|
canagliflozin 100 mg Tab [VDMC]
|
Facility
|
IP
|
$68.38
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373518
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.87 |
| Max. Negotiated Rate |
$61.54 |
| Rate for Payer: Aetna of IA Commercial |
$61.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$61.54
|
| Rate for Payer: Cash Price |
$54.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.28
|
| Rate for Payer: Medical Associates Commercial |
$51.28
|
| Rate for Payer: Midlands Choice Commercial |
$47.87
|
| Rate for Payer: United Healthcare Commercial |
$61.54
|
|
|
canagliflozin 100 mg Tab [VDMC]
|
Facility
|
OP
|
$68.38
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373518
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.18 |
| Max. Negotiated Rate |
$61.54 |
| Rate for Payer: Aetna of IA Commercial |
$61.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$61.54
|
| Rate for Payer: Aetna of IA Medicare |
$38.98
|
| Rate for Payer: Amerigroup Medicaid |
$34.51
|
| Rate for Payer: Amerigroup Medicare |
$34.53
|
| Rate for Payer: Cash Price |
$54.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.19
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.18
|
| Rate for Payer: Medical Associates Commercial |
$51.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.19
|
| Rate for Payer: Midlands Choice Commercial |
$47.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.70
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$34.68
|
| Rate for Payer: Oscar Health of IA Commercial |
$51.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.28
|
| Rate for Payer: United Healthcare Commercial |
$61.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$40.34
|
|
|
CANALITH REPOSITIONING PROC
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 95992 GP
|
| Hospital Charge Code |
6344980
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna of IA Commercial |
$104.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$104.40
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.00
|
| Rate for Payer: Medical Associates Commercial |
$87.00
|
| Rate for Payer: Midlands Choice Commercial |
$81.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
|
|
CANALITH REPOSITIONING PROC
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 95992 GP
|
| Hospital Charge Code |
6344980
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.98 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna of IA Commercial |
$104.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$104.40
|
| Rate for Payer: Aetna of IA Medicare |
$66.12
|
| Rate for Payer: Amerigroup Medicaid |
$58.55
|
| Rate for Payer: Amerigroup Medicare |
$58.58
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$58.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.98
|
| Rate for Payer: Medical Associates Commercial |
$87.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.00
|
| Rate for Payer: Midlands Choice Commercial |
$81.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$58.87
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$58.84
|
| Rate for Payer: Oscar Health of IA Commercial |
$87.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$87.00
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$68.44
|
|
|
CANNULATED SCREW
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8767789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$119.70 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna of IA Commercial |
$153.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$153.90
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$128.25
|
| Rate for Payer: Medical Associates Commercial |
$128.25
|
| Rate for Payer: Midlands Choice Commercial |
$119.70
|
| Rate for Payer: United Healthcare Commercial |
$153.90
|
|
|
CANNULATED SCREW
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8767789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.47 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna of IA Commercial |
$153.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$153.90
|
| Rate for Payer: Aetna of IA Medicare |
$97.47
|
| Rate for Payer: Amerigroup Medicaid |
$86.30
|
| Rate for Payer: Amerigroup Medicare |
$86.36
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$128.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$85.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$85.47
|
| Rate for Payer: Medical Associates Commercial |
$128.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$119.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$86.78
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$86.73
|
| Rate for Payer: Oscar Health of IA Commercial |
$128.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$128.25
|
| Rate for Payer: United Healthcare Commercial |
$153.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$100.89
|
|
|
capsaicin topical 0.1% Cream 42.5gm [VDMC]
|
Facility
|
IP
|
$42.80
|
|
|
Service Code
|
NDC 41167-0751-42
|
| Hospital Charge Code |
18835897
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$38.52 |
| Rate for Payer: Aetna of IA Commercial |
$38.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.52
|
| Rate for Payer: Cash Price |
$34.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.10
|
| Rate for Payer: Medical Associates Commercial |
$32.10
|
| Rate for Payer: Midlands Choice Commercial |
$29.96
|
| Rate for Payer: United Healthcare Commercial |
$38.52
|
|
|
capsaicin topical 0.1% Cream 42.5gm [VDMC]
|
Facility
|
OP
|
$42.80
|
|
|
Service Code
|
NDC 41167-0751-42
|
| Hospital Charge Code |
18835897
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.39 |
| Max. Negotiated Rate |
$38.52 |
| Rate for Payer: Aetna of IA Commercial |
$38.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.52
|
| Rate for Payer: Aetna of IA Medicare |
$24.40
|
| Rate for Payer: Amerigroup Medicaid |
$21.60
|
| Rate for Payer: Amerigroup Medicare |
$21.61
|
| Rate for Payer: Cash Price |
$34.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.10
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$21.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.39
|
| Rate for Payer: Medical Associates Commercial |
$32.10
|
| Rate for Payer: Medical Associates Managed Medicare |
$21.40
|
| Rate for Payer: Midlands Choice Commercial |
$29.96
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$21.71
|
