|
atorvastatin 10 mg Tab [VDMC]
|
Facility
|
OP
|
$1.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10368310
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Aetna of IA Commercial |
$1.01
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.01
|
| Rate for Payer: Aetna of IA Medicare |
$0.64
|
| Rate for Payer: Amerigroup Medicaid |
$0.65
|
| Rate for Payer: Amerigroup Medicare |
$0.51
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.84
|
| 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 |
$0.64
|
| Rate for Payer: Medical Associates Commercial |
$0.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.50
|
| Rate for Payer: Midlands Choice Commercial |
$0.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.58
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.66
|
|
|
atorvastatin 10 mg Tab [VDMC]
|
Facility
|
IP
|
$1.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10368310
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Aetna of IA Commercial |
$1.01
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.01
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.84
|
| Rate for Payer: Medical Associates Commercial |
$0.84
|
| Rate for Payer: Midlands Choice Commercial |
$0.78
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
|
|
atorvastatin 20 mg Tab [VDMC]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11514534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna of IA Commercial |
$0.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.98
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.82
|
| Rate for Payer: Medical Associates Commercial |
$0.82
|
| Rate for Payer: Midlands Choice Commercial |
$0.76
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
|
|
atorvastatin 20 mg Tab [VDMC]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11514534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna of IA Commercial |
$0.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.98
|
| Rate for Payer: Aetna of IA Medicare |
$0.62
|
| Rate for Payer: Amerigroup Medicaid |
$0.63
|
| Rate for Payer: Amerigroup Medicare |
$0.50
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.49
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.62
|
| Rate for Payer: Medical Associates Commercial |
$0.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.49
|
| Rate for Payer: Midlands Choice Commercial |
$0.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.56
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.64
|
|
|
atorvastatin 40 mg Tab [VDMC]
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10368448
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of IA Commercial |
$1.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.54
|
| Rate for Payer: Aetna of IA Medicare |
$0.98
|
| Rate for Payer: Amerigroup Medicaid |
$0.99
|
| Rate for Payer: Amerigroup Medicare |
$0.78
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.29
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.77
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.98
|
| Rate for Payer: Medical Associates Commercial |
$1.29
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.77
|
| Rate for Payer: Midlands Choice Commercial |
$1.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.89
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.01
|
|
|
atorvastatin 40 mg Tab [VDMC]
|
Facility
|
IP
|
$1.71
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10368448
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of IA Commercial |
$1.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.54
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.29
|
| Rate for Payer: Medical Associates Commercial |
$1.29
|
| Rate for Payer: Midlands Choice Commercial |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
|
|
atropine 1 mg/mL 1 ml SDV Inj Sol [VDMC]
|
Facility
|
IP
|
$41.67
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
10368588
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.17 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Aetna of IA Commercial |
$37.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$37.50
|
| Rate for Payer: Cash Price |
$33.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.25
|
| Rate for Payer: Medical Associates Commercial |
$31.25
|
| Rate for Payer: Midlands Choice Commercial |
$29.17
|
| Rate for Payer: United Healthcare Commercial |
$37.50
|
|
|
atropine 1 mg/mL 1 ml SDV Inj Sol [VDMC]
|
Facility
|
OP
|
$41.67
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
10368588
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$37.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$37.50
|
| Rate for Payer: Aetna of IA Medicare |
$23.75
|
| Rate for Payer: Amerigroup Medicaid |
$24.04
|
| Rate for Payer: Amerigroup Medicare |
$18.94
|
| Rate for Payer: Cash Price |
$33.34
|
| Rate for Payer: Cash Price |
$33.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.80
|
| Rate for Payer: Medical Associates Commercial |
$31.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.75
|
| Rate for Payer: Midlands Choice Commercial |
$29.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.56
|
| Rate for Payer: United Healthcare Commercial |
$37.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.59
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
atropine-diphenoxylate 0.025 mg-2.5 mg Tab [VDMC]
|
Facility
|
OP
|
$3.62
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10368722
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Aetna of IA Commercial |
$3.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.26
|
| Rate for Payer: Aetna of IA Medicare |
$2.07
|
| Rate for Payer: Amerigroup Medicaid |
$2.09
|
| Rate for Payer: Amerigroup Medicare |
$1.65
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.72
