THP amoxicillin-clavulanate 250 mg-62.5 mg/5 mL Oral Liq 75 ml[VDMC]
|
Facility
|
OP
|
$186.56
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10366591
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$93.24 |
Max. Negotiated Rate |
$167.90 |
Rate for Payer: Aetna of IA Commercial |
$167.90
|
Rate for Payer: Aetna of IA Medical Rental Products |
$167.90
|
Rate for Payer: Aetna of IA Medicare |
$106.34
|
Rate for Payer: Amerigroup Medicaid |
$94.16
|
Rate for Payer: Amerigroup Medicare |
$94.21
|
Rate for Payer: Cash Price |
$149.25
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$139.92
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$93.28
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$93.24
|
Rate for Payer: Medical Associates Commercial |
$139.92
|
Rate for Payer: Medical Associates Managed Medicare |
$93.28
|
Rate for Payer: Midlands Choice Commercial |
$130.59
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$94.68
|
Rate for Payer: Molina Healthcare Managed Medicare |
$94.62
|
Rate for Payer: Oscar Health of IA Commercial |
$139.92
|
Rate for Payer: Partners Health Alliance Commercial |
$139.92
|
Rate for Payer: United Healthcare Commercial |
$167.90
|
Rate for Payer: United Healthcare Managed Medicare |
$110.07
|
|
THP amoxicillin-clavulanate 250 mg-62.5 mg/5 mL Oral Liq 75 ml[VDMC]
|
Facility
|
IP
|
$186.56
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10366591
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$130.59 |
Max. Negotiated Rate |
$167.90 |
Rate for Payer: Aetna of IA Commercial |
$167.90
|
Rate for Payer: Aetna of IA Medical Rental Products |
$167.90
|
Rate for Payer: Cash Price |
$149.25
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$139.92
|
Rate for Payer: Medical Associates Commercial |
$139.92
|
Rate for Payer: Midlands Choice Commercial |
$130.59
|
Rate for Payer: United Healthcare Commercial |
$167.90
|
|
THP Amoxicillin Clavulanate 875mg/125mg 6 tablets [VDMC]
|
Facility
|
IP
|
$21.52
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10736392
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$15.06 |
Max. Negotiated Rate |
$19.37 |
Rate for Payer: Aetna of IA Commercial |
$19.37
|
Rate for Payer: Aetna of IA Medical Rental Products |
$19.37
|
Rate for Payer: Cash Price |
$17.22
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.14
|
Rate for Payer: Medical Associates Commercial |
$16.14
|
Rate for Payer: Midlands Choice Commercial |
$15.06
|
Rate for Payer: United Healthcare Commercial |
$19.37
|
|
THP Amoxicillin Clavulanate 875mg/125mg 6 tablets [VDMC]
|
Facility
|
OP
|
$21.52
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10736392
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$10.76 |
Max. Negotiated Rate |
$19.37 |
Rate for Payer: Aetna of IA Commercial |
$19.37
|
Rate for Payer: Aetna of IA Medical Rental Products |
$19.37
|
Rate for Payer: Aetna of IA Medicare |
$12.27
|
Rate for Payer: Amerigroup Medicaid |
$10.86
|
Rate for Payer: Amerigroup Medicare |
$10.87
|
Rate for Payer: Cash Price |
$17.22
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.14
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.76
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$10.76
|
Rate for Payer: Medical Associates Commercial |
$16.14
|
Rate for Payer: Medical Associates Managed Medicare |
$10.76
|
Rate for Payer: Midlands Choice Commercial |
$15.06
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$10.92
|
Rate for Payer: Molina Healthcare Managed Medicare |
$10.91
|
Rate for Payer: Oscar Health of IA Commercial |
$16.14
|
Rate for Payer: Partners Health Alliance Commercial |
$16.14
|
Rate for Payer: United Healthcare Commercial |
$19.37
|
Rate for Payer: United Healthcare Managed Medicare |
$12.70
|
|
THP Azithromycin 200mg/5ml 15ml Susp [VDMC]
|
Facility
|
OP
|
$66.60
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
