|
CLEAR OUTER EAR CANAL
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
4866849
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna of IA Commercial |
$129.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$129.60
|
| Rate for Payer: Aetna of IA Medicare |
$82.08
|
| Rate for Payer: Amerigroup Medicaid |
$83.06
|
| Rate for Payer: Amerigroup Medicare |
$65.45
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$82.25
|
| Rate for Payer: Medical Associates Commercial |
$108.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.80
|
| Rate for Payer: Midlands Choice Commercial |
$100.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$83.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.52
|
| Rate for Payer: United Healthcare Commercial |
$129.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.96
|
|
|
clindamycin 150 mg Cap [VDMC]
|
Facility
|
IP
|
$1.86
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10378332
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna of IA Commercial |
$1.67
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.67
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.40
|
| Rate for Payer: Medical Associates Commercial |
$1.40
|
| Rate for Payer: Midlands Choice Commercial |
$1.30
|
| Rate for Payer: United Healthcare Commercial |
$1.67
|
|
|
clindamycin 150 mg Cap [VDMC]
|
Facility
|
OP
|
$1.86
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10378332
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna of IA Commercial |
$1.67
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.67
|
| Rate for Payer: Aetna of IA Medicare |
$1.06
|
| Rate for Payer: Amerigroup Medicaid |
$1.07
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.40
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.84
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.06
|
| Rate for Payer: Medical Associates Commercial |
$1.40
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.84
|
| Rate for Payer: Midlands Choice Commercial |
$1.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.96
|
| Rate for Payer: United Healthcare Commercial |
$1.67
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.10
|
|
|
clindamycin 300 mg/50 mL-D5W IV SDV [VDMC]
|
Facility
|
IP
|
$76.05
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
10378403
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$68.44 |
| Rate for Payer: Aetna of IA Commercial |
$68.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.44
|
| Rate for Payer: Cash Price |
$60.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.04
|
| Rate for Payer: Medical Associates Commercial |
$57.04
|
| Rate for Payer: Midlands Choice Commercial |
$53.24
|
| Rate for Payer: United Healthcare Commercial |
$68.44
|
|
|
clindamycin 300 mg/50 mL-D5W IV SDV [VDMC]
|
Facility
|
OP
|
$76.05
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
10378403
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.22 |
| Max. Negotiated Rate |
$68.44 |
| Rate for Payer: Aetna of IA Commercial |
$68.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.44
|
| Rate for Payer: Aetna of IA Medicare |
$43.35
|
| Rate for Payer: Amerigroup Medicaid |
$43.87
|
| Rate for Payer: Amerigroup Medicare |
$34.56
|
| Rate for Payer: Cash Price |
$60.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.44
|
| Rate for Payer: Medical Associates Commercial |
$57.04
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.22
|
| Rate for Payer: Midlands Choice Commercial |
$53.24
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.36
|
| Rate for Payer: United Healthcare Commercial |
$68.44
|
| Rate for Payer: United Healthcare Managed Medicare |
$44.87
|
|
|
clindamycin 600 mg/50 mL-D5W IV SDV [VDMC]
|
Facility
|
OP
|
$66.38
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
10378474
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.87 |
| Max. Negotiated Rate |
$59.74 |
| Rate for Payer: Aetna of IA Commercial |
$59.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.74
|
| Rate for Payer: Aetna of IA Medicare |
$37.83
|
| Rate for Payer: Amerigroup Medicaid |
$38.29
|
| Rate for Payer: Amerigroup Medicare |
$30.17
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.87
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.91
|
| Rate for Payer: Medical Associates Commercial |
$49.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.87
|
| Rate for Payer: Midlands Choice Commercial |
$46.46
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.35
|
| Rate for Payer: United Healthcare Commercial |
$59.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.16
|
|
|
clindamycin 600 mg/50 mL-D5W IV SDV [VDMC]
|
Facility
|
IP
|
$66.38
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
10378474
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$46.46 |
| Max. Negotiated Rate |
$59.74 |
| Rate for Payer: Aetna of IA Commercial |
$59.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.74
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.78
|
| Rate for Payer: Medical Associates Commercial |
$49.78
|
| Rate for Payer: Midlands Choice Commercial |
$46.46
|
| Rate for Payer: United Healthcare Commercial |
$59.74
|
|
|
clindamycin 900 mg/50 mL-D5W IV SDV [VDMC]
|
Facility
|
OP
|
$98.02
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
11881828
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$44.11 |
| Max. Negotiated Rate |
$88.21 |
| Rate for Payer: Aetna of IA Commercial |
$88.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.21
|
| Rate for Payer: Aetna of IA Medicare |
$55.87
|
| Rate for Payer: Amerigroup Medicaid |
$56.54
|
| Rate for Payer: Amerigroup Medicare |
$44.55
|
| Rate for Payer: Cash Price |
$78.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.51
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$44.11
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$55.99
|
| Rate for Payer: Medical Associates Commercial |
$73.51
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.11
|
| Rate for Payer: Midlands Choice Commercial |
