|
benzocaine topical 20% Spray Unit Dose [VDMC]
|
Facility
|
IP
|
$48.49
|
|
|
Service Code
|
NDC 00283-0610-26
|
| Hospital Charge Code |
15281292
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.94 |
| Max. Negotiated Rate |
$43.64 |
| Rate for Payer: Aetna of IA Commercial |
$43.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$43.64
|
| Rate for Payer: Cash Price |
$38.79
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.37
|
| Rate for Payer: Medical Associates Commercial |
$36.37
|
| Rate for Payer: Midlands Choice Commercial |
$33.94
|
| Rate for Payer: United Healthcare Commercial |
$43.64
|
|
|
Benzoin Topical compound Tincture [VDMC]
|
Facility
|
IP
|
$21.56
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222680
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.09 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Aetna of IA Commercial |
$19.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.40
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.17
|
| Rate for Payer: Medical Associates Commercial |
$16.17
|
| Rate for Payer: Midlands Choice Commercial |
$15.09
|
| Rate for Payer: United Healthcare Commercial |
$19.40
|
|
|
Benzoin Topical compound Tincture [VDMC]
|
Facility
|
OP
|
$21.56
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222680
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Aetna of IA Commercial |
$19.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.40
|
| Rate for Payer: Aetna of IA Medicare |
$12.29
|
| Rate for Payer: Amerigroup Medicaid |
$12.44
|
| Rate for Payer: Amerigroup Medicare |
$9.80
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.17
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.32
|
| Rate for Payer: Medical Associates Commercial |
$16.17
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.70
|
| Rate for Payer: Midlands Choice Commercial |
$15.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.16
|
| Rate for Payer: United Healthcare Commercial |
$19.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.72
|
|
|
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 |
$2.11
|
| Rate for Payer: Medical Associates Commercial |
$2.11
|
| Rate for Payer: Midlands Choice Commercial |
$1.97
|
| Rate for Payer: United Healthcare Commercial |
$2.54
|
|
|
benzonatate 100 mg Cap [VDMC]
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10370011
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| 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 |
$1.63
|
| Rate for Payer: Amerigroup Medicare |
$1.28
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.11
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.27
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.61
|
| Rate for Payer: Medical Associates Commercial |
$2.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.27
|
| Rate for Payer: Midlands Choice Commercial |
$1.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.46
|
| Rate for Payer: United Healthcare Commercial |
$2.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.66
|
|
|
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 |
$84.93 |
| 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 |
$108.87
|
| Rate for Payer: Amerigroup Medicare |
$85.78
|
| 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 |
$84.93
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.81
|
| Rate for Payer: Medical Associates Commercial |
$141.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$84.93
|
| Rate for Payer: Midlands Choice Commercial |
$132.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$109.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$97.68
|
| Rate for Payer: United Healthcare Commercial |
$169.87
|
| Rate for Payer: United Healthcare Managed Medicare |
$111.36
|
|
|
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 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 |
$1.56
|
| Rate for Payer: Medical Associates Commercial |
$1.56
|
| Rate for Payer: Midlands Choice Commercial |
$1.46
|
| Rate for Payer: United Healthcare Commercial |
$1.88
|
|
|
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 |
$0.94 |
| 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 |
$1.20
|
| Rate for Payer: Amerigroup Medicare |
$0.95
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.56
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.19
|
| Rate for Payer: Medical Associates Commercial |
$1.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.94
|
| Rate for Payer: Midlands Choice Commercial |
$1.46
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.23
|
|
|
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 Glyco Cardio Ab DMCL
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
8037501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.83 |
| 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 |
$90.56
|
| Rate for Payer: Amerigroup Medicare |
$71.36
|
| 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 |
$70.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.68
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.65
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.25
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.63
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
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 GLYCOPROTIEN
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
8093927
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.83 |
| 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 |
$90.56
|
| Rate for Payer: Amerigroup Medicare |
$71.36
|
| 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 |
$70.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.68
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.65
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.25
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.63
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
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 |
$49.63 |
| 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 |
$77.87
|
| Rate for Payer: Amerigroup Medicare |
$61.36
|
| 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 |