14364642
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$33.29 |
Max. Negotiated Rate |
$59.94 |
Rate for Payer: Aetna of IA Commercial |
$59.94
|
Rate for Payer: Aetna of IA Medical Rental Products |
$59.94
|
Rate for Payer: Aetna of IA Medicare |
$37.96
|
Rate for Payer: Amerigroup Medicaid |
$33.61
|
Rate for Payer: Amerigroup Medicare |
$33.63
|
Rate for Payer: Cash Price |
$53.28
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.95
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.30
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$33.29
|
Rate for Payer: Medical Associates Commercial |
$49.95
|
Rate for Payer: Medical Associates Managed Medicare |
$33.30
|
Rate for Payer: Midlands Choice Commercial |
$46.62
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$33.80
|
Rate for Payer: Molina Healthcare Managed Medicare |
$33.78
|
Rate for Payer: Oscar Health of IA Commercial |
$49.95
|
Rate for Payer: Partners Health Alliance Commercial |
$49.95
|
Rate for Payer: United Healthcare Commercial |
$59.94
|
Rate for Payer: United Healthcare Managed Medicare |
$39.29
|
|
THP Azithromycin 200mg/5ml 15ml Susp [VDMC]
|
Facility
|
IP
|
$66.60
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
14364642
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$46.62 |
Max. Negotiated Rate |
$59.94 |
Rate for Payer: Aetna of IA Commercial |
$59.94
|
Rate for Payer: Aetna of IA Medical Rental Products |
$59.94
|
Rate for Payer: Cash Price |
$53.28
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.95
|
Rate for Payer: Medical Associates Commercial |
$49.95
|
Rate for Payer: Midlands Choice Commercial |
$46.62
|
Rate for Payer: United Healthcare Commercial |
$59.94
|
|
THP Azithromycin 250mg 3 tablets [VDMC]
|
Facility
|
OP
|
$21.62
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10736680
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$10.81 |
Max. Negotiated Rate |
$19.46 |
Rate for Payer: Aetna of IA Commercial |
$19.46
|
Rate for Payer: Aetna of IA Medical Rental Products |
$19.46
|
Rate for Payer: Aetna of IA Medicare |
$12.32
|
Rate for Payer: Amerigroup Medicaid |
$10.91
|
Rate for Payer: Amerigroup Medicare |
$10.92
|
Rate for Payer: Cash Price |
$17.29
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.22
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.81
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$10.81
|
Rate for Payer: Medical Associates Commercial |
$16.22
|
Rate for Payer: Medical Associates Managed Medicare |
$10.81
|
Rate for Payer: Midlands Choice Commercial |
$15.13
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$10.97
|
Rate for Payer: Molina Healthcare Managed Medicare |
$10.97
|
Rate for Payer: Oscar Health of IA Commercial |
$16.22
|
Rate for Payer: Partners Health Alliance Commercial |
$16.22
|
Rate for Payer: United Healthcare Commercial |
$19.46
|
Rate for Payer: United Healthcare Managed Medicare |
$12.76
|
|
THP Azithromycin 250mg 3 tablets [VDMC]
|
Facility
|
IP
|
$21.62
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10736680
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$15.13 |
Max. Negotiated Rate |
$19.46 |
Rate for Payer: Aetna of IA Commercial |
$19.46
|
Rate for Payer: Aetna of IA Medical Rental Products |
$19.46
|
Rate for Payer: Cash Price |
$17.29
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.22
|
Rate for Payer: Medical Associates Commercial |
$16.22
|
Rate for Payer: Midlands Choice Commercial |
$15.13
|
Rate for Payer: United Healthcare Commercial |
$19.46
|
|
THP benzonatate 100mg 5 capsules [VDMC]
|
Facility
|
IP
|
$10.18
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
26928388
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$7.13 |
Max. Negotiated Rate |
$9.16 |
Rate for Payer: Aetna of IA Commercial |
$9.16
|
Rate for Payer: Aetna of IA Medical Rental Products |
$9.16
|