$68.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$56.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.72
|
| Rate for Payer: United Healthcare Commercial |
$88.21
|
| Rate for Payer: United Healthcare Managed Medicare |
$57.83
|
|
|
clindamycin 900 mg/50 mL-D5W IV SDV [VDMC]
|
Facility
|
IP
|
$98.02
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
11881828
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$68.61 |
| Max. Negotiated Rate |
$88.21 |
| Rate for Payer: Aetna of IA Commercial |
$88.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.21
|
| Rate for Payer: Cash Price |
$78.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.51
|
| Rate for Payer: Medical Associates Commercial |
$73.51
|
| Rate for Payer: Midlands Choice Commercial |
$68.61
|
| Rate for Payer: United Healthcare Commercial |
$88.21
|
|
|
clobetasol propionate topical 0.05% Sol 50ml [VDMC]
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
21028886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of IA Commercial |
$97.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.20
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.00
|
| Rate for Payer: Medical Associates Commercial |
$81.00
|
| Rate for Payer: Midlands Choice Commercial |
$75.60
|
| Rate for Payer: United Healthcare Commercial |
$97.20
|
|
|
clobetasol propionate topical 0.05% Sol 50ml [VDMC]
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
21028886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of IA Commercial |
$97.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.20
|
| Rate for Payer: Aetna of IA Medicare |
$61.56
|
| Rate for Payer: Amerigroup Medicaid |
$62.29
|
| Rate for Payer: Amerigroup Medicare |
$49.09
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$48.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.69
|
| Rate for Payer: Medical Associates Commercial |
$81.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$48.60
|
| Rate for Payer: Midlands Choice Commercial |
$75.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.89
|
| Rate for Payer: United Healthcare Commercial |
$97.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.72
|
|
|
clonazePAM 0.25 mg Dis Tab [VDMC]
|
Facility
|
OP
|
$4.53
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10378545
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna of IA Commercial |
$4.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.07
|
| Rate for Payer: Aetna of IA Medicare |
$2.58
|
| Rate for Payer: Amerigroup Medicaid |
$2.61
|
| Rate for Payer: Amerigroup Medicare |
$2.06
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.39
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.58
|
| Rate for Payer: Medical Associates Commercial |
$3.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.04
|
| Rate for Payer: Midlands Choice Commercial |
$3.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.34
|
| Rate for Payer: United Healthcare Commercial |
$4.07
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.67
|
|
|
clonazePAM 0.25 mg Dis Tab [VDMC]
|
Facility
|
IP
|
$4.53
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10378545
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna of IA Commercial |
$4.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.07
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.39
|
| Rate for Payer: Medical Associates Commercial |
$3.39
|
| Rate for Payer: Midlands Choice Commercial |
$3.17
|
| Rate for Payer: United Healthcare Commercial |
$4.07
|
|
|
clonazePAM 0.5 mg Tab [VDMC]
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10378614
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna of IA Commercial |
$4.43
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.43
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.69
|
| Rate for Payer: Medical Associates Commercial |
$3.69
|
| Rate for Payer: Midlands Choice Commercial |
$3.44
|
| Rate for Payer: United Healthcare Commercial |
$4.43
|
|
|
clonazePAM 0.5 mg Tab [VDMC]
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10378614
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna of IA Commercial |
$4.43
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.43
|
| Rate for Payer: Aetna of IA Medicare |
$2.81
|
| Rate for Payer: Amerigroup Medicaid |
$2.84
|
| Rate for Payer: Amerigroup Medicare |
$2.24
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.69
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.21
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.81
|
| Rate for Payer: Medical Associates Commercial |
$3.69
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.21
|
| Rate for Payer: Midlands Choice Commercial |
$3.44
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.55
|
| Rate for Payer: United Healthcare Commercial |
$4.43
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.90
|
|
|
clonazePAM 1 mg Tab [VDMC]
|
Facility
|
OP
|
$3.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10378683
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Aetna of IA Commercial |
$2.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.85
|
| Rate for Payer: Aetna of IA Medicare |
$1.80
|
| Rate for Payer: Amerigroup Medicaid |
$1.82
|
| Rate for Payer: Amerigroup Medicare |
$1.44
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.37
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.81
|
| Rate for Payer: Medical Associates Commercial |
$2.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.42
|
| Rate for Payer: Midlands Choice Commercial |
$2.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.64
|
| Rate for Payer: United Healthcare Commercial |
$2.85
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.87
|
|
|
clonazePAM 1 mg Tab [VDMC]
|
Facility
|
IP
|
$3.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10378683
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Aetna of IA Commercial |
$2.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.85
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.37
|
| Rate for Payer: Medical Associates Commercial |
$2.37
|
