: Midlands Choice Commercial |
$406.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$336.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$300.15
|
| Rate for Payer: United Healthcare Commercial |
$522.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$342.20
|
|
|
POWER PORT INFUSAPORT
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
8026269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of IA Commercial |
$522.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$522.00
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$435.00
|
| Rate for Payer: Medical Associates Commercial |
$435.00
|
| Rate for Payer: Midlands Choice Commercial |
$406.00
|
| Rate for Payer: United Healthcare Commercial |
$522.00
|
|
|
pralidoxime 1 g IV SDV Inj [VDMC]
|
Facility
|
OP
|
$349.46
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
10430046
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$157.26 |
| Max. Negotiated Rate |
$314.51 |
| Rate for Payer: Aetna of IA Commercial |
$314.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$314.51
|
| Rate for Payer: Aetna of IA Medicare |
$199.19
|
| Rate for Payer: Amerigroup Medicaid |
$201.57
|
| Rate for Payer: Amerigroup Medicare |
$158.83
|
| Rate for Payer: Cash Price |
$279.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$262.10
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$157.26
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$199.61
|
| Rate for Payer: Medical Associates Commercial |
$262.10
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.26
|
| Rate for Payer: Midlands Choice Commercial |
$244.62
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$202.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$180.85
|
| Rate for Payer: United Healthcare Commercial |
$314.51
|
| Rate for Payer: United Healthcare Managed Medicare |
$206.18
|
|
|
pralidoxime 1 g IV SDV Inj [VDMC]
|
Facility
|
IP
|
$349.46
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
10430046
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$244.62 |
| Max. Negotiated Rate |
$314.51 |
| Rate for Payer: Aetna of IA Commercial |
$314.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$314.51
|
| Rate for Payer: Cash Price |
$279.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$262.10
|
| Rate for Payer: Medical Associates Commercial |
$262.10
|
| Rate for Payer: Midlands Choice Commercial |
$244.62
|
| Rate for Payer: United Healthcare Commercial |
$314.51
|
|
|
pramipexole 0.25 mg Tab [VDMC]
|
Facility
|
IP
|
$1.56
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10415154
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of IA Commercial |
$1.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.41
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.17
|
| Rate for Payer: Medical Associates Commercial |
$1.17
|
| Rate for Payer: Midlands Choice Commercial |
$1.09
|
| Rate for Payer: United Healthcare Commercial |
$1.41
|
|
|
pramipexole 0.25 mg Tab [VDMC]
|
Facility
|
OP
|
$1.56
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10415154
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of IA Commercial |
$1.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.41
|
| Rate for Payer: Aetna of IA Medicare |
$0.89
|
| Rate for Payer: Amerigroup Medicaid |
$0.90
|
| Rate for Payer: Amerigroup Medicare |
$0.71
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.17
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.89
|
| Rate for Payer: Medical Associates Commercial |
$1.17
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.70
|
| Rate for Payer: Midlands Choice Commercial |
$1.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.41
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.92
|
|
|
pramipexole 0.5 mg Tab [VDMC]
|
Facility
|
IP
|
$1.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10415223
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna of IA Commercial |
$0.99
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.99
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.83
|
| Rate for Payer: Medical Associates Commercial |
$0.83
|
| Rate for Payer: Midlands Choice Commercial |
$0.77
|
| Rate for Payer: United Healthcare Commercial |
$0.99
|
|
|
pramipexole 0.5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10415223
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| 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 |
$0.64
|
| Rate for Payer: Amerigroup Medicare |
$0.50
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.83
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.63
|
| Rate for Payer: Medical Associates Commercial |
$0.83
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.50
|
| 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
|
|
|
pramoxine Top 1% Rectal Foam 15gm [VDMC]
|
Facility
|
IP
|
$412.04
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10437296
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$288.43 |
| Max. Negotiated Rate |
$370.84 |
| Rate for Payer: Aetna of IA Commercial |
$370.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$370.84
|
| Rate for Payer: Cash Price |
$329.63
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$309.03
|
| Rate for Payer: Medical Associates Commercial |
$309.03
|
| Rate for Payer: Midlands Choice Commercial |
$288.43
|
| Rate for Payer: United Healthcare Commercial |
$370.84
|
|
|
pramoxine Top 1% Rectal Foam 15gm [VDMC]
|
Facility
|
OP
|
$412.04
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10437296
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$185.42 |
| Max. Negotiated Rate |
$370.84 |
| Rate for Payer: Aetna of IA Commercial |
$370.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$370.84
|
| Rate for Payer: Aetna of IA Medicare |
$234.86
|
| Rate for Payer: Amerigroup Medicaid |
$237.66
|
| Rate for Payer: Amerigroup Medicare |
$187.27
|
| Rate for Payer: Cash Price |
$329.63
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$309.03
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$185.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$235.36
|
| Rate for Payer: Medical Associates Commercial |
$309.03
|
| Rate for Payer: Medical Associates Managed Medicare |
$185.42
|
| Rate for Payer: Midlands Choice Commercial |
$288.43
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$238.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$213.23
|
| Rate for Payer: United Healthcare Commercial |
$370.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$243.10
|
|
|
prasugrel 10 mg Tab [VDMC]
|
Facility
|
OP
|
$1.74
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10415292