Rate for Payer: Cash Price |
$8.15
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.64
|
Rate for Payer: Medical Associates Commercial |
$7.64
|
Rate for Payer: Midlands Choice Commercial |
$7.13
|
Rate for Payer: United Healthcare Commercial |
$9.16
|
|
THP benzonatate 100mg 5 capsules [VDMC]
|
Facility
|
OP
|
$10.18
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
26928388
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$5.09 |
Max. Negotiated Rate |
$9.16 |
Rate for Payer: Aetna of IA Commercial |
$9.16
|
Rate for Payer: Aetna of IA Medical Rental Products |
$9.16
|
Rate for Payer: Aetna of IA Medicare |
$5.80
|
Rate for Payer: Amerigroup Medicaid |
$5.14
|
Rate for Payer: Amerigroup Medicare |
$5.14
|
Rate for Payer: Cash Price |
$8.15
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.64
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.09
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$5.09
|
Rate for Payer: Medical Associates Commercial |
$7.64
|
Rate for Payer: Medical Associates Managed Medicare |
$5.09
|
Rate for Payer: Midlands Choice Commercial |
$7.13
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$5.17
|
Rate for Payer: Molina Healthcare Managed Medicare |
$5.16
|
Rate for Payer: Oscar Health of IA Commercial |
$7.64
|
Rate for Payer: Partners Health Alliance Commercial |
$7.64
|
Rate for Payer: United Healthcare Commercial |
$9.16
|
Rate for Payer: United Healthcare Managed Medicare |
$6.01
|
|
THP cefdinir 250 mg/5 mL Oral Susp 60ML [VDMC]
|
Facility
|
IP
|
$50.12
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10375249
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$35.08 |
Max. Negotiated Rate |
$45.11 |
Rate for Payer: Aetna of IA Commercial |
$45.11
|
Rate for Payer: Aetna of IA Medical Rental Products |
$45.11
|
Rate for Payer: Cash Price |
$40.10
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.59
|
Rate for Payer: Medical Associates Commercial |
$37.59
|
Rate for Payer: Midlands Choice Commercial |
$35.08
|
Rate for Payer: United Healthcare Commercial |
$45.11
|
|
THP cefdinir 250 mg/5 mL Oral Susp 60ML [VDMC]
|
Facility
|
OP
|
$50.12
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10375249
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$25.05 |
Max. Negotiated Rate |
$45.11 |
Rate for Payer: Aetna of IA Commercial |
$45.11
|
Rate for Payer: Aetna of IA Medical Rental Products |
$45.11
|
Rate for Payer: Aetna of IA Medicare |
$28.57
|
Rate for Payer: Amerigroup Medicaid |
$25.30
|
Rate for Payer: Amerigroup Medicare |
$25.31
|
Rate for Payer: Cash Price |
$40.10
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.59
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.06
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$25.05
|
Rate for Payer: Medical Associates Commercial |
$37.59
|
Rate for Payer: Medical Associates Managed Medicare |
$25.06
|
Rate for Payer: Midlands Choice Commercial |
$35.08
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$25.44
|
Rate for Payer: Molina Healthcare Managed Medicare |
$25.42
|
Rate for Payer: Oscar Health of IA Commercial |
$37.59
|
Rate for Payer: Partners Health Alliance Commercial |
$37.59
|
Rate for Payer: United Healthcare Commercial |
$45.11
|
Rate for Payer: United Healthcare Managed Medicare |
$29.57
|
|
THP cefprozil 250 mg/5 mL 50ml Oral Liq [VDMC]
|
Facility
|
IP
|
$99.52
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10375793
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$69.66 |
Max. Negotiated Rate |
$89.57 |
Rate for Payer: Aetna of IA Commercial |
$89.57
|
Rate for Payer: Aetna of IA Medical Rental Products |
$89.57
|
Rate for Payer: Cash Price |
$79.62
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.64
|
Rate for Payer: Medical Associates Commercial |
$74.64
|
Rate for Payer: Midlands Choice Commercial |
$69.66
|
Rate for Payer: United Healthcare Commercial |
