Mumps Virus IgG Antibody DMCL
|
Facility
|
OP
|
$124.00
|
|
Service Code
|
CPT 86735
|
Hospital Charge Code |
8037744
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$47.12 |
Max. Negotiated Rate |
$111.60 |
Rate for Payer: Aetna of IA Commercial |
$111.60
|
Rate for Payer: Aetna of IA Medical Rental Products |
$111.60
|
Rate for Payer: Aetna of IA Medicare |
$70.68
|
Rate for Payer: Amerigroup Medicaid |
$62.58
|
Rate for Payer: Amerigroup Medicare |
$62.62
|
Rate for Payer: Cash Price |
$99.20
|
Rate for Payer: Cash Price |
$99.20
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.00
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$62.00
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$61.98
|
Rate for Payer: Medical Associates Commercial |
$93.00
|
Rate for Payer: Medical Associates Managed Medicare |
$62.00
|
Rate for Payer: Midlands Choice Commercial |
$86.80
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$62.93
|
Rate for Payer: Molina Healthcare Managed Medicare |
$62.89
|
Rate for Payer: Oscar Health of IA Commercial |
$93.00
|
Rate for Payer: Partners Health Alliance Commercial |
$93.00
|
Rate for Payer: United Healthcare Commercial |
$111.60
|
Rate for Payer: United Healthcare Managed Medicare |
$73.16
|
Rate for Payer: Wellmark IA HMO |
$47.12
|
Rate for Payer: Wellmark IA PPO |
$51.83
|
|
MUPIROCIN 2% OINTMENT
|
Facility
|
OP
|
$41.00
|
|
Hospital Charge Code |
8013713
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$20.49 |
Max. Negotiated Rate |
$36.90 |
Rate for Payer: Aetna of IA Commercial |
$36.90
|
Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
Rate for Payer: Aetna of IA Medicare |
$23.37
|
Rate for Payer: Amerigroup Medicaid |
$20.69
|
Rate for Payer: Amerigroup Medicare |
$20.70
|
Rate for Payer: Cash Price |
$32.80
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.50
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$20.49
|
Rate for Payer: Medical Associates Commercial |
$30.75
|
Rate for Payer: Medical Associates Managed Medicare |
$20.50
|
Rate for Payer: Midlands Choice Commercial |
$28.70
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$20.81
|
Rate for Payer: Molina Healthcare Managed Medicare |
$20.80
|
Rate for Payer: Oscar Health of IA Commercial |
$30.75
|
Rate for Payer: Partners Health Alliance Commercial |
$30.75
|
Rate for Payer: United Healthcare Commercial |
$36.90
|
Rate for Payer: United Healthcare Managed Medicare |
$24.19
|
|
MUPIROCIN 2% OINTMENT
|
Facility
|
IP
|
$41.00
|
|
Hospital Charge Code |
8013713
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$28.70 |
Max. Negotiated Rate |
$36.90 |
Rate for Payer: Aetna of IA Commercial |
$36.90
|
Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
Rate for Payer: Cash Price |
$32.80
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
Rate for Payer: Medical Associates Commercial |
$30.75
|
Rate for Payer: Midlands Choice Commercial |
$28.70
|
Rate for Payer: United Healthcare Commercial |
$36.90
|
|
mupirocin Top 2% Oint [VDMC]
|
Facility
|
IP
|
$25.40
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10436449
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$17.78 |
Max. Negotiated Rate |
$22.86 |
Rate for Payer: Aetna of IA Commercial |
$22.86
|
Rate for Payer: Aetna of IA Medical Rental Products |
$22.86
|
Rate for Payer: Cash Price |
$20.32
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.05
|
Rate for Payer: Medical Associates Commercial |
$19.05
|
Rate for Payer: Midlands Choice Commercial |
$17.78
|
Rate for Payer: United Healthcare Commercial |
$22.86
|
|
mupirocin Top 2% Oint [VDMC]
|
Facility
|
OP
|
$25.40
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10436449
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$12.69 |
Max. Negotiated Rate |
$22.86 |
Rate for Payer: Aetna of IA Commercial |
$22.86
|
Rate for Payer: Aetna of IA Medical Rental Products |
$22.86
|
Rate for Payer: Aetna of IA Medicare |
$14.48
|
Rate for Payer: Amerigroup Medicaid |
$12.82
|
Rate for Payer: Amerigroup Medicare |
$12.83
|
Rate for Payer: Cash Price |
