|
benzocaine Top 20% mucous membrane spray [VDMC]
|
Facility
|
OP
|
$9.79
|
|
|
Service Code
|
NDC 00283-0679-02
|
| Hospital Charge Code |
10433282
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$8.81 |
| Rate for Payer: Aetna of IA Commercial |
$8.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8.81
|
| Rate for Payer: Aetna of IA Medicare |
$5.58
|
| Rate for Payer: Amerigroup Medicaid |
$4.94
|
| Rate for Payer: Amerigroup Medicare |
$4.94
|
| Rate for Payer: Cash Price |
$7.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.34
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4.89
|
| Rate for Payer: Medical Associates Commercial |
$7.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$4.90
|
| Rate for Payer: Midlands Choice Commercial |
$6.85
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4.97
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$4.97
|
| Rate for Payer: Oscar Health of IA Commercial |
$7.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.34
|
| Rate for Payer: United Healthcare Commercial |
$8.81
|
| Rate for Payer: United Healthcare Managed Medicare |
$5.78
|
|
|
benzocaine Top 20% mucous membrane spray [VDMC]
|
Facility
|
IP
|
$9.79
|
|
|
Service Code
|
NDC 00283-0679-02
|
| Hospital Charge Code |
10433282
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$8.81 |
| Rate for Payer: Aetna of IA Commercial |
$8.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8.81
|
| Rate for Payer: Cash Price |
$7.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.34
|
| Rate for Payer: Medical Associates Commercial |
$7.34
|
| Rate for Payer: Midlands Choice Commercial |
$6.85
|
| Rate for Payer: United Healthcare Commercial |
$8.81
|
|
|
benzocaine topical 20% Spray Unit Dose [VDMC]
|
Facility
|
IP
|
$54.57
|
|
|
Service Code
|
NDC 00283-0610-26
|
| Hospital Charge Code |
15281292
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$49.11 |
| Rate for Payer: Aetna of IA Commercial |
$49.11
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.11
|
| Rate for Payer: Cash Price |
$43.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$40.93
|
| Rate for Payer: Medical Associates Commercial |
$40.93
|
| Rate for Payer: Midlands Choice Commercial |
$38.20
|
| Rate for Payer: United Healthcare Commercial |
$49.11
|
|
|
benzocaine topical 20% Spray Unit Dose [VDMC]
|
Facility
|
OP
|
$54.57
|
|
|
Service Code
|
NDC 00283-0610-26
|
| Hospital Charge Code |
15281292
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.27 |
| Max. Negotiated Rate |
$49.11 |
| Rate for Payer: Aetna of IA Commercial |
$49.11
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.11
|
| Rate for Payer: Aetna of IA Medicare |
$31.10
|
| Rate for Payer: Amerigroup Medicaid |
$27.54
|
| Rate for Payer: Amerigroup Medicare |
$27.56
|
| Rate for Payer: Cash Price |
$43.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$40.93
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.27
|
| Rate for Payer: Medical Associates Commercial |
$40.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.28
|
| Rate for Payer: Midlands Choice Commercial |
$38.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27.69
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$27.68
|
| Rate for Payer: Oscar Health of IA Commercial |
$40.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$40.93
|
| Rate for Payer: United Healthcare Commercial |
$49.11
|
| Rate for Payer: United Healthcare Managed Medicare |
$32.20
|
|
|
Benzoin Topical compound Tincture [VDMC]
|
Facility
|
OP
|
$20.26
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222680
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Aetna of IA Commercial |
$18.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.23
|
| Rate for Payer: Aetna of IA Medicare |
$11.55
|
| Rate for Payer: Amerigroup Medicaid |
$10.23
|
| Rate for Payer: Amerigroup Medicare |
$10.23
|
| Rate for Payer: Cash Price |
$16.21
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.20
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.13
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.13
|
| Rate for Payer: Medical Associates Commercial |
$15.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.13
|
| Rate for Payer: Midlands Choice Commercial |
$14.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.28
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$10.28
|
| Rate for Payer: Oscar Health of IA Commercial |
$15.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$15.20
|
| Rate for Payer: United Healthcare Commercial |
$18.23
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.95
|
|
|
Benzoin Topical compound Tincture [VDMC]
|
Facility
|
IP
|
$20.26
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222680
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Medical Associates Commercial |
$15.20
|
| Rate for Payer: Aetna of IA Commercial |
$18.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.23
|
| Rate for Payer: Cash Price |
$16.21
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.20
|
| Rate for Payer: Midlands Choice Commercial |
$14.18
|
| Rate for Payer: United Healthcare Commercial |
$18.23
|
|
|
benzonatate 100 mg Cap [VDMC]
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10370011
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna of IA Commercial |
$2.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.54
|
| Rate for Payer: Aetna of IA Medicare |
$1.61
|
| Rate for Payer: Amerigroup Medicaid |
$1.42
|
| Rate for Payer: Amerigroup Medicare |
$1.42
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.41
|
| Rate for Payer: Medical Associates Commercial |
$2.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.41
|
| Rate for Payer: Midlands Choice Commercial |
$1.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.43
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.12
|
| Rate for Payer: United Healthcare Commercial |