$60.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$77.11
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$60.75
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$78.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$69.86
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.65
|
| Rate for Payer: Wellmark IA HMO WHPI |
$49.63
|
| Rate for Payer: Wellmark IA PPO |
$54.67
|
|
|
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 HCG
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
4017122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.63 |
| 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 |
$82.48
|
| Rate for Payer: Amerigroup Medicare |
$64.99
|
| 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 |
$64.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$81.68
|
| Rate for Payer: Medical Associates Commercial |
$107.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.35
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$82.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.00
|
| Rate for Payer: United Healthcare Commercial |
$128.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.37
|
| Rate for Payer: Wellmark IA HMO WHPI |
$49.63
|
| Rate for Payer: Wellmark IA PPO |
$54.67
|
|
|
Beta-hydroxybutyric Acid DMCL
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
8804480
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.49 |
| 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 |
$92.29
|
| Rate for Payer: Amerigroup Medicare |
$72.72
|
| 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 |
$72.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$91.39
|
| Rate for Payer: Medical Associates Commercial |
$120.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.00
|
| Rate for Payer: Midlands Choice Commercial |
$112.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.80
|
| Rate for Payer: United Healthcare Commercial |
$144.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.40
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
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
|
|
|
betamethasone acetate-betamethasone sodium phosphate 3 mg-3 mg Inj Susp 5 mL MDV [VDMC]
|
Facility
|
IP
|
$156.52
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
10370222
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$109.56 |
| Max. Negotiated Rate |
$140.87 |
| Rate for Payer: Aetna of IA Commercial |
$140.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.87
|
| Rate for Payer: Cash Price |
$125.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.39
|
| Rate for Payer: Medical Associates Commercial |
$117.39
|
| Rate for Payer: Midlands Choice Commercial |
$109.56
|
| Rate for Payer: United Healthcare Commercial |
$140.87
|
|
|
betamethasone acetate-betamethasone sodium phosphate 3 mg-3 mg Inj Susp 5 mL MDV [VDMC]
|
Facility
|
OP
|
$156.52
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
10370222
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$70.43 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$140.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.87
|
| Rate for Payer: Aetna of IA Medicare |
$89.22
|
| Rate for Payer: Amerigroup Medicaid |
$90.28
|
| Rate for Payer: Amerigroup Medicare |
$71.14
|
| Rate for Payer: Cash Price |
$125.22
|
| Rate for Payer: Cash Price |
$125.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.39
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.43
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.40
|
| Rate for Payer: Medical Associates Commercial |
$117.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.43
|
| Rate for Payer: Midlands Choice Commercial |
$109.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$90.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$140.87
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.35
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
betamethasone-clotrimazole topical 0.05%-1% Cre 45gm [VDMC]
|
Facility
|
IP
|
$75.61
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222287
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$52.93 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna of IA Commercial |
$68.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.05
|
| Rate for Payer: Cash Price |
$60.49
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$56.71
|
| Rate for Payer: Medical Associates Commercial |
$56.71
|
| Rate for Payer: Midlands Choice Commercial |
$52.93
|
| Rate for Payer: United Healthcare Commercial |
$68.05
|
|
|
betamethasone-clotrimazole topical 0.05%-1% Cre 45gm [VDMC]
|
Facility
|
OP
|
$75.61
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222287
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.02 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna of IA Commercial |
$68.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.05
|
| Rate for Payer: Aetna of IA Medicare |
$43.10
|
| Rate for Payer: Amerigroup Medicaid |
$43.61
|
| Rate for Payer: Amerigroup Medicare |
$34.36
|
| Rate for Payer: Cash Price |
$60.49
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$56.71
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.19
|
| Rate for Payer: Medical Associates Commercial |
$56.71
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.02
|
| Rate for Payer: Midlands Choice Commercial |
$52.93
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.13
|
| Rate for Payer: United Healthcare Commercial |
$68.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$44.61
|
|
|
bicalutamide 50 mg Tab [VDMC]
|
Facility
|
IP
|
$1.74
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10370427
|
|
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 |
$1.31
|
| Rate for Payer: Medical Associates Commercial |
$1.31
|
| Rate for Payer: Midlands Choice Commercial |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
|
|
bicalutamide 50 mg Tab [VDMC]
|
Facility
|
OP
|
$1.74
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10370427
|
|
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 |
$1.31
|
| 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 |
$1.31
|
| 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
|
|