$20.32
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.05
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.70
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$12.69
|
Rate for Payer: Medical Associates Commercial |
$19.05
|
Rate for Payer: Medical Associates Managed Medicare |
$12.70
|
Rate for Payer: Midlands Choice Commercial |
$17.78
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$12.89
|
Rate for Payer: Molina Healthcare Managed Medicare |
$12.88
|
Rate for Payer: Oscar Health of IA Commercial |
$19.05
|
Rate for Payer: Partners Health Alliance Commercial |
$19.05
|
Rate for Payer: United Healthcare Commercial |
$22.86
|
Rate for Payer: United Healthcare Managed Medicare |
$14.99
|
|
mycophenolate mofetil 250 mg Cap [VDMC]
|
Facility
|
IP
|
$1.54
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10407718
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.08 |
Max. Negotiated Rate |
$1.39 |
Rate for Payer: Aetna of IA Commercial |
$1.39
|
Rate for Payer: Aetna of IA Medical Rental Products |
$1.39
|
Rate for Payer: Cash Price |
$1.23
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.16
|
Rate for Payer: Medical Associates Commercial |
$1.16
|
Rate for Payer: Midlands Choice Commercial |
$1.08
|
Rate for Payer: United Healthcare Commercial |
$1.39
|
|
mycophenolate mofetil 250 mg Cap [VDMC]
|
Facility
|
OP
|
$1.54
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10407718
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.77 |
Max. Negotiated Rate |
$1.39 |
Rate for Payer: Aetna of IA Commercial |
$1.39
|
Rate for Payer: Aetna of IA Medical Rental Products |
$1.39
|
Rate for Payer: Aetna of IA Medicare |
$0.88
|
Rate for Payer: Amerigroup Medicaid |
$0.78
|
Rate for Payer: Amerigroup Medicare |
$0.78
|
Rate for Payer: Cash Price |
$1.23
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.16
|
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 |
$0.77
|
Rate for Payer: Medical Associates Commercial |
$1.16
|
Rate for Payer: Medical Associates Managed Medicare |
$0.77
|
Rate for Payer: Midlands Choice Commercial |
$1.08
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$0.78
|
Rate for Payer: Molina Healthcare Managed Medicare |
$0.78
|
Rate for Payer: Oscar Health of IA Commercial |
$1.16
|
Rate for Payer: Partners Health Alliance Commercial |
$1.16
|
Rate for Payer: United Healthcare Commercial |
$1.39
|
Rate for Payer: United Healthcare Managed Medicare |
$0.91
|
|
Mycoplasma Pneumonia antibody
|
Facility
|
IP
|
$114.00
|
|
Service Code
|
CPT 86738
|
Hospital Charge Code |
4108792
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$79.80 |
Max. Negotiated Rate |
$102.60 |
Rate for Payer: Aetna of IA Commercial |
$102.60
|
Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
Rate for Payer: Cash Price |
$91.20
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
Rate for Payer: Medical Associates Commercial |
$85.50
|
Rate for Payer: Midlands Choice Commercial |
$79.80
|
Rate for Payer: United Healthcare Commercial |
$102.60
|
|
Mycoplasma Pneumonia antibody
|
Facility
|
OP
|
$114.00
|
|
Service Code
|
CPT 86738
|
Hospital Charge Code |
4108792
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$47.12 |
Max. Negotiated Rate |
$102.60 |
Rate for Payer: Aetna of IA Commercial |
$102.60
|
Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
Rate for Payer: Aetna of IA Medicare |
$64.98
|
Rate for Payer: Amerigroup Medicaid |
$57.54
|
Rate for Payer: Amerigroup Medicare |
$57.57
|
Rate for Payer: Cash Price |
$91.20
|
Rate for Payer: Cash Price |
$91.20
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.00
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$56.98
|
Rate for Payer: Medical Associates Commercial |
$85.50
|
Rate for Payer: Medical Associates Managed Medicare |
$57.00
|
Rate for Payer: Midlands Choice Commercial |
$79.80
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$57.86
|
Rate for Payer: Molina Healthcare Managed Medicare |
$57.82
|
Rate for Payer: Oscar Health of IA Commercial |
$85.50
|