$89.57
|
|
THP cefprozil 250 mg/5 mL 50ml Oral Liq [VDMC]
|
Facility
|
OP
|
$99.52
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10375793
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$49.74 |
Max. Negotiated Rate |
$89.57 |
Rate for Payer: Aetna of IA Commercial |
$89.57
|
Rate for Payer: Aetna of IA Medical Rental Products |
$89.57
|
Rate for Payer: Aetna of IA Medicare |
$56.73
|
Rate for Payer: Amerigroup Medicaid |
$50.23
|
Rate for Payer: Amerigroup Medicare |
$50.26
|
Rate for Payer: Cash Price |
$79.62
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.64
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.76
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$49.74
|
Rate for Payer: Medical Associates Commercial |
$74.64
|
Rate for Payer: Medical Associates Managed Medicare |
$49.76
|
Rate for Payer: Midlands Choice Commercial |
$69.66
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$50.51
|
Rate for Payer: Molina Healthcare Managed Medicare |
$50.48
|
Rate for Payer: Oscar Health of IA Commercial |
$74.64
|
Rate for Payer: Partners Health Alliance Commercial |
$74.64
|
Rate for Payer: United Healthcare Commercial |
$89.57
|
Rate for Payer: United Healthcare Managed Medicare |
$58.72
|
|
THP Cefuroxime 250mg 3 tabs [VDMC]
|
Facility
|
IP
|
$21.92
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10736915
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$15.34 |
Max. Negotiated Rate |
$19.73 |
Rate for Payer: Aetna of IA Commercial |
$19.73
|
Rate for Payer: Aetna of IA Medical Rental Products |
$19.73
|
Rate for Payer: Cash Price |
$17.54
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.44
|
Rate for Payer: Medical Associates Commercial |
$16.44
|
Rate for Payer: Midlands Choice Commercial |
$15.34
|
Rate for Payer: United Healthcare Commercial |
$19.73
|
|
THP Cefuroxime 250mg 3 tabs [VDMC]
|
Facility
|
OP
|
$21.92
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10736915
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$10.96 |
Max. Negotiated Rate |
$19.73 |
Rate for Payer: Aetna of IA Commercial |
$19.73
|
Rate for Payer: Aetna of IA Medical Rental Products |
$19.73
|
Rate for Payer: Aetna of IA Medicare |
$12.49
|
Rate for Payer: Amerigroup Medicaid |
$11.06
|
Rate for Payer: Amerigroup Medicare |
$11.07
|
Rate for Payer: Cash Price |
$17.54
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.44
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.96
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$10.96
|
Rate for Payer: Medical Associates Commercial |
$16.44
|
Rate for Payer: Medical Associates Managed Medicare |
$10.96
|
Rate for Payer: Midlands Choice Commercial |
$15.34
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$11.12
|
Rate for Payer: Molina Healthcare Managed Medicare |
$11.12
|
Rate for Payer: Oscar Health of IA Commercial |
$16.44
|
Rate for Payer: Partners Health Alliance Commercial |
$16.44
|
Rate for Payer: United Healthcare Commercial |
$19.73
|
Rate for Payer: United Healthcare Managed Medicare |
$12.93
|
|
THP Cephalexin 250mg/5ml 100ml Oral Susp Bottle [VDMC]
|
Facility
|
OP
|
$60.96
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
14217797
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$30.47 |
Max. Negotiated Rate |
$54.86 |
Rate for Payer: Aetna of IA Commercial |
$54.86
|
Rate for Payer: Aetna of IA Medical Rental Products |
$54.86
|
Rate for Payer: Aetna of IA Medicare |
$34.75
|
Rate for Payer: Amerigroup Medicaid |
$30.77
|
Rate for Payer: Amerigroup Medicare |
$30.78
|
Rate for Payer: Cash Price |
$48.77
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.72
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.48
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$30.47
|
Rate for Payer: Medical Associates Commercial |
$45.72
|
Rate for Payer: Medical Associates Managed Medicare |
$30.48