$2.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.66
|
|
|
benzonatate 100 mg Cap [VDMC]
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10370011
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna of IA Commercial |
$2.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.54
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.12
|
| Rate for Payer: Medical Associates Commercial |
$2.12
|
| Rate for Payer: Midlands Choice Commercial |
$1.97
|
| Rate for Payer: United Healthcare Commercial |
$2.54
|
|
|
benztropine 1 mg/mL 2ml Inj SDV Sol [VDMC]
|
Facility
|
IP
|
$188.74
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
10370151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$132.12 |
| Max. Negotiated Rate |
$169.87 |
| Rate for Payer: Aetna of IA Commercial |
$169.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$169.87
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$141.56
|
| Rate for Payer: Medical Associates Commercial |
$141.56
|
| Rate for Payer: Midlands Choice Commercial |
$132.12
|
| Rate for Payer: United Healthcare Commercial |
$169.87
|
|
|
benztropine 1 mg/mL 2ml Inj SDV Sol [VDMC]
|
Facility
|
OP
|
$188.74
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
10370151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$94.33 |
| Max. Negotiated Rate |
$169.87 |
| Rate for Payer: Aetna of IA Commercial |
$169.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$169.87
|
| Rate for Payer: Aetna of IA Medicare |
$107.58
|
| Rate for Payer: Amerigroup Medicaid |
$95.26
|
| Rate for Payer: Amerigroup Medicare |
$95.31
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$141.56
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$94.37
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$94.33
|
| Rate for Payer: Medical Associates Commercial |
$141.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$94.37
|
| Rate for Payer: Midlands Choice Commercial |
$132.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$95.79
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$95.73
|
| Rate for Payer: Oscar Health of IA Commercial |
$141.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$141.56
|
| Rate for Payer: United Healthcare Commercial |
$169.87
|
| Rate for Payer: United Healthcare Managed Medicare |
$111.36
|
|
|
benztropine mesylate 1 mg Tab [VDMC]
|
Facility
|
OP
|
$2.09
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10370080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna of IA Commercial |
$1.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.88
|
| Rate for Payer: Aetna of IA Medicare |
$1.19
|
| Rate for Payer: Amerigroup Medicaid |
$1.05
|
| Rate for Payer: Amerigroup Medicare |
$1.06
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.57
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.04
|
| Rate for Payer: Medical Associates Commercial |
$1.57
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.04
|
| Rate for Payer: Midlands Choice Commercial |
$1.46
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.06
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.06
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.57
|
| Rate for Payer: United Healthcare Commercial |
$1.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.23
|
|
|
benztropine mesylate 1 mg Tab [VDMC]
|
Facility
|
IP
|
$2.09
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10370080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna of IA Commercial |
$1.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.88
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.57
|
| Rate for Payer: Medical Associates Commercial |
$1.57
|
| Rate for Payer: Midlands Choice Commercial |
$1.46
|
| Rate for Payer: United Healthcare Commercial |
$1.88
|
|
|
Beta 2 Glyco Cardio Ab DMCL
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
8037501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Aetna of IA Medicare |
$89.49
|
| Rate for Payer: Amerigroup Medicaid |
$79.24
|
| Rate for Payer: Amerigroup Medicare |
$79.28
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$78.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$78.47
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$78.50
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79.68
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$79.63
|
| Rate for Payer: Oscar Health of IA Commercial |
$117.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$117.75
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.63
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Beta 2 Glyco Cardio Ab DMCL
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
8037501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
|
|
BETA 2 GLYCOPROTIEN
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
8093927
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Aetna of IA Medicare |
$89.49
|
| Rate for Payer: Amerigroup Medicaid |
$79.24
|
| Rate for Payer: Amerigroup Medicare |
$79.28
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$78.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$78.47
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$78.50
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79.68
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$79.63
|
| Rate for Payer: Oscar Health of IA Commercial |
$117.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$117.75
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.63
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
BETA 2 GLYCOPROTIEN
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
8093927
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
|
|
Beta 2 Microglobulin DMCL
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
8037502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
|
|
Beta 2 Microglobulin DMCL
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
8037502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Aetna of IA Medicare |