Rate for Payer: Partners Health Alliance Commercial |
$85.50
|
Rate for Payer: United Healthcare Commercial |
$102.60
|
Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
Rate for Payer: Wellmark IA HMO |
$47.12
|
Rate for Payer: Wellmark IA PPO |
$51.83
|
|
Myeloproliferative Disorders or Poorly Differentiated Neoplasms With Major O.R. Procedures With CC
|
Facility
|
IP
|
$20,588.36
|
|
Service Code
|
MS-DRG 827
|
Hospital Charge Code |
569
|
Min. Negotiated Rate |
$20,289.98 |
Max. Negotiated Rate |
$20,588.36 |
Rate for Payer: Amerigroup Medicaid |
$20,488.90
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$20,289.98
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$20,588.36
|
|
Myeloproliferative Disorders or Poorly Differentiated Neoplasms With Major O.R. Procedures With MCC
|
Facility
|
IP
|
$49,587.07
|
|
Service Code
|
MS-DRG 826
|
Hospital Charge Code |
568
|
Min. Negotiated Rate |
$48,868.41 |
Max. Negotiated Rate |
$49,587.07 |
Rate for Payer: Amerigroup Medicaid |
$49,347.52
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$48,868.41
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$49,587.07
|
|
Myeloproliferative Disorders or Poorly Differentiated Neoplasms With Major O.R. Procedures Without CC/MCC
|
Facility
|
IP
|
$13,882.72
|
|
Service Code
|
MS-DRG 828
|
Hospital Charge Code |
570
|
Min. Negotiated Rate |
$13,681.53 |
Max. Negotiated Rate |
$13,882.72 |
Rate for Payer: Amerigroup Medicaid |
$13,815.66
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$13,681.53
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$13,882.72
|
|
Myeloproliferative Disorders or Poorly Differentiated Neoplasms With Other Procedures With CC/MCC
|
Facility
|
IP
|
$19,808.84
|
|
Service Code
|
MS-DRG 829
|
Hospital Charge Code |
571
|
Min. Negotiated Rate |
$19,521.76 |
Max. Negotiated Rate |
$19,808.84 |
Rate for Payer: Amerigroup Medicaid |
$19,713.15
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$19,521.76
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$19,808.84
|
|
Myeloproliferative Disorders or Poorly Differentiated Neoplasms With Other Procedures Without CC/MCC
|
Facility
|
IP
|
$13,824.66
|
|
Service Code
|
MS-DRG 830
|
Hospital Charge Code |
572
|
Min. Negotiated Rate |
$13,624.30 |
Max. Negotiated Rate |
$13,824.66 |
Rate for Payer: Amerigroup Medicaid |
$13,757.87
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$13,624.30
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$13,824.66
|
|
nabumetone 500 mg Tab [VDMC]
|
Facility
|
IP
|
$1.34
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10407789
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.94 |
Max. Negotiated Rate |
$1.21 |
Rate for Payer: Aetna of IA Commercial |
$1.21
|
Rate for Payer: Aetna of IA Medical Rental Products |
$1.21
|
Rate for Payer: Cash Price |
$1.07
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.00
|
Rate for Payer: Medical Associates Commercial |
$1.00
|
Rate for Payer: Midlands Choice Commercial |
$0.94
|
Rate for Payer: United Healthcare Commercial |
$1.21
|
|
nabumetone 500 mg Tab [VDMC]
|
Facility
|
OP
|
$1.34
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10407789
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.67 |
Max. Negotiated Rate |
$1.21 |
Rate for Payer: Aetna of IA Commercial |
$1.21
|
Rate for Payer: Aetna of IA Medical Rental Products |
$1.21
|
Rate for Payer: Aetna of IA Medicare |
$0.76
|
Rate for Payer: Amerigroup Medicaid |
$0.68
|
Rate for Payer: Amerigroup Medicare |
$0.68
|
Rate for Payer: Cash Price |
$1.07
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.00
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.67
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$0.67
|
Rate for Payer: Medical Associates Commercial |
$1.00
|
Rate for Payer: Medical Associates Managed Medicare |
$0.67
|
Rate for Payer: Midlands Choice Commercial |
$0.94
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$0.68
|
Rate for Payer: Molina Healthcare Managed Medicare |
$0.68
|
Rate for Payer: Oscar Health of IA Commercial |
$1.00
|
Rate for Payer: Partners Health Alliance Commercial |
