|
CULTURE OTHER
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633894
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
|
|
CULTURE OTHER
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633900
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
|
|
CULTURE OTHER
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633890
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
|
|
CULTURE OTHER
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633903
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Aetna of IA Medicare |
$57.00
|
| Rate for Payer: Amerigroup Medicaid |
$50.47
|
| Rate for Payer: Amerigroup Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$50.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.98
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.75
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$50.72
|
| Rate for Payer: Oscar Health of IA Commercial |
$75.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
CULTURE OTHER
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633903
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
|
|
CULTURE OTHER
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633883
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Aetna of IA Medicare |
$57.00
|
| Rate for Payer: Amerigroup Medicaid |
$50.47
|
| Rate for Payer: Amerigroup Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$50.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.98
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.75
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$50.72
|
| Rate for Payer: Oscar Health of IA Commercial |
$75.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
CULTURE OTHER
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633890
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Aetna of IA Medicare |
$57.00
|
| Rate for Payer: Amerigroup Medicaid |
$50.47
|
| Rate for Payer: Amerigroup Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$50.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.98
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.75
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$50.72
|
| Rate for Payer: Oscar Health of IA Commercial |
$75.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
CULTURE URINE WITH COLONY COUNT
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
633907
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.00 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
CULTURE URINE WITH COLONY COUNT
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
633907
|
|
Hospital Revenue Code
|
306
|
| 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
|
|
|
cyanocobalamin 1000 mcg/mL 1 ml MDV Inj [VDMC]
|
Facility
|
IP
|
$24.38
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
10380188
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.07 |
| Max. Negotiated Rate |
$21.94 |
| Rate for Payer: Aetna of IA Commercial |
$21.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.94
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.28
|
| Rate for Payer: Medical Associates Commercial |
$18.28
|
| Rate for Payer: Midlands Choice Commercial |
$17.07
|
| Rate for Payer: United Healthcare Commercial |
$21.94
|
|
|
cyanocobalamin 1000 mcg/mL 1 ml MDV Inj [VDMC]
|
Facility
|
OP
|
$24.38
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
10380188
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$21.94 |
| Rate for Payer: Aetna of IA Commercial |
$21.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.94
|
| Rate for Payer: Aetna of IA Medicare |
$13.90
|
| Rate for Payer: Amerigroup Medicaid |
$12.30
|
| Rate for Payer: Amerigroup Medicare |
$12.31
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.19
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.19
|
| Rate for Payer: Medical Associates Commercial |
$18.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.19
|
| Rate for Payer: Midlands Choice Commercial |
$17.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.37
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$12.37
|
| Rate for Payer: Oscar Health of IA Commercial |
$18.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.28
|
| Rate for Payer: United Healthcare Commercial |
$21.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.38
|
|
|
cyanocobalamin 1000 mcg Tab [VDMC]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10380119
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna of IA Commercial |
$0.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.98
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.82
|
| Rate for Payer: Medical Associates Commercial |
$0.82
|
| Rate for Payer: Midlands Choice Commercial |
$0.76
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
|
|
cyanocobalamin 1000 mcg Tab [VDMC]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10380119
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna of IA Commercial |
$0.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.98
|
| Rate for Payer: Aetna of IA Medicare |
$0.62
|
| Rate for Payer: Amerigroup Medicaid |
$0.55
|
| Rate for Payer: Amerigroup Medicare |
$0.55
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.54
|
| Rate for Payer: Medical Associates Commercial |