|
Rate for Payer: Midlands Choice Commercial |
$42.67
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$30.94
|
Rate for Payer: Molina Healthcare Managed Medicare |
$30.92
|
Rate for Payer: Oscar Health of IA Commercial |
$45.72
|
Rate for Payer: Partners Health Alliance Commercial |
$45.72
|
Rate for Payer: United Healthcare Commercial |
$54.86
|
Rate for Payer: United Healthcare Managed Medicare |
$35.97
|
|
THP Cephalexin 250mg/5ml 100ml Oral Susp Bottle [VDMC]
|
Facility
|
IP
|
$60.96
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
14217797
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$42.67 |
Max. Negotiated Rate |
$54.86 |
Rate for Payer: Aetna of IA Commercial |
$54.86
|
Rate for Payer: Aetna of IA Medical Rental Products |
$54.86
|
Rate for Payer: Cash Price |
$48.77
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.72
|
Rate for Payer: Medical Associates Commercial |
$45.72
|
Rate for Payer: Midlands Choice Commercial |
$42.67
|
Rate for Payer: United Healthcare Commercial |
$54.86
|
|
THP Cephalexin 500mg 6 capsules [VDMC]
|
Facility
|
OP
|
$12.16
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10737970
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$6.08 |
Max. Negotiated Rate |
$10.94 |
Rate for Payer: Aetna of IA Commercial |
$10.94
|
Rate for Payer: Aetna of IA Medical Rental Products |
$10.94
|
Rate for Payer: Aetna of IA Medicare |
$6.93
|
Rate for Payer: Amerigroup Medicaid |
$6.14
|
Rate for Payer: Amerigroup Medicare |
$6.14
|
Rate for Payer: Cash Price |
$9.73
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.12
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.08
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$6.08
|
Rate for Payer: Medical Associates Commercial |
$9.12
|
Rate for Payer: Medical Associates Managed Medicare |
$6.08
|
Rate for Payer: Midlands Choice Commercial |
$8.51
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$6.17
|
Rate for Payer: Molina Healthcare Managed Medicare |
$6.17
|
Rate for Payer: Oscar Health of IA Commercial |
$9.12
|
Rate for Payer: Partners Health Alliance Commercial |
$9.12
|
Rate for Payer: United Healthcare Commercial |
$10.94
|
Rate for Payer: United Healthcare Managed Medicare |
$7.17
|
|
THP Cephalexin 500mg 6 capsules [VDMC]
|
Facility
|
IP
|
$12.16
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10737970
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$8.51 |
Max. Negotiated Rate |
$10.94 |
Rate for Payer: Aetna of IA Commercial |
$10.94
|
Rate for Payer: Aetna of IA Medical Rental Products |
$10.94
|
Rate for Payer: Cash Price |
$9.73
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.12
|
Rate for Payer: Medical Associates Commercial |
$9.12
|
Rate for Payer: Midlands Choice Commercial |
$8.51
|
Rate for Payer: United Healthcare Commercial |
$10.94
|
|
THP Ciprofloxacin-dexamethasone 0.3%-0.1% Otic Susp 7.5 ml [VDMC]
|
Facility
|
OP
|
$488.96
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10378125
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$244.38 |
Max. Negotiated Rate |
$440.06 |
Rate for Payer: Aetna of IA Commercial |
$440.06
|
Rate for Payer: Aetna of IA Medical Rental Products |
$440.06
|
Rate for Payer: Aetna of IA Medicare |
$278.71
|
Rate for Payer: Amerigroup Medicaid |
$246.78
|
Rate for Payer: Amerigroup Medicare |
$246.92
|
Rate for Payer: Cash Price |
$391.17
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$366.72
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$244.48
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$244.38
|
Rate for Payer: Medical Associates Commercial |
$366.72
|
Rate for Payer: Medical Associates Managed Medicare |
$244.48
|
Rate for Payer: Midlands Choice Commercial |
$342.27
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$248.15
|
Rate for Payer: Molina Healthcare Managed Medicare |
$248.00
|