$1.00
|
Rate for Payer: United Healthcare Commercial |
$1.21
|
Rate for Payer: United Healthcare Managed Medicare |
$0.79
|
|
naloxone 0.4 mg/mL 1 ml Inj Sol [VDMC]
|
Facility
|
OP
|
$31.90
|
|
Service Code
|
HCPCS J2310
|
Hospital Charge Code |
10408193
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$15.94 |
Max. Negotiated Rate |
$28.71 |
Rate for Payer: Aetna of IA Commercial |
$28.71
|
Rate for Payer: Aetna of IA Medical Rental Products |
$28.71
|
Rate for Payer: Aetna of IA Medicare |
$18.18
|
Rate for Payer: Amerigroup Medicaid |
$16.10
|
Rate for Payer: Amerigroup Medicare |
$16.11
|
Rate for Payer: Cash Price |
$25.52
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.92
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.95
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$15.94
|
Rate for Payer: Medical Associates Commercial |
$23.92
|
Rate for Payer: Medical Associates Managed Medicare |
$15.95
|
Rate for Payer: Midlands Choice Commercial |
$22.33
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$16.19
|
Rate for Payer: Molina Healthcare Managed Medicare |
$16.18
|
Rate for Payer: Oscar Health of IA Commercial |
$23.92
|
Rate for Payer: Partners Health Alliance Commercial |
$23.92
|
Rate for Payer: United Healthcare Commercial |
$28.71
|
Rate for Payer: United Healthcare Managed Medicare |
$18.82
|
|
naloxone 0.4 mg/mL 1 ml Inj Sol [VDMC]
|
Facility
|
IP
|
$31.90
|
|
Service Code
|
HCPCS J2310
|
Hospital Charge Code |
10408193
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$22.33 |
Max. Negotiated Rate |
$28.71 |
Rate for Payer: Aetna of IA Commercial |
$28.71
|
Rate for Payer: Aetna of IA Medical Rental Products |
$28.71
|
Rate for Payer: Cash Price |
$25.52
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.92
|
Rate for Payer: Medical Associates Commercial |
$23.92
|
Rate for Payer: Midlands Choice Commercial |
$22.33
|
Rate for Payer: United Healthcare Commercial |
$28.71
|
|
naloxone 1 mg/mL Inj Sol [VDMC]
|
Facility
|
IP
|
$141.42
|
|
Service Code
|
HCPCS J2310
|
Hospital Charge Code |
10408262
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$98.99 |
Max. Negotiated Rate |
$127.28 |
Rate for Payer: Aetna of IA Commercial |
$127.28
|
Rate for Payer: Aetna of IA Medical Rental Products |
$127.28
|
Rate for Payer: Cash Price |
$113.13
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$106.06
|
Rate for Payer: Medical Associates Commercial |
$106.06
|
Rate for Payer: Midlands Choice Commercial |
$98.99
|
Rate for Payer: United Healthcare Commercial |
$127.28
|
|
naloxone 1 mg/mL Inj Sol [VDMC]
|
Facility
|
OP
|
$141.42
|
|
Service Code
|
HCPCS J2310
|
Hospital Charge Code |
10408262
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$70.68 |
Max. Negotiated Rate |
$127.28 |
Rate for Payer: Aetna of IA Commercial |
$127.28
|
Rate for Payer: Aetna of IA Medical Rental Products |
$127.28
|
Rate for Payer: Aetna of IA Medicare |
$80.61
|
Rate for Payer: Amerigroup Medicaid |
$71.37
|
Rate for Payer: Amerigroup Medicare |
$71.42
|
Rate for Payer: Cash Price |
$113.13
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$106.06
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.71
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$70.68
|
Rate for Payer: Medical Associates Commercial |
$106.06
|
Rate for Payer: Medical Associates Managed Medicare |
$70.71
|
Rate for Payer: Midlands Choice Commercial |
$98.99
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$71.77
|
Rate for Payer: Molina Healthcare Managed Medicare |
$71.73
|
Rate for Payer: Oscar Health of IA Commercial |
$106.06
|
Rate for Payer: Partners Health Alliance Commercial |
$106.06
|
Rate for Payer: United Healthcare Commercial |
$127.28
|
Rate for Payer: United Healthcare Managed Medicare |
$83.44
|
|
naltrexone 50 mg Tab[VDMC]
|
Facility
|
OP
|
$3.38
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
11391896
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.69 |
Max. Negotiated Rate |
$3.04 |
Rate for Payer: Aetna of IA Commercial |
$3.04
|
