|
promethazine 25 mg Tab [VDMC]
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10416729
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of IA Commercial |
$1.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.47
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.22
|
| Rate for Payer: Medical Associates Commercial |
$1.22
|
| Rate for Payer: Midlands Choice Commercial |
$1.14
|
| Rate for Payer: United Healthcare Commercial |
$1.47
|
|
|
promethazine 6.25 mg/5 mL Oral Syrup [VDMC]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
HCPCS Q0169
|
| Hospital Charge Code |
10416800
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna of IA Commercial |
$3.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.00
|
| Rate for Payer: Medical Associates Commercial |
$3.00
|
| Rate for Payer: Midlands Choice Commercial |
$2.80
|
| Rate for Payer: United Healthcare Commercial |
$3.60
|
|
|
promethazine 6.25 mg/5 mL Oral Syrup [VDMC]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
HCPCS Q0169
|
| Hospital Charge Code |
10416800
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$3.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.60
|
| Rate for Payer: Aetna of IA Medicare |
$2.28
|
| Rate for Payer: Amerigroup Medicaid |
$2.31
|
| Rate for Payer: Amerigroup Medicare |
$1.82
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.28
|
| Rate for Payer: Medical Associates Commercial |
$3.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.80
|
| Rate for Payer: Midlands Choice Commercial |
$2.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.07
|
| Rate for Payer: United Healthcare Commercial |
$3.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.36
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
promethazine-codein 6.25 mg-10mg/5 mL 5ml Oral Syrup [VDMC]
|
Facility
|
OP
|
$3.55
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10379233
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna of IA Commercial |
$3.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.20
|
| Rate for Payer: Aetna of IA Medicare |
$2.02
|
| Rate for Payer: Amerigroup Medicaid |
$2.05
|
| Rate for Payer: Amerigroup Medicare |
$1.61
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.66
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.03
|
| Rate for Payer: Medical Associates Commercial |
$2.66
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.60
|
| Rate for Payer: Midlands Choice Commercial |
$2.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.84
|
| Rate for Payer: United Healthcare Commercial |
$3.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.10
|
|
|
promethazine-codein 6.25 mg-10mg/5 mL 5ml Oral Syrup [VDMC]
|
Facility
|
IP
|
$3.55
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10379233
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna of IA Commercial |
$3.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.20
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.66
|
| Rate for Payer: Medical Associates Commercial |
$2.66
|
| Rate for Payer: Midlands Choice Commercial |
$2.49
|
| Rate for Payer: United Healthcare Commercial |
$3.20
|
|
|
promethazine-dextromethorphan 6.25mg-15 mg/5 mL Oral Syrup 10mL [VDMC]
|
Facility
|
IP
|
$5.25
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10382102
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Aetna of IA Commercial |
$4.72
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.72
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.93
|
| Rate for Payer: Medical Associates Commercial |
$3.93
|
| Rate for Payer: Midlands Choice Commercial |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$4.72
|
|
|
promethazine-dextromethorphan 6.25mg-15 mg/5 mL Oral Syrup 10mL [VDMC]
|
Facility
|
OP
|
$5.25
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10382102
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Aetna of IA Commercial |
$4.72
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.72
|
| Rate for Payer: Aetna of IA Medicare |
$2.99
|
| Rate for Payer: Amerigroup Medicaid |
$3.03
|
| Rate for Payer: Amerigroup Medicare |
$2.38
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.93
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.00
|
| Rate for Payer: Medical Associates Commercial |
$3.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.36
|
| Rate for Payer: Midlands Choice Commercial |
$3.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.71
|
| Rate for Payer: United Healthcare Commercial |
$4.72
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.09
|
|
|
propafenone 150 mg Tab [VDMC]
|
Facility
|
OP
|
$1.46
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10416869
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Aetna of IA Commercial |
$1.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.32
|
| Rate for Payer: Aetna of IA Medicare |
$0.83
|
| Rate for Payer: Amerigroup Medicaid |
$0.84
|
| Rate for Payer: Amerigroup Medicare |
$0.66
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.10
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.84
|
| Rate for Payer: Medical Associates Commercial |
$1.10
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.66
|
| Rate for Payer: Midlands Choice Commercial |
$1.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.76
|