| Rate for Payer: Oscar Health of IA Commercial |
$32.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$32.10
|
| Rate for Payer: United Healthcare Commercial |
$38.52
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.25
|
|
|
capsaicin topical 8% Kit [VDMC]
|
Facility
|
IP
|
$1,868.80
|
|
|
Service Code
|
HCPCS J7336
|
| Hospital Charge Code |
26706652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,308.16 |
| Max. Negotiated Rate |
$1,681.92 |
| Rate for Payer: Aetna of IA Commercial |
$1,681.92
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,681.92
|
| Rate for Payer: Cash Price |
$1,495.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,401.60
|
| Rate for Payer: Medical Associates Commercial |
$1,401.60
|
| Rate for Payer: Midlands Choice Commercial |
$1,308.16
|
| Rate for Payer: United Healthcare Commercial |
$1,681.92
|
|
|
capsaicin topical 8% Kit [VDMC]
|
Facility
|
OP
|
$1,868.80
|
|
|
Service Code
|
HCPCS J7336
|
| Hospital Charge Code |
26706652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$934.03 |
| Max. Negotiated Rate |
$1,681.92 |
| Rate for Payer: Aetna of IA Commercial |
$1,681.92
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,681.92
|
| Rate for Payer: Aetna of IA Medicare |
$1,065.22
|
| Rate for Payer: Amerigroup Medicaid |
$943.18
|
| Rate for Payer: Amerigroup Medicare |
$943.74
|
| Rate for Payer: Cash Price |
$1,495.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,401.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$934.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$934.03
|
| Rate for Payer: Medical Associates Commercial |
$1,401.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$934.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,308.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$948.42
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$947.86
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,401.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,401.60
|
| Rate for Payer: United Healthcare Commercial |
$1,681.92
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,102.59
|
|
|
CAPSURE 30 SHOT
|
Facility
|
IP
|
$1,017.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8417550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$711.90 |
| Max. Negotiated Rate |
$915.30 |
| Rate for Payer: Aetna of IA Commercial |
$915.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$915.30
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$762.75
|
| Rate for Payer: Medical Associates Commercial |
$762.75
|
| Rate for Payer: Midlands Choice Commercial |
$711.90
|
| Rate for Payer: United Healthcare Commercial |
$915.30
|
|
|
CAPSURE 30 SHOT
|
Facility
|
OP
|
$1,017.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8417550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.30 |
| Max. Negotiated Rate |
$915.30 |
| Rate for Payer: Aetna of IA Commercial |
$915.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$915.30
|
| Rate for Payer: Aetna of IA Medicare |
$579.69
|
| Rate for Payer: Amerigroup Medicaid |
$513.28
|
| Rate for Payer: Amerigroup Medicare |
$513.58
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$762.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$508.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$508.30
|
| Rate for Payer: Medical Associates Commercial |
$762.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$508.50
|
| Rate for Payer: Midlands Choice Commercial |
$711.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$516.13
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$515.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$762.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$762.75
|
| Rate for Payer: United Healthcare Commercial |
$915.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$600.03
|
|
|
carbachol Ophth 0.01% Sol 1.5ml [VDMC]
|
Facility
|
IP
|
$70.72
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11558009
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna of IA Commercial |
$63.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.65
|
| Rate for Payer: Cash Price |
$56.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.04
|
| Rate for Payer: Medical Associates Commercial |
$53.04
|
| Rate for Payer: Midlands Choice Commercial |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$63.65
|
|
|
carbachol Ophth 0.01% Sol 1.5ml [VDMC]
|
Facility
|
OP
|
$70.72
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11558009
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna of IA Commercial |
$63.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.65
|
| Rate for Payer: Aetna of IA Medicare |
$40.31
|
| Rate for Payer: Amerigroup Medicaid |
$35.69
|
| Rate for Payer: Amerigroup Medicare |
$35.71
|
| Rate for Payer: Cash Price |
$56.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.35
|
| Rate for Payer: Medical Associates Commercial |
$53.04
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.36
|
| Rate for Payer: Midlands Choice Commercial |
$49.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.89
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$35.87
|
| Rate for Payer: Oscar Health of IA Commercial |
$53.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.04
|
| Rate for Payer: United Healthcare Commercial |
$63.65
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.72
|
|
|
carBAMazepine 100 mg ER Tab [VDMC]
|
Facility
|
IP
|
$1.93
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373786
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Aetna of IA Commercial |
$1.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.74
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.45
|
| Rate for Payer: Medical Associates Commercial |
$1.45
|
| Rate for Payer: Midlands Choice Commercial |
$1.35
|
| Rate for Payer: United Healthcare Commercial |
$1.74
|
|
|
carBAMazepine 100 mg ER Tab [VDMC]
|
Facility
|
OP
|
$1.93
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373786
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Aetna of IA Commercial |
$1.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.74
|
| Rate for Payer: Aetna of IA Medicare |
$1.10
|
| Rate for Payer: Amerigroup Medicaid |
$0.97
|
| Rate for Payer: Amerigroup Medicare |
$0.97
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.45
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.97