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Aetna of IA Commercial |
$1.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.56
|
| Rate for Payer: Aetna of IA Medicare |
$0.99
|
| Rate for Payer: Amerigroup Medicaid |
$1.00
|
| Rate for Payer: Amerigroup Medicare |
$0.79
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.30
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.99
|
| Rate for Payer: Medical Associates Commercial |
$1.30
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.78
|
| Rate for Payer: Midlands Choice Commercial |
$1.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.56
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.02
|
|
|
prasugrel 10 mg Tab [VDMC]
|
Facility
|
IP
|
$1.74
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10415292
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Aetna of IA Commercial |
$1.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.56
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.30
|
| Rate for Payer: Medical Associates Commercial |
$1.30
|
| Rate for Payer: Midlands Choice Commercial |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$1.56
|
|
|
pravastatin 20 mg Tab [VDMC]
|
Facility
|
IP
|
$1.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10415361
|
|
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
|
|
|
pravastatin 20 mg Tab [VDMC]
|
Facility
|
OP
|
$1.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10415361
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| 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 |
$0.68
|
| Rate for Payer: Amerigroup Medicare |
$0.53
|
| 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 |
$0.53
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.67
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.53
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.61
|
| Rate for Payer: United Healthcare Commercial |
$1.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.69
|
|
|
prazosin 1 mg Cap [VDMC]
|
Facility
|
OP
|
$1.53
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10415430
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna of IA Commercial |
$1.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.38
|
| Rate for Payer: Aetna of IA Medicare |
$0.87
|
| Rate for Payer: Amerigroup Medicaid |
$0.88
|
| Rate for Payer: Amerigroup Medicare |
$0.70
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.15
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.69
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.88
|
| Rate for Payer: Medical Associates Commercial |
$1.15
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.69
|
| Rate for Payer: Midlands Choice Commercial |
$1.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.38
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.90
|
|
|
prazosin 1 mg Cap [VDMC]
|
Facility
|
IP
|
$1.53
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10415430
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna of IA Commercial |
$1.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.38
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.15
|
| Rate for Payer: Medical Associates Commercial |
$1.15
|
| Rate for Payer: Midlands Choice Commercial |
$1.07
|
| Rate for Payer: United Healthcare Commercial |
$1.38
|
|
|
Prealbumin DMCL
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
8037781
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
Prealbumin DMCL
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
8037781
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.68 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$80.18
|
| Rate for Payer: Amerigroup Medicare |
$63.18
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$62.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.40
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.55
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.93
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO WHPI |
$61.68
|
| Rate for Payer: Wellmark IA PPO |
$67.95
|
|
|
prednisoLONE 45 mg/15 mL Syr [VDMC]
|
Facility
|
OP
|
$38.98
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
11221578
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$35.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$35.08
|
| Rate for Payer: Aetna of IA Medicare |
$22.22
|
| Rate for Payer: Amerigroup Medicaid |
$22.49
|
| Rate for Payer: Amerigroup Medicare |
$17.72
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$29.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.27
|
| Rate for Payer: Medical Associates Commercial |
$29.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.54
|
| Rate for Payer: Midlands Choice Commercial |
$27.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.17
|
| Rate for Payer: United Healthcare Commercial |
$35.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.00
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
prednisoLONE 45 mg/15 mL Syr [VDMC]
|
Facility
|
IP
|
$38.98
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
11221578
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.29 |
| Max. Negotiated Rate |
$35.08 |
| Rate for Payer: Aetna of IA Commercial |
$35.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$35.08
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$29.24
|
| Rate for Payer: Medical Associates Commercial |
$29.24
|
| Rate for Payer: Midlands Choice Commercial |
$27.29
|
| Rate for Payer: United Healthcare Commercial |
$35.08
|
|
|
prednisoLONE Ophth acetate 1% Susp 5 ml [VDMC]
|
Facility
|
OP
|
$125.32
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10437361
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$56.39 |
| Max. Negotiated Rate |
$112.79 |
| Rate for Payer: Aetna of IA Commercial |
$112.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$112.79
|
| Rate for Payer: Aetna of IA Medicare |
$71.43
|
| Rate for Payer: Amerigroup Medicaid |
$72.28
|
| Rate for Payer: Amerigroup Medicare |
$56.96
|
| Rate for Payer: Cash Price |
$100.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.99
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$56.39
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.58
|
| Rate for Payer: Medical Associates Commercial |
$93.99
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.39
|
| Rate for Payer: Midlands Choice Commercial |
$87.72
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$72.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.85
|
| Rate for Payer: United Healthcare Commercial |
$112.79
|
| Rate for Payer: United Healthcare Managed Medicare |
$73.94
|
|