$76.95
|
| Rate for Payer: Amerigroup Medicaid |
$68.13
|
| Rate for Payer: Amerigroup Medicare |
$68.18
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.47
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.51
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$68.47
|
| Rate for Payer: Oscar Health of IA Commercial |
$101.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.25
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.65
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
BETA HCG
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
4017122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Aetna of IA Commercial |
$128.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$128.70
|
| Rate for Payer: Aetna of IA Medicare |
$81.51
|
| Rate for Payer: Amerigroup Medicaid |
$72.17
|
| Rate for Payer: Amerigroup Medicare |
$72.22
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$107.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$71.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.47
|
| Rate for Payer: Medical Associates Commercial |
$107.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.50
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$72.57
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$72.53
|
| Rate for Payer: Oscar Health of IA Commercial |
$107.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$107.25
|
| Rate for Payer: United Healthcare Commercial |
$128.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.37
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
BETA HCG
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
4017122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Aetna of IA Commercial |
$128.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$128.70
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$107.25
|
| Rate for Payer: Medical Associates Commercial |
$107.25
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: United Healthcare Commercial |
$128.70
|
|
|
Beta-hydroxybutyric Acid DMCL
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
8804480
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna of IA Commercial |
$144.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.00
|
| Rate for Payer: Medical Associates Commercial |
$120.00
|
| Rate for Payer: Midlands Choice Commercial |
$112.00
|
| Rate for Payer: United Healthcare Commercial |
$144.00
|
|
|
Beta-hydroxybutyric Acid DMCL
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
8804480
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna of IA Commercial |
$144.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.00
|
| Rate for Payer: Aetna of IA Medicare |
$91.20
|
| Rate for Payer: Amerigroup Medicaid |
$80.75
|
| Rate for Payer: Amerigroup Medicare |
$80.80
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$80.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.97
|
| Rate for Payer: Medical Associates Commercial |
$120.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.00
|
| Rate for Payer: Midlands Choice Commercial |
$112.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.20
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$81.15
|
| Rate for Payer: Oscar Health of IA Commercial |
$120.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$120.00
|
| Rate for Payer: United Healthcare Commercial |
$144.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.40
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
betamethasone acetate-betamethasone sodium phosphate 3 mg-3 mg Inj Susp 5 mL MDV [VDMC]
|
Facility
|
OP
|
$148.80
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
10370222
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$74.37 |
| Max. Negotiated Rate |
$133.92 |
| Rate for Payer: Aetna of IA Commercial |
$133.92
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$133.92
|
| Rate for Payer: Aetna of IA Medicare |
$84.82
|
| Rate for Payer: Amerigroup Medicaid |
$75.10
|
| Rate for Payer: Amerigroup Medicare |
$75.14
|
| Rate for Payer: Cash Price |
$119.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$74.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.37
|
| Rate for Payer: Medical Associates Commercial |
$111.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$74.40
|
| Rate for Payer: Midlands Choice Commercial |
$104.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.52
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$75.47
|
| Rate for Payer: Oscar Health of IA Commercial |
$111.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.60
|
| Rate for Payer: United Healthcare Commercial |
$133.92
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.79
|
|
|
betamethasone acetate-betamethasone sodium phosphate 3 mg-3 mg Inj Susp 5 mL MDV [VDMC]
|
Facility
|
IP
|
$148.80
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
10370222
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$104.16 |
| Max. Negotiated Rate |
$133.92 |
| Rate for Payer: Aetna of IA Commercial |
$133.92
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$133.92
|
| Rate for Payer: Cash Price |
$119.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.60
|
| Rate for Payer: Medical Associates Commercial |
$111.60
|
| Rate for Payer: Midlands Choice Commercial |
$104.16
|
| Rate for Payer: United Healthcare Commercial |
$133.92
|
|
|
betamethasone-clotrimazole topical 0.05%-1% Cre 45gm [VDMC]
|
Facility
|
IP
|
$45.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222287
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$41.08 |
| Rate for Payer: Aetna of IA Commercial |
$41.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.08
|
| Rate for Payer: Cash Price |
$36.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.23
|
| Rate for Payer: Medical Associates Commercial |
$34.23
|
| Rate for Payer: Midlands Choice Commercial |
$31.95
|
| Rate for Payer: United Healthcare Commercial |
$41.08
|
|