| Rate for Payer: Midlands Choice Commercial |
$2.21
|
| Rate for Payer: United Healthcare Commercial |
$2.85
|
|
|
cloNIDine 0.1 mg/24 hr Transderm ER Film [VDMC]
|
Facility
|
OP
|
$56.80
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10378821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.56 |
| Max. Negotiated Rate |
$51.12 |
| Rate for Payer: Aetna of IA Commercial |
$51.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.12
|
| Rate for Payer: Aetna of IA Medicare |
$32.38
|
| Rate for Payer: Amerigroup Medicaid |
$32.76
|
| Rate for Payer: Amerigroup Medicare |
$25.82
|
| Rate for Payer: Cash Price |
$45.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.44
|
| Rate for Payer: Medical Associates Commercial |
$42.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.56
|
| Rate for Payer: Midlands Choice Commercial |
$39.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$29.39
|
| Rate for Payer: United Healthcare Commercial |
$51.12
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.51
|
|
|
cloNIDine 0.1 mg/24 hr Transderm ER Film [VDMC]
|
Facility
|
IP
|
$56.80
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10378821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.76 |
| Max. Negotiated Rate |
$51.12 |
| Rate for Payer: Aetna of IA Commercial |
$51.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.12
|
| Rate for Payer: Cash Price |
$45.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.60
|
| Rate for Payer: Medical Associates Commercial |
$42.60
|
| Rate for Payer: Midlands Choice Commercial |
$39.76
|
| Rate for Payer: United Healthcare Commercial |
$51.12
|
|
|
cloNIDine 0.1 mg Tab [VDMC]
|
Facility
|
OP
|
$1.79
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10378752
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Aetna of IA Commercial |
$1.61
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.61
|
| Rate for Payer: Aetna of IA Medicare |
$1.02
|
| Rate for Payer: Amerigroup Medicaid |
$1.03
|
| Rate for Payer: Amerigroup Medicare |
$0.81
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.34
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.02
|
| Rate for Payer: Medical Associates Commercial |
$1.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.80
|
| Rate for Payer: Midlands Choice Commercial |
$1.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$1.61
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.06
|
|
|
cloNIDine 0.1 mg Tab [VDMC]
|
Facility
|
IP
|
$1.79
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10378752
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Aetna of IA Commercial |
$1.61
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.61
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.34
|
| Rate for Payer: Medical Associates Commercial |
$1.34
|
| Rate for Payer: Midlands Choice Commercial |
$1.25
|
| Rate for Payer: United Healthcare Commercial |
$1.61
|
|
|
cloNIDine 0.3 mg/24 hr Transderm ER Film [VDMC]
|
Facility
|
OP
|
$78.33
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10378886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna of IA Commercial |
$70.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$70.50
|
| Rate for Payer: Aetna of IA Medicare |
$44.65
|
| Rate for Payer: Amerigroup Medicaid |
$45.18
|
| Rate for Payer: Amerigroup Medicare |
$35.60
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$44.74
|
| Rate for Payer: Medical Associates Commercial |
$58.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.25
|
| Rate for Payer: Midlands Choice Commercial |
$54.83
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$45.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$40.53
|
| Rate for Payer: United Healthcare Commercial |
$70.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$46.21
|
|
|
cloNIDine 0.3 mg/24 hr Transderm ER Film [VDMC]
|
Facility
|
IP
|
$78.33
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10378886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$54.83 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna of IA Commercial |
$70.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$70.50
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.75
|
| Rate for Payer: Medical Associates Commercial |
$58.75
|
| Rate for Payer: Midlands Choice Commercial |
$54.83
|
| Rate for Payer: United Healthcare Commercial |
$70.50
|
|
|
cloNIDine 100mcg/1mL 10mL SDV IV Sol[VDMC]
|
Facility
|
IP
|
$82.56
|
|
|
Service Code
|
HCPCS J0735
|
| Hospital Charge Code |
29046892
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$57.79 |
| Max. Negotiated Rate |
$74.30 |
| Rate for Payer: Aetna of IA Commercial |
$74.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$74.30
|
| Rate for Payer: Cash Price |
$66.05
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.92
|
| Rate for Payer: Medical Associates Commercial |
$61.92
|
| Rate for Payer: Midlands Choice Commercial |
$57.79
|
| Rate for Payer: United Healthcare Commercial |
$74.30
|
|
|
cloNIDine 100mcg/1mL 10mL SDV IV Sol[VDMC]
|
Facility
|
OP
|
$82.56
|
|
|
Service Code
|
HCPCS J0735
|
| Hospital Charge Code |
29046892
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.15 |
| Max. Negotiated Rate |
$74.30 |
| Rate for Payer: Aetna of IA Commercial |
$74.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$74.30
|
| Rate for Payer: Aetna of IA Medicare |
$47.06
|
| Rate for Payer: Amerigroup Medicaid |
$47.62
|
| Rate for Payer: Amerigroup Medicare |
$37.52
|
| Rate for Payer: Cash Price |
$66.05
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.92
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$37.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.16
|
| Rate for Payer: Medical Associates Commercial |
$61.92
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.15
|
| Rate for Payer: Midlands Choice Commercial |
$57.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$47.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.72
|
| Rate for Payer: United Healthcare Commercial |
$74.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.71
|
|