$0.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.55
|
| Rate for Payer: Midlands Choice Commercial |
$0.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.55
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.55
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.64
|
|
|
Cyclic Citrullinated Peptide Ab DMCL
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
8037832
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna of IA Commercial |
$110.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$110.70
|
| Rate for Payer: Aetna of IA Medicare |
$70.11
|
| Rate for Payer: Amerigroup Medicaid |
$62.08
|
| Rate for Payer: Amerigroup Medicare |
$62.12
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$61.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.48
|
| Rate for Payer: Medical Associates Commercial |
$92.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$61.50
|
| Rate for Payer: Midlands Choice Commercial |
$86.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.42
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$62.39
|
| Rate for Payer: Oscar Health of IA Commercial |
$92.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$110.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$72.57
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Cyclic Citrullinated Peptide Ab DMCL
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
8037832
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna of IA Commercial |
$110.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$110.70
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.25
|
| Rate for Payer: Medical Associates Commercial |
$92.25
|
| Rate for Payer: Midlands Choice Commercial |
$86.10
|
| Rate for Payer: United Healthcare Commercial |
$110.70
|
|
|
cyclobenzaprine 10 mg Tab [VDMC]
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10380257
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Aetna of IA Commercial |
$0.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.97
|
| Rate for Payer: Aetna of IA Medicare |
$0.62
|
| Rate for Payer: Amerigroup Medicaid |
$0.55
|
| Rate for Payer: Amerigroup Medicare |
$0.55
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.81
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.54
|
| Rate for Payer: Medical Associates Commercial |
$0.81
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.54
|
| Rate for Payer: Midlands Choice Commercial |
$0.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.55
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.55
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$0.97
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.64
|
|
|
cyclobenzaprine 10 mg Tab [VDMC]
|
Facility
|
IP
|
$1.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10380257
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Aetna of IA Commercial |
$0.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.97
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.81
|
| Rate for Payer: Medical Associates Commercial |
$0.81
|
| Rate for Payer: Midlands Choice Commercial |
$0.76
|
| Rate for Payer: United Healthcare Commercial |
$0.97
|
|
|
cyclopentolate Ophth 1% 2 ml SDV [VDMC]
|
Facility
|
OP
|
$54.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10434193
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.13 |
| Max. Negotiated Rate |
$48.85 |
| Rate for Payer: Aetna of IA Commercial |
$48.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$48.85
|
| Rate for Payer: Aetna of IA Medicare |
$30.94
|
| Rate for Payer: Amerigroup Medicaid |
$27.40
|
| Rate for Payer: Amerigroup Medicare |
$27.41
|
| Rate for Payer: Cash Price |
$43.42
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$40.71
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.14
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.13
|
| Rate for Payer: Medical Associates Commercial |
$40.71
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.14
|
| Rate for Payer: Midlands Choice Commercial |
$38.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27.55
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$27.53
|
| Rate for Payer: Oscar Health of IA Commercial |
$40.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$40.71
|
| Rate for Payer: United Healthcare Commercial |
$48.85
|
| Rate for Payer: United Healthcare Managed Medicare |
$32.03
|
|
|
cyclopentolate Ophth 1% 2 ml SDV [VDMC]
|
Facility
|
IP
|
$54.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10434193
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$48.85 |
| Rate for Payer: Aetna of IA Commercial |
$48.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$48.85
|
| Rate for Payer: Cash Price |
$43.42
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$40.71
|
| Rate for Payer: Medical Associates Commercial |
$40.71
|
| Rate for Payer: Midlands Choice Commercial |
$38.00
|
| Rate for Payer: United Healthcare Commercial |
$48.85
|
|
|
cyclopentolate ophthalmic 1% 15ml SDV [VDMC]
|
Facility
|
IP
|
$53.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
21434014
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.21 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna of IA Commercial |