Rate for Payer: Oscar Health of IA Commercial |
$366.72
|
Rate for Payer: Partners Health Alliance Commercial |
$366.72
|
Rate for Payer: United Healthcare Commercial |
$440.06
|
Rate for Payer: United Healthcare Managed Medicare |
$288.49
|
|
THP Ciprofloxacin-dexamethasone 0.3%-0.1% Otic Susp 7.5 ml [VDMC]
|
Facility
|
IP
|
$488.96
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10378125
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$342.27 |
Max. Negotiated Rate |
$440.06 |
Rate for Payer: Aetna of IA Commercial |
$440.06
|
Rate for Payer: Aetna of IA Medical Rental Products |
$440.06
|
Rate for Payer: Cash Price |
$391.17
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$366.72
|
Rate for Payer: Medical Associates Commercial |
$366.72
|
Rate for Payer: Midlands Choice Commercial |
$342.27
|
Rate for Payer: United Healthcare Commercial |
$440.06
|
|
THP Clindamycin 150mg 6 capsules [VDMC]
|
Facility
|
IP
|
$13.12
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10738150
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$9.18 |
Max. Negotiated Rate |
$11.81 |
Rate for Payer: Aetna of IA Commercial |
$11.81
|
Rate for Payer: Aetna of IA Medical Rental Products |
$11.81
|
Rate for Payer: Cash Price |
$10.50
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.84
|
Rate for Payer: Medical Associates Commercial |
$9.84
|
Rate for Payer: Midlands Choice Commercial |
$9.18
|
Rate for Payer: United Healthcare Commercial |
$11.81
|
|
THP Clindamycin 150mg 6 capsules [VDMC]
|
Facility
|
OP
|
$13.12
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10738150
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$6.56 |
Max. Negotiated Rate |
$11.81 |
Rate for Payer: Aetna of IA Commercial |
$11.81
|
Rate for Payer: Aetna of IA Medical Rental Products |
$11.81
|
Rate for Payer: Aetna of IA Medicare |
$7.48
|
Rate for Payer: Amerigroup Medicaid |
$6.62
|
Rate for Payer: Amerigroup Medicare |
$6.63
|
Rate for Payer: Cash Price |
$10.50
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.84
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.56
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$6.56
|
Rate for Payer: Medical Associates Commercial |
$9.84
|
Rate for Payer: Medical Associates Managed Medicare |
$6.56
|
Rate for Payer: Midlands Choice Commercial |
$9.18
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$6.66
|
Rate for Payer: Molina Healthcare Managed Medicare |
$6.65
|
Rate for Payer: Oscar Health of IA Commercial |
$9.84
|
Rate for Payer: Partners Health Alliance Commercial |
$9.84
|
Rate for Payer: United Healthcare Commercial |
$11.81
|
Rate for Payer: United Healthcare Managed Medicare |
$7.74
|
|
THP Cyclobenzaprine 10mg 4 tablets [VDMC]
|
Facility
|
OP
|
$10.88
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10738246
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$5.44 |
Max. Negotiated Rate |
$9.79 |
Rate for Payer: Aetna of IA Commercial |
$9.79
|
Rate for Payer: Aetna of IA Medical Rental Products |
$9.79
|
Rate for Payer: Aetna of IA Medicare |
$6.20
|
Rate for Payer: Amerigroup Medicaid |
$5.49
|
Rate for Payer: Amerigroup Medicare |
$5.49
|
Rate for Payer: Cash Price |
$8.71
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.16
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.44
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$5.44
|
Rate for Payer: Medical Associates Commercial |
$8.16
|
Rate for Payer: Medical Associates Managed Medicare |
$5.44
|
Rate for Payer: Midlands Choice Commercial |
$7.62
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$5.52
|
Rate for Payer: Molina Healthcare Managed Medicare |
$5.52
|
Rate for Payer: Oscar Health of IA Commercial |
$8.16
|
Rate for Payer: Partners Health Alliance Commercial |
$8.16
|
Rate for Payer: United Healthcare Commercial |
$9.79
|
Rate for Payer: United Healthcare Managed Medicare |
$6.42
|
|