Rate for Payer: Aetna of IA Medical Rental Products |
$3.04
|
Rate for Payer: Aetna of IA Medicare |
$1.93
|
Rate for Payer: Amerigroup Medicaid |
$1.71
|
Rate for Payer: Amerigroup Medicare |
$1.71
|
Rate for Payer: Cash Price |
$2.70
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.54
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.69
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$1.69
|
Rate for Payer: Medical Associates Commercial |
$2.54
|
Rate for Payer: Medical Associates Managed Medicare |
$1.69
|
Rate for Payer: Midlands Choice Commercial |
$2.37
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$1.72
|
Rate for Payer: Molina Healthcare Managed Medicare |
$1.71
|
Rate for Payer: Oscar Health of IA Commercial |
$2.54
|
Rate for Payer: Partners Health Alliance Commercial |
$2.54
|
Rate for Payer: United Healthcare Commercial |
$3.04
|
Rate for Payer: United Healthcare Managed Medicare |
$1.99
|
|
naltrexone 50 mg Tab[VDMC]
|
Facility
|
IP
|
$3.38
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
11391896
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$2.37 |
Max. Negotiated Rate |
$3.04 |
Rate for Payer: Aetna of IA Commercial |
$3.04
|
Rate for Payer: Aetna of IA Medical Rental Products |
$3.04
|
Rate for Payer: Cash Price |
$2.70
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.54
|
Rate for Payer: Medical Associates Commercial |
$2.54
|
Rate for Payer: Midlands Choice Commercial |
$2.37
|
Rate for Payer: United Healthcare Commercial |
$3.04
|
|
naproxen 500 mg Tab [VDMC]
|
Facility
|
IP
|
$1.34
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10408333
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.94 |
Max. Negotiated Rate |
$1.21 |
Rate for Payer: Aetna of IA Commercial |
$1.21
|
Rate for Payer: Aetna of IA Medical Rental Products |
$1.21
|
Rate for Payer: Cash Price |
$1.07
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.00
|
Rate for Payer: Medical Associates Commercial |
$1.00
|
Rate for Payer: Midlands Choice Commercial |
$0.94
|
Rate for Payer: United Healthcare Commercial |
$1.21
|
|
naproxen 500 mg Tab [VDMC]
|
Facility
|
OP
|
$1.34
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10408333
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.67 |
Max. Negotiated Rate |
$1.21 |
Rate for Payer: Aetna of IA Commercial |
$1.21
|
Rate for Payer: Aetna of IA Medical Rental Products |
$1.21
|
Rate for Payer: Aetna of IA Medicare |
$0.76
|
Rate for Payer: Amerigroup Medicaid |
$0.68
|
Rate for Payer: Amerigroup Medicare |
$0.68
|
Rate for Payer: Cash Price |
$1.07
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.00
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.67
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$0.67
|
Rate for Payer: Medical Associates Commercial |
$1.00
|
Rate for Payer: Medical Associates Managed Medicare |
$0.67
|
Rate for Payer: Midlands Choice Commercial |
$0.94
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$0.68
|
Rate for Payer: Molina Healthcare Managed Medicare |
$0.68
|
Rate for Payer: Oscar Health of IA Commercial |
$1.00
|
Rate for Payer: Partners Health Alliance Commercial |
$1.00
|
Rate for Payer: United Healthcare Commercial |
$1.21
|
Rate for Payer: United Healthcare Managed Medicare |
$0.79
|
|
NASAL CAUTERY/PACKING
|
Professional
|
Both
|
$315.00
|
|
Service Code
|
CPT 30901
|
Hospital Charge Code |
7982782
|
Hospital Revenue Code
|
981
|
Min. Negotiated Rate |
$50.82 |
Max. Negotiated Rate |
$220.50 |
Rate for Payer: Aetna of IA Medicare |
$50.82
|
Rate for Payer: Amerigroup Medicaid |
$52.55
|
Rate for Payer: Cash Price |
$252.00
|
Rate for Payer: Cash Price |
$252.00
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$60.98
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$51.84
|
Rate for Payer: Medical Associates Commercial |
$91.48
|
Rate for Payer: Medical Associates Managed Medicare |
$50.82
|
Rate for Payer: Midlands Choice Commercial |
$220.50
|
Rate for Payer: Oscar Health of IA Commercial |
$87.92
|
Rate for Payer: Partners Health Alliance Commercial |
$76.23
|
|