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.96
|
| Rate for Payer: Medical Associates Commercial |
$1.45
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.97
|
| Rate for Payer: Midlands Choice Commercial |
$1.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.98
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.98
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.45
|
| Rate for Payer: United Healthcare Commercial |
$1.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.14
|
|
|
carBAMazepine 200 mg ER Tab [VDMC]
|
Facility
|
OP
|
$11.68
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373855
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna of IA Commercial |
$10.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.51
|
| Rate for Payer: Aetna of IA Medicare |
$6.66
|
| Rate for Payer: Amerigroup Medicaid |
$5.89
|
| Rate for Payer: Amerigroup Medicare |
$5.90
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.76
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.84
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5.84
|
| Rate for Payer: Medical Associates Commercial |
$8.76
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.84
|
| Rate for Payer: Midlands Choice Commercial |
$8.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5.93
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$5.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$8.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$8.76
|
| Rate for Payer: United Healthcare Commercial |
$10.51
|
| Rate for Payer: United Healthcare Managed Medicare |
$6.89
|
|
|
carBAMazepine 200 mg ER Tab [VDMC]
|
Facility
|
IP
|
$11.68
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373855
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna of IA Commercial |
$10.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.51
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.76
|
| Rate for Payer: Medical Associates Commercial |
$8.76
|
| Rate for Payer: Midlands Choice Commercial |
$8.18
|
| Rate for Payer: United Healthcare Commercial |
$10.51
|
|
|
carBAMazepine 200 mg Tab [VDMC]
|
Facility
|
OP
|
$3.50
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373926
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Aetna of IA Commercial |
$3.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.15
|
| Rate for Payer: Aetna of IA Medicare |
$2.00
|
| Rate for Payer: Amerigroup Medicaid |
$1.77
|
| Rate for Payer: Amerigroup Medicare |
$1.77
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.62
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.75
|
| Rate for Payer: Medical Associates Commercial |
$2.62
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.75
|
| Rate for Payer: Midlands Choice Commercial |
$2.45
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.78
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.78
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.62
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.06
|
|
|
carBAMazepine 200 mg Tab [VDMC]
|
Facility
|
IP
|
$3.50
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373926
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Aetna of IA Commercial |
$3.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.15
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.62
|
| Rate for Payer: Medical Associates Commercial |
$2.62
|
| Rate for Payer: Midlands Choice Commercial |
$2.45
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
|
|
Carbamazepine Level DMCL
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
8037508
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
|
|
Carbamazepine Level DMCL
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
8037508
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.48 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Aetna of IA Medicare |
$56.43
|
| Rate for Payer: Amerigroup Medicaid |
$49.97
|
| Rate for Payer: Amerigroup Medicare |
$50.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.48
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.24
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$50.21
|
| Rate for Payer: Oscar Health of IA Commercial |
$74.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.25
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.41
|
| Rate for Payer: Wellmark IA HMO |
$49.60
|
| Rate for Payer: Wellmark IA PPO |
$54.56
|
|
|
carbamide peroxide Otic 6.5% Sol [VDMC]
|
Facility
|
OP
|
$19.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433737
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna of IA Commercial |
$17.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.68
|
| Rate for Payer: Aetna of IA Medicare |
$11.19
|
| Rate for Payer: Amerigroup Medicaid |
$9.91
|
| Rate for Payer: Amerigroup Medicare |
$9.92
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9.82
|
| Rate for Payer: Medical Associates Commercial |
$14.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.82
|
| Rate for Payer: Midlands Choice Commercial |
$13.75
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9.97
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$9.96
|
| Rate for Payer: Oscar Health of IA Commercial |
$14.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.73
|
| Rate for Payer: United Healthcare Commercial |
$17.68
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.59
|
|
|
carbamide peroxide Otic 6.5% Sol [VDMC]
|
Facility
|
IP
|
$19.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433737
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna of IA Commercial |
$17.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.68
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.73
|
| Rate for Payer: Medical Associates Commercial |
$14.73
|
| Rate for Payer: Midlands Choice Commercial |
$13.75
|
| Rate for Payer: United Healthcare Commercial |
$17.68
|
|
|
carbidopa/entacapone/levodopa 25 mg-200 mg-100 mg Tab [VDMC]
|
Facility
|
IP
|
$3.80
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10374064
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Aetna of IA Commercial |
$3.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.42
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.85
|
| Rate for Payer: Medical Associates Commercial |
$2.85
|
| Rate for Payer: Midlands Choice Commercial |
$2.66
|
| Rate for Payer: United Healthcare Commercial |
$3.42
|
|
