|
clotrimazole Top 1% Crm 30gm [VDMC]
|
Facility
|
OP
|
$16.20
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10434063
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna of IA Commercial |
$14.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.58
|
| Rate for Payer: Aetna of IA Medicare |
$9.23
|
| Rate for Payer: Amerigroup Medicaid |
$8.18
|
| Rate for Payer: Amerigroup Medicare |
$8.18
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.15
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.10
|
| Rate for Payer: Medical Associates Commercial |
$12.15
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.10
|
| Rate for Payer: Midlands Choice Commercial |
$11.34
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.22
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$8.22
|
| Rate for Payer: Oscar Health of IA Commercial |
$12.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.15
|
| Rate for Payer: United Healthcare Commercial |
$14.58
|
| Rate for Payer: United Healthcare Managed Medicare |
$9.56
|
|
|
clotrimazole Top 1% Crm 30gm [VDMC]
|
Facility
|
IP
|
$16.20
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10434063
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.34 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna of IA Commercial |
$14.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.58
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.15
|
| Rate for Payer: Medical Associates Commercial |
$12.15
|
| Rate for Payer: Midlands Choice Commercial |
$11.34
|
| Rate for Payer: United Healthcare Commercial |
$14.58
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
7982819
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$251.83 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna of IA Medicare |
$251.83
|
| Rate for Payer: Amerigroup Medicaid |
$260.39
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$302.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$256.87
|
| Rate for Payer: Medical Associates Commercial |
$453.29
|
| Rate for Payer: Medical Associates Managed Medicare |
$251.83
|
| Rate for Payer: Midlands Choice Commercial |
$980.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$435.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$377.74
|
|
|
CMPLX RPR F/C/C/M/N/AX/G/H/F
|
Professional
|
Both
|
$1,277.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
7982820
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$274.46 |
| Max. Negotiated Rate |
$638.34 |
| Rate for Payer: Aetna of IA Medicare |
$274.46
|
| Rate for Payer: Amerigroup Medicaid |
$283.79
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$329.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$279.95
|
| Rate for Payer: Medical Associates Commercial |
$494.03
|
| Rate for Payer: Medical Associates Managed Medicare |
$274.46
|
| Rate for Payer: Midlands Choice Commercial |
$638.34
|
| Rate for Payer: Oscar Health of IA Commercial |
$474.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$411.69
|
|
|
CMPLX RPR S/A/L 2.6-7.5 CM
|
Professional
|
Both
|
$1,415.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
7982821
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$233.97 |
| Max. Negotiated Rate |
$990.50 |
| Rate for Payer: Aetna of IA Medicare |
$233.97
|
| Rate for Payer: Amerigroup Medicaid |
$241.92
|
| Rate for Payer: Cash Price |
$1,132.00
|
| Rate for Payer: Cash Price |
$1,132.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$280.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$238.65
|
| Rate for Payer: Medical Associates Commercial |
$421.15
|
| Rate for Payer: Medical Associates Managed Medicare |
$233.97
|
| Rate for Payer: Midlands Choice Commercial |
$990.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$404.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$350.96
|
|
|
CNBT EACH ADDITIONAL HOUR
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
6345015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$282.35 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Aetna of IA Medicare |
$148.20
|
| Rate for Payer: Amerigroup Medicaid |
$131.22
|
| Rate for Payer: Amerigroup Medicare |
$131.30
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$130.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$129.95
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$130.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$131.95
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$131.87
|
| Rate for Payer: Oscar Health of IA Commercial |
$195.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$195.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.40
|
| Rate for Payer: Wellmark IA HMO |
$256.68
|
| Rate for Payer: Wellmark IA PPO |
$282.35
|
|
|
CNBT EACH ADDITIONAL HOUR
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
6345015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
|
|
CNBT INITIAL 1ST HOUR
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
6594783
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
|
|
CNBT INITIAL 1ST HOUR
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
6594783
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$282.35 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Aetna of IA Medicare |
$148.20
|
| Rate for Payer: Amerigroup Medicaid |
$131.22
|
| Rate for Payer: Amerigroup Medicare |
$131.30
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$130.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$129.95
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$130.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$131.95
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$131.87
|
| Rate for Payer: Oscar Health of IA Commercial |
$195.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$195.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.40
|