| Rate for Payer: United Healthcare Commercial |
$1.32
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.86
|
|
|
propafenone 150 mg Tab [VDMC]
|
Facility
|
IP
|
$1.46
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10416869
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Aetna of IA Commercial |
$1.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.32
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.10
|
| Rate for Payer: Medical Associates Commercial |
$1.10
|
| Rate for Payer: Midlands Choice Commercial |
$1.02
|
| Rate for Payer: United Healthcare Commercial |
$1.32
|
|
|
propafenone 225 mg Tab [VDMC]
|
Facility
|
IP
|
$1.75
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10416930
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of IA Commercial |
$1.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.57
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.31
|
| Rate for Payer: Medical Associates Commercial |
$1.31
|
| Rate for Payer: Midlands Choice Commercial |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
|
|
propafenone 225 mg Tab [VDMC]
|
Facility
|
OP
|
$1.75
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10416930
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of IA Commercial |
$1.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.57
|
| Rate for Payer: Aetna of IA Medicare |
$1.00
|
| Rate for Payer: Amerigroup Medicaid |
$1.01
|
| Rate for Payer: Amerigroup Medicare |
$0.79
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.31
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.79
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.00
|
| Rate for Payer: Medical Associates Commercial |
$1.31
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.79
|
| 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 |
$1.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.03
|
|
|
propofol 10 mg/mL 100ml SDV IV Emul [VDMC]
|
Facility
|
IP
|
$56.72
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
17564591
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.70 |
| Max. Negotiated Rate |
$51.05 |
| Rate for Payer: Aetna of IA Commercial |
$51.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.05
|
| Rate for Payer: Cash Price |
$45.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.54
|
| Rate for Payer: Medical Associates Commercial |
$42.54
|
| Rate for Payer: Midlands Choice Commercial |
$39.70
|
| Rate for Payer: United Healthcare Commercial |
$51.05
|
|
|
propofol 10 mg/mL 100ml SDV IV Emul [VDMC]
|
Facility
|
OP
|
$56.72
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
17564591
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$51.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.05
|
| Rate for Payer: Aetna of IA Medicare |
$32.33
|
| Rate for Payer: Amerigroup Medicaid |
$32.72
|
| Rate for Payer: Amerigroup Medicare |
$25.78
|
| Rate for Payer: Cash Price |
$45.38
|
| Rate for Payer: Cash Price |
$45.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.54
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.40
|
| Rate for Payer: Medical Associates Commercial |
$42.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.52
|
| Rate for Payer: Midlands Choice Commercial |
$39.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$29.35
|
| Rate for Payer: United Healthcare Commercial |
$51.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.46
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
propofol 10 mg/mL 20 ml SDV IV Emul [VDMC]
|
Facility
|
OP
|
$27.36
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
10417070
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$24.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.62
|
| Rate for Payer: Aetna of IA Medicare |
$15.60
|
| Rate for Payer: Amerigroup Medicaid |
$15.78
|
| Rate for Payer: Amerigroup Medicare |
$12.44
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.31
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.63
|
| Rate for Payer: Medical Associates Commercial |
$20.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.31
|
| Rate for Payer: Midlands Choice Commercial |
$19.15
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.16
|
| Rate for Payer: United Healthcare Commercial |
$24.62
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.14
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
propofol 10 mg/mL 20 ml SDV IV Emul [VDMC]
|
Facility
|
IP
|
$27.36
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
10417070
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.15 |
| Max. Negotiated Rate |
$24.62 |
| Rate for Payer: Aetna of IA Commercial |
$24.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.62
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.52
|
| Rate for Payer: Medical Associates Commercial |
$20.52
|
| Rate for Payer: Midlands Choice Commercial |
$19.15
|
| Rate for Payer: United Healthcare Commercial |
$24.62
|
|
|
propofol 10 mg/mL 50 ml SDV IV Emul [VDMC]
|
Facility
|
OP
|
$41.05
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
10416999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$36.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.94
|
| Rate for Payer: Aetna of IA Medicare |
$23.40
|
| Rate for Payer: Amerigroup Medicaid |
$23.68
|
| Rate for Payer: Amerigroup Medicare |
$18.66
|
| Rate for Payer: Cash Price |
$32.84