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.63
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.07
|
| Rate for Payer: Medical Associates Commercial |
$2.72
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.63
|
| Rate for Payer: Midlands Choice Commercial |
$2.54
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.88
|
| Rate for Payer: United Healthcare Commercial |
$3.26
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.14
|
|
|
atropine-diphenoxylate 0.025 mg-2.5 mg Tab [VDMC]
|
Facility
|
IP
|
$3.62
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10368722
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Aetna of IA Commercial |
$3.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.26
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.72
|
| Rate for Payer: Medical Associates Commercial |
$2.72
|
| Rate for Payer: Midlands Choice Commercial |
$2.54
|
| Rate for Payer: United Healthcare Commercial |
$3.26
|
|
|
atropine emergency syringe 0.1 mg/mL 10 ml SDV Inj Sol [VDMC]
|
Facility
|
OP
|
$68.52
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
10368517
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.83 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$61.67
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$61.67
|
| Rate for Payer: Aetna of IA Medicare |
$39.06
|
| Rate for Payer: Amerigroup Medicaid |
$39.52
|
| Rate for Payer: Amerigroup Medicare |
$31.14
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.39
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.83
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$39.14
|
| Rate for Payer: Medical Associates Commercial |
$51.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.83
|
| Rate for Payer: Midlands Choice Commercial |
$47.96
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$35.46
|
| Rate for Payer: United Healthcare Commercial |
$61.67
|
| Rate for Payer: United Healthcare Managed Medicare |
$40.43
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
atropine emergency syringe 0.1 mg/mL 10 ml SDV Inj Sol [VDMC]
|
Facility
|
IP
|
$68.52
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
10368517
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$61.67 |
| Rate for Payer: Aetna of IA Commercial |
$61.67
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$61.67
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.39
|
| Rate for Payer: Medical Associates Commercial |
$51.39
|
| Rate for Payer: Midlands Choice Commercial |
$47.96
|
| Rate for Payer: United Healthcare Commercial |
$61.67
|
|
|
atropine/hyoscyamine/PB/scopolamine Oral Elix [VDMC]
|
Facility
|
OP
|
$43.72
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10368657
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.67 |
| Max. Negotiated Rate |
$39.34 |
| Rate for Payer: Aetna of IA Commercial |
$39.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.34
|
| Rate for Payer: Aetna of IA Medicare |
$24.92
|
| Rate for Payer: Amerigroup Medicaid |
$25.21
|
| Rate for Payer: Amerigroup Medicare |
$19.87
|
| Rate for Payer: Cash Price |
$34.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.79
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$19.67
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$24.97
|
| Rate for Payer: Medical Associates Commercial |
$32.79
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.67
|
| Rate for Payer: Midlands Choice Commercial |
$30.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.62
|
| Rate for Payer: United Healthcare Commercial |
$39.34
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.79
|
|
|
atropine/hyoscyamine/PB/scopolamine Oral Elix [VDMC]
|
Facility
|
IP
|
$43.72
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10368657
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$39.34 |
| Rate for Payer: Aetna of IA Commercial |
$39.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.34
|
| Rate for Payer: Cash Price |
$34.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.79
|
| Rate for Payer: Medical Associates Commercial |
$32.79
|
| Rate for Payer: Midlands Choice Commercial |
$30.60
|
| Rate for Payer: United Healthcare Commercial |
$39.34
|
|
|
atropine Ophth 1% Sol 5mL [VDMC]
|
Facility
|
OP
|
$140.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11555809
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$63.07 |
| Max. Negotiated Rate |
$126.14 |
| Rate for Payer: Aetna of IA Commercial |
$126.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.14
|
| Rate for Payer: Aetna of IA Medicare |
$79.89
|
| Rate for Payer: Amerigroup Medicaid |
$80.84
|
| Rate for Payer: Amerigroup Medicare |
$63.70
|
| Rate for Payer: Cash Price |
$112.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$63.07
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.06
|
| Rate for Payer: Medical Associates Commercial |
$105.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$63.07
|
| Rate for Payer: Midlands Choice Commercial |
$98.11
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$72.53
|
| Rate for Payer: United Healthcare Commercial |
$126.14
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.69
|
|
|
atropine Ophth 1% Sol 5mL [VDMC]
|
Facility
|
IP
|
$140.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11555809
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$98.11 |
| Max. Negotiated Rate |
$126.14 |
| Rate for Payer: Aetna of IA Commercial |
$126.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.14
|
| Rate for Payer: Cash Price |
$112.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.12
|
| Rate for Payer: Medical Associates Commercial |
$105.12
|
| Rate for Payer: Midlands Choice Commercial |
$98.11
|
| Rate for Payer: United Healthcare Commercial |
$126.14
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC
|
Facility
|
IP
|
$72,837.20