| Rate for Payer: Wellmark IA HMO |
$256.68
|
| Rate for Payer: Wellmark IA PPO |
$282.35
|
|
|
Coagulation Disorders
|
Facility
|
IP
|
$9,404.42
|
|
|
Service Code
|
MS-DRG 813
|
| Hospital Charge Code |
555
|
| Min. Negotiated Rate |
$9,268.13 |
| Max. Negotiated Rate |
$9,404.42 |
| Rate for Payer: Amerigroup Medicaid |
$9,358.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9,268.13
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,404.42
|
|
|
cocaine Top 40 mg/mL 4 ML Sol [VDMC]
|
Facility
|
OP
|
$665.08
|
|
|
Service Code
|
NDC 00527-1728-74
|
| Hospital Charge Code |
10434128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$332.41 |
| Max. Negotiated Rate |
$598.57 |
| Rate for Payer: Aetna of IA Commercial |
$598.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$598.57
|
| Rate for Payer: Aetna of IA Medicare |
$379.10
|
| Rate for Payer: Amerigroup Medicaid |
$335.67
|
| Rate for Payer: Amerigroup Medicare |
$335.87
|
| Rate for Payer: Cash Price |
$532.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$498.81
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$332.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$332.41
|
| Rate for Payer: Medical Associates Commercial |
$498.81
|
| Rate for Payer: Medical Associates Managed Medicare |
$332.54
|
| Rate for Payer: Midlands Choice Commercial |
$465.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$337.53
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$337.33
|
| Rate for Payer: Oscar Health of IA Commercial |
$498.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$498.81
|
| Rate for Payer: United Healthcare Commercial |
$598.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$392.40
|
|
|
cocaine Top 40 mg/mL 4 ML Sol [VDMC]
|
Facility
|
IP
|
$665.08
|
|
|
Service Code
|
NDC 00527-1728-74
|
| Hospital Charge Code |
10434128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$465.56 |
| Max. Negotiated Rate |
$598.57 |
| Rate for Payer: Aetna of IA Commercial |
$598.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$598.57
|
| Rate for Payer: Cash Price |
$532.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$498.81
|
| Rate for Payer: Medical Associates Commercial |
$498.81
|
| Rate for Payer: Midlands Choice Commercial |
$465.56
|
| Rate for Payer: United Healthcare Commercial |
$598.57
|
|
|
CoEnzyme Q-10 100 mg Cap
|
Facility
|
IP
|
$1.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
19626908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Aetna of IA Commercial |
$1.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.37
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.14
|
| Rate for Payer: Medical Associates Commercial |
$1.14
|
| Rate for Payer: Midlands Choice Commercial |
$1.06
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
|
|
CoEnzyme Q-10 100 mg Cap
|
Facility
|
OP
|
$1.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
19626908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Aetna of IA Commercial |
$1.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.37
|
| Rate for Payer: Aetna of IA Medicare |
$0.87
|
| Rate for Payer: Amerigroup Medicaid |
$0.77
|
| Rate for Payer: Amerigroup Medicare |
$0.77
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.14
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.76
|
| Rate for Payer: Medical Associates Commercial |
$1.14
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.76
|
| Rate for Payer: Midlands Choice Commercial |
$1.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.77
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.77
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.14
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.90
|
|
|
COG EVAL
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 96125 GN
|
| Hospital Charge Code |
7106809
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$311.40 |
| Rate for Payer: Aetna of IA Commercial |
$311.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$311.40
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$259.50
|
| Rate for Payer: Medical Associates Commercial |
$259.50
|
| Rate for Payer: Midlands Choice Commercial |
$242.20
|
| Rate for Payer: United Healthcare Commercial |
$311.40
|
|
|
COG EVAL
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 96125 GN
|
| Hospital Charge Code |
7106809
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$172.93 |
| Max. Negotiated Rate |
$311.40 |
| Rate for Payer: Aetna of IA Commercial |
$311.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$311.40
|
| Rate for Payer: Aetna of IA Medicare |
$197.22
|
| Rate for Payer: Amerigroup Medicaid |
$174.63
|
| Rate for Payer: Amerigroup Medicare |
$174.73
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$259.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$173.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$172.93
|
| Rate for Payer: Medical Associates Commercial |
$259.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$173.00
|
| Rate for Payer: Midlands Choice Commercial |
$242.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$175.60
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$175.49
|
| Rate for Payer: Oscar Health of IA Commercial |
$259.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$259.50
|
| Rate for Payer: United Healthcare Commercial |
$311.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$204.14
|
|
|
COGNITIVE DEV 15 MIN
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 97532 GN
|
| Hospital Charge Code |
1373954
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna of IA Commercial |
$79.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$79.20
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$66.00
|
| Rate for Payer: Medical Associates Commercial |
$66.00
|
| Rate for Payer: Midlands Choice Commercial |