|
| Rate for Payer: Cash Price |
$32.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.47
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.45
|
| Rate for Payer: Medical Associates Commercial |
$30.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.47
|
| Rate for Payer: Midlands Choice Commercial |
$28.73
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.24
|
| Rate for Payer: United Healthcare Commercial |
$36.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.22
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
propofol 10 mg/mL 50 ml SDV IV Emul [VDMC]
|
Facility
|
IP
|
$41.05
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
10416999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$36.94 |
| Rate for Payer: Aetna of IA Commercial |
$36.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.94
|
| Rate for Payer: Cash Price |
$32.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.78
|
| Rate for Payer: Medical Associates Commercial |
$30.78
|
| Rate for Payer: Midlands Choice Commercial |
$28.73
|
| Rate for Payer: United Healthcare Commercial |
$36.94
|
|
|
propranolol 20 mg Tab [VDMC]
|
Facility
|
IP
|
$2.15
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417141
|
|
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 |
$1.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.61
|
| Rate for Payer: Medical Associates Commercial |
$1.61
|
| Rate for Payer: Midlands Choice Commercial |
$1.51
|
| Rate for Payer: United Healthcare Commercial |
$1.94
|
|
|
propranolol 20 mg Tab [VDMC]
|
Facility
|
OP
|
$2.15
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417141
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.97 |
| 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 |
$1.24
|
| Rate for Payer: Amerigroup Medicare |
$0.98
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.61
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.97
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.23
|
| Rate for Payer: Medical Associates Commercial |
$1.61
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.97
|
| Rate for Payer: Midlands Choice Commercial |
$1.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.11
|
| Rate for Payer: United Healthcare Commercial |
$1.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.27
|
|
|
propranolol 60 mg ER Cap [VDMC]
|
Facility
|
OP
|
$1.63
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of IA Commercial |
$1.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.47
|
| Rate for Payer: Aetna of IA Medicare |
$0.93
|
| Rate for Payer: Amerigroup Medicaid |
$0.94
|
| Rate for Payer: Amerigroup Medicare |
$0.74
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.93
|
| Rate for Payer: Medical Associates Commercial |
$1.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.73
|
| Rate for Payer: Midlands Choice Commercial |
$1.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.47
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.96
|
|
|
propranolol 60 mg ER Cap [VDMC]
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of IA Commercial |
$1.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.47
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.22
|
| Rate for Payer: Medical Associates Commercial |
$1.22
|
| Rate for Payer: Midlands Choice Commercial |
$1.14
|
| Rate for Payer: United Healthcare Commercial |
$1.47
|
|
|
propranolol 80 mg ERCap [VDMC]
|
Facility
|
OP
|
$1.74
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417281
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of IA Commercial |
$1.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.57
|
| 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 |
$1.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.03
|
|
|
propranolol 80 mg ERCap [VDMC]
|
Facility
|
IP
|
$1.74
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417281
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of IA Commercial |
$1.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.57
|
| 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 |
$1.57
|
|
|
propylthiouracil 50 mg Tab [VDMC]
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417350
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna of IA Commercial |
$2.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.69
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.24
|
| Rate for Payer: Medical Associates Commercial |
$2.24
|
| Rate for Payer: Midlands Choice Commercial |
$2.09
|
| Rate for Payer: United Healthcare Commercial |
$2.69
|
|
|
propylthiouracil 50 mg Tab [VDMC]
|
Facility
|
OP
|
$2.99
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417350
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna of IA Commercial |
$2.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.69
|
| Rate for Payer: Aetna of IA Medicare |
$1.70
|
| Rate for Payer: Amerigroup Medicaid |
$1.72
|
| Rate for Payer: Amerigroup Medicare |
$1.36
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.71
|
| Rate for Payer: Medical Associates Commercial |
$2.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.34
|
| Rate for Payer: Midlands Choice Commercial |
$2.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.55
|
| Rate for Payer: United Healthcare Commercial |
$2.69
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.76
|
|