$47.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$47.84
|
| Rate for Payer: Cash Price |
$42.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.87
|
| Rate for Payer: Medical Associates Commercial |
$39.87
|
| Rate for Payer: Midlands Choice Commercial |
$37.21
|
| Rate for Payer: United Healthcare Commercial |
$47.84
|
|
|
cyclopentolate ophthalmic 1% 15ml SDV [VDMC]
|
Facility
|
OP
|
$53.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
21434014
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna of IA Commercial |
$47.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$47.84
|
| Rate for Payer: Aetna of IA Medicare |
$30.30
|
| Rate for Payer: Amerigroup Medicaid |
$26.83
|
| Rate for Payer: Amerigroup Medicare |
$26.85
|
| Rate for Payer: Cash Price |
$42.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.87
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$26.57
|
| Rate for Payer: Medical Associates Commercial |
$39.87
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.58
|
| Rate for Payer: Midlands Choice Commercial |
$37.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.98
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$26.96
|
| Rate for Payer: Oscar Health of IA Commercial |
$39.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.87
|
| Rate for Payer: United Healthcare Commercial |
$47.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$31.36
|
|
|
cyclophosphamide 1 g IV SDV Inj [VDMC]
|
Facility
|
OP
|
$1,456.46
|
|
|
Service Code
|
HCPCS J9070
|
| Hospital Charge Code |
10380326
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$727.94 |
| Max. Negotiated Rate |
$1,310.81 |
| Rate for Payer: Aetna of IA Commercial |
$1,310.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,310.81
|
| Rate for Payer: Aetna of IA Medicare |
$830.18
|
| Rate for Payer: Amerigroup Medicaid |
$735.08
|
| Rate for Payer: Amerigroup Medicare |
$735.51
|
| Rate for Payer: Cash Price |
$1,165.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,092.34
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$728.23
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$727.94
|
| Rate for Payer: Medical Associates Commercial |
$1,092.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$728.23
|
| Rate for Payer: Midlands Choice Commercial |
$1,019.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$739.15
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$738.72
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,092.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,092.34
|
| Rate for Payer: United Healthcare Commercial |
$1,310.81
|
| Rate for Payer: United Healthcare Managed Medicare |
$859.31
|
|
|
cyclophosphamide 1 g IV SDV Inj [VDMC]
|
Facility
|
IP
|
$1,456.46
|
|
|
Service Code
|
HCPCS J9070
|
| Hospital Charge Code |
10380326
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,019.52 |
| Max. Negotiated Rate |
$1,310.81 |
| Rate for Payer: Aetna of IA Commercial |
$1,310.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,310.81
|
| Rate for Payer: Cash Price |
$1,165.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,092.34
|
| Rate for Payer: Medical Associates Commercial |
$1,092.34
|
| Rate for Payer: Midlands Choice Commercial |
$1,019.52
|
| Rate for Payer: United Healthcare Commercial |
$1,310.81
|
|
|
cyclophosphamide 500 mg SDV Pow[VDMC]
|
Facility
|
IP
|
$817.52
|
|
|
Service Code
|
HCPCS J9070
|
| Hospital Charge Code |
13339677
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$572.26 |
| Max. Negotiated Rate |
$735.77 |
| Rate for Payer: Aetna of IA Commercial |
$735.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$735.77
|
| Rate for Payer: Cash Price |
$654.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$613.14
|
| Rate for Payer: Medical Associates Commercial |
$613.14
|
| Rate for Payer: Midlands Choice Commercial |
$572.26
|
| Rate for Payer: United Healthcare Commercial |
$735.77
|
|
|
cyclophosphamide 500 mg SDV Pow[VDMC]
|
Facility
|
OP
|
$817.52
|
|
|
Service Code
|
HCPCS J9070
|
| Hospital Charge Code |
13339677
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$408.60 |
| Max. Negotiated Rate |
$735.77 |
| Rate for Payer: Aetna of IA Commercial |
$735.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$735.77
|
| Rate for Payer: Aetna of IA Medicare |
$465.99
|
| Rate for Payer: Amerigroup Medicaid |
$412.60
|
| Rate for Payer: Amerigroup Medicare |
$412.85
|
| Rate for Payer: Cash Price |
$654.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$613.14
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$408.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$408.60
|
| Rate for Payer: Medical Associates Commercial |
$613.14
|
| Rate for Payer: Medical Associates Managed Medicare |
$408.76
|
| Rate for Payer: Midlands Choice Commercial |
$572.26
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$414.89
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$414.65
|
| Rate for Payer: Oscar Health of IA Commercial |
$613.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$613.14
|
| Rate for Payer: United Healthcare Commercial |
$735.77
|
| Rate for Payer: United Healthcare Managed Medicare |
$482.34
|
|