$61.60
|
| Rate for Payer: United Healthcare Commercial |
$79.20
|
|
|
COGNITIVE DEV 15 MIN
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 97532 GN
|
| Hospital Charge Code |
1373954
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$43.98 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna of IA Commercial |
$79.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$79.20
|
| Rate for Payer: Aetna of IA Medicare |
$50.16
|
| Rate for Payer: Amerigroup Medicaid |
$44.41
|
| Rate for Payer: Amerigroup Medicare |
$44.44
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$66.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$44.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.98
|
| Rate for Payer: Medical Associates Commercial |
$66.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.00
|
| Rate for Payer: Midlands Choice Commercial |
$61.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.66
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$44.63
|
| Rate for Payer: Oscar Health of IA Commercial |
$66.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$79.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$51.92
|
|
|
COGNITIVE TRAINING/PER 15 MIN
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 97532 GO
|
| Hospital Charge Code |
1373452
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of IA Commercial |
$77.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.40
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.50
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
|
|
COGNITIVE TRAINING/PER 15 MIN
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 97532 GO
|
| Hospital Charge Code |
1373452
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of IA Commercial |
$77.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.40
|
| Rate for Payer: Aetna of IA Medicare |
$49.02
|
| Rate for Payer: Amerigroup Medicaid |
$43.40
|
| Rate for Payer: Amerigroup Medicare |
$43.43
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$43.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.98
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$43.00
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.64
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$43.62
|
| Rate for Payer: Oscar Health of IA Commercial |
$64.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.50
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.74
|
|
|
colchicine 0.6 mg Tab [VDMC]
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
22541047
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of IA Commercial |
$1.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.54
|
| Rate for Payer: Aetna of IA Medicare |
$0.97
|
| Rate for Payer: Amerigroup Medicaid |
$0.86
|
| Rate for Payer: Amerigroup Medicare |
$0.86
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.85
|
| Rate for Payer: Medical Associates Commercial |
$1.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.86
|
| Rate for Payer: Midlands Choice Commercial |
$1.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.87
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.87
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.28
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.01
|
|
|
colchicine 0.6 mg Tab [VDMC]
|
Facility
|
IP
|
$1.71
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
22541047
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of IA Commercial |
$1.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.54
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.28
|
| Rate for Payer: Medical Associates Commercial |
$1.28
|
| Rate for Payer: Midlands Choice Commercial |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
|
|
colesevelam 3.75 g Pow [VDMC]
|
Facility
|
IP
|
$36.89
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10379367
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.82 |
| Max. Negotiated Rate |
$33.20 |
| Rate for Payer: Aetna of IA Commercial |
$33.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.20
|
| Rate for Payer: Cash Price |
$29.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.67
|
| Rate for Payer: Medical Associates Commercial |
$27.67
|
| Rate for Payer: Midlands Choice Commercial |
$25.82
|
| Rate for Payer: United Healthcare Commercial |
$33.20
|
|
|
colesevelam 3.75 g Pow [VDMC]
|
Facility
|
OP
|
$36.89
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10379367
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$33.20 |
| Rate for Payer: Aetna of IA Commercial |
$33.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.20
|
| Rate for Payer: Aetna of IA Medicare |
$21.03
|
| Rate for Payer: Amerigroup Medicaid |
$18.62
|
| Rate for Payer: Amerigroup Medicare |
$18.63
|
| Rate for Payer: Cash Price |
$29.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.67
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.44
|
| Rate for Payer: Medical Associates Commercial |
$27.67
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.44
|
| Rate for Payer: Midlands Choice Commercial |
$25.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$18.71
|
| Rate for Payer: Oscar Health of IA Commercial |
$27.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.67
|
| Rate for Payer: United Healthcare Commercial |
$33.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.77
|
|
|
colesevelam 625 mg Tab [VDMC]
|
Facility
|
IP
|
$2.67
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10379436
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Aetna of IA Commercial |
$2.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.40
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.00
|
| Rate for Payer: Medical Associates Commercial |
$2.00
|
| Rate for Payer: Midlands Choice Commercial |
$1.87
|
| Rate for Payer: United Healthcare Commercial |
$2.40
|
|