|
|
|
Service Code
|
MSDRG 016
|
| Min. Negotiated Rate |
$71,781.56 |
| Max. Negotiated Rate |
$72,837.20 |
| Rate for Payer: Amerigroup Medicaid |
$72,485.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71,781.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$72,837.20
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC
|
Facility
|
IP
|
$44,428.80
|
|
|
Service Code
|
MSDRG 017
|
| Min. Negotiated Rate |
$43,784.89 |
| Max. Negotiated Rate |
$44,428.80 |
| Rate for Payer: Amerigroup Medicaid |
$44,214.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43,784.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44,428.80
|
|
|
azaTHIOprine 50 mg Tab [VDMC]
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10368791
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna of IA Commercial |
$2.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.41
|
| Rate for Payer: Aetna of IA Medicare |
$1.53
|
| Rate for Payer: Amerigroup Medicaid |
$1.54
|
| Rate for Payer: Amerigroup Medicare |
$1.22
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.01
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.53
|
| Rate for Payer: Medical Associates Commercial |
$2.01
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.20
|
| Rate for Payer: Midlands Choice Commercial |
$1.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.39
|
| Rate for Payer: United Healthcare Commercial |
$2.41
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.58
|
|
|
azaTHIOprine 50 mg Tab [VDMC]
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10368791
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna of IA Commercial |
$2.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.41
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.01
|
| Rate for Payer: Medical Associates Commercial |
$2.01
|
| Rate for Payer: Midlands Choice Commercial |
$1.87
|
| Rate for Payer: United Healthcare Commercial |
$2.41
|
|
|
azithromycin 200 mg/5 mL Oral Liq 15 ml [VDMC]
|
Facility
|
OP
|
$29.88
|
|
|
Service Code
|
HCPCS Q0144
|
| Hospital Charge Code |
10368860
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.45 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$26.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$26.89
|
| Rate for Payer: Aetna of IA Medicare |
$17.03
|
| Rate for Payer: Amerigroup Medicaid |
$17.23
|
| Rate for Payer: Amerigroup Medicare |
$13.58
|
| Rate for Payer: Cash Price |
$23.90
|
| Rate for Payer: Cash Price |
$23.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.07
|
| Rate for Payer: Medical Associates Commercial |
$22.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.45
|
| Rate for Payer: Midlands Choice Commercial |
$20.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$15.46
|
| Rate for Payer: United Healthcare Commercial |
$26.89
|
| Rate for Payer: United Healthcare Managed Medicare |
$17.63
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
azithromycin 200 mg/5 mL Oral Liq 15 ml [VDMC]
|
Facility
|
IP
|
$29.88
|
|
|
Service Code
|
HCPCS Q0144
|
| Hospital Charge Code |
10368860
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.92 |
| Max. Negotiated Rate |
$26.89 |
| Rate for Payer: Aetna of IA Commercial |
$26.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$26.89
|
| Rate for Payer: Cash Price |
$23.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.41
|
| Rate for Payer: Medical Associates Commercial |
$22.41
|
| Rate for Payer: Midlands Choice Commercial |
$20.92
|
| Rate for Payer: United Healthcare Commercial |
$26.89
|
|
|
azithromycin 250 mg Tab [VDMC]
|
Facility
|
OP
|
$1.83
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10606481
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Aetna of IA Commercial |
$1.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.64
|
| Rate for Payer: Aetna of IA Medicare |
$1.04
|
| Rate for Payer: Amerigroup Medicaid |
$1.05
|
| Rate for Payer: Amerigroup Medicare |
$0.83
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.37
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.04
|
| Rate for Payer: Medical Associates Commercial |
$1.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.82
|
| Rate for Payer: Midlands Choice Commercial |
$1.28
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.95
|
| Rate for Payer: United Healthcare Commercial |
$1.64
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.08
|
|
|
azithromycin 250 mg Tab [VDMC]
|
Facility
|
IP
|
$1.83
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10606481
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Aetna of IA Commercial |
$1.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.64
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.37
|
| Rate for Payer: Medical Associates Commercial |
$1.37
|
| Rate for Payer: Midlands Choice Commercial |
$1.28
|
| Rate for Payer: United Healthcare Commercial |
$1.64
|
|
|
azithromycin 500 mg IV SDV Inj [VDMC]
|
Facility
|
OP
|
$38.40
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
10368929
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$34.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.56
|
| Rate for Payer: Aetna of IA Medicare |
$21.89
|
| Rate for Payer: Amerigroup Medicaid |
$22.15
|
| Rate for Payer: Amerigroup Medicare |
$17.45
|
| Rate for Payer: Cash Price |
$30.72
|
| Rate for Payer: Cash Price |
$30.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.93
|
| Rate for Payer: Medical Associates Commercial |
$28.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.28
|
| Rate for Payer: Midlands Choice Commercial |
$26.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.87
|
| Rate for Payer: United Healthcare Commercial |
$34.56
|
| Rate for Payer: United Healthcare Managed Medicare |
$22.65
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
