|
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 |
633900
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.03 |
| 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 |
$57.68
|
| Rate for Payer: Amerigroup Medicare |
$45.45
|
| 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 |
$45.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.12
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$45.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.75
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
|
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
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633894
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.03 |
| 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 |
$57.68
|
| Rate for Payer: Amerigroup Medicare |
$45.45
|
| 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 |
$45.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.12
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$45.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.75
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
|
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 |
633892
|
|
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 |
633890
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.03 |
| 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 |
$57.68
|
| Rate for Payer: Amerigroup Medicare |
$45.45
|
| 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 |
$45.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.12
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$45.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.75
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
|
CULTURE OTHER
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633906
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.03 |
| 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 |
$57.68
|
| Rate for Payer: Amerigroup Medicare |
$45.45
|
| 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 |
$45.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.12
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$45.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.75
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
|
CULTURE OTHER
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633906
|
|
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 |
633886
|
|
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 |
633883
|
|
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 |
$34.03 |
| 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 |
$57.68
|
| Rate for Payer: Amerigroup Medicare |
$45.45
|
| 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 |
$45.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.12
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$45.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.75
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
|
CULTURE URINE WITH COLONY COUNT
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
633907
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.03 |
| 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 |
$50.76
|
| Rate for Payer: Amerigroup Medicare |
$40.00
|
| 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 |
$39.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$50.27
|
| Rate for Payer: Medical Associates Commercial |
$66.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$39.60
|
| Rate for Payer: Midlands Choice Commercial |
$61.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$51.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.54
|
| Rate for Payer: United Healthcare Commercial |
$79.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$51.92
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
|
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
|
OP
|
$24.38
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
10380188
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$221.80 |
| 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 |
$14.06
|
| Rate for Payer: Amerigroup Medicare |
$11.08
|
| Rate for Payer: Cash Price |
$19.50
|
| 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 |
$10.97
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.93
|
| Rate for Payer: Medical Associates Commercial |
$18.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.97
|
| Rate for Payer: Midlands Choice Commercial |
$17.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.13
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.62
|
| Rate for Payer: United Healthcare Commercial |
$21.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.38
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
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 Tab [VDMC]
|
Facility
|
OP
|
$1.07
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10380119
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| 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 |
$0.61
|
| Rate for Payer: Amerigroup Medicaid |
$0.62
|
| Rate for Payer: Amerigroup Medicare |
$0.49
|
| 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 |
$0.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.61
|
| Rate for Payer: Medical Associates Commercial |
$0.81
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.48
|
| Rate for Payer: Midlands Choice Commercial |
$0.75
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.56
|
| Rate for Payer: United Healthcare Commercial |
$0.97
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.63
|
|
|
cyanocobalamin 1000 mcg Tab [VDMC]
|
Facility
|
IP
|
$1.07
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10380119
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| 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 |
$0.75
|
| Rate for Payer: United Healthcare Commercial |
$0.97
|
|
|
Cyclic Citrullinated Peptide Ab DMCL
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
8037832
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.83 |
| 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 |
$70.95
|
| Rate for Payer: Amerigroup Medicare |
$55.90
|
| 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 |
$55.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$70.26
|
| Rate for Payer: Medical Associates Commercial |
$92.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.35
|
| Rate for Payer: Midlands Choice Commercial |
$86.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$63.65
|
| Rate for Payer: United Healthcare Commercial |
$110.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$72.57
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
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
|
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
|
|
|
cyclobenzaprine 10 mg Tab [VDMC]
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10380257
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| 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 |
$0.61
|
| Rate for Payer: Amerigroup Medicaid |
$0.62
|
| Rate for Payer: Amerigroup Medicare |
$0.49
|
| 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 |
$0.49
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.62
|
| Rate for Payer: Medical Associates Commercial |
$0.81
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.49
|
| Rate for Payer: Midlands Choice Commercial |
$0.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.56
|
| Rate for Payer: United Healthcare Commercial |
$0.97
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.64
|
|
|
cyclopentolate Ophth 1% 2 ml SDV [VDMC]
|
Facility
|
OP
|
$44.32
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10434193
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.94 |
| Max. Negotiated Rate |
$39.89 |
| Rate for Payer: Aetna of IA Commercial |
$39.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.89
|
| Rate for Payer: Aetna of IA Medicare |
$25.26
|
| Rate for Payer: Amerigroup Medicaid |
$25.56
|
| Rate for Payer: Amerigroup Medicare |
$20.14
|
| Rate for Payer: Cash Price |
$35.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$19.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.32
|
| Rate for Payer: Medical Associates Commercial |
$33.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.94
|
| Rate for Payer: Midlands Choice Commercial |
$31.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.94
|
| Rate for Payer: United Healthcare Commercial |
$39.89
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.15
|
|
|
cyclopentolate Ophth 1% 2 ml SDV [VDMC]
|
Facility
|
IP
|
$44.32
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10434193
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$39.89 |
| Rate for Payer: Aetna of IA Commercial |
$39.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.89
|
| Rate for Payer: Cash Price |
$35.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.24
|
| Rate for Payer: Medical Associates Commercial |
$33.24
|
| Rate for Payer: Midlands Choice Commercial |
$31.02
|
| Rate for Payer: United Healthcare Commercial |
$39.89
|
|
|
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 |
$23.92 |
| 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 |
$30.66
|
| Rate for Payer: Amerigroup Medicare |
$24.16
|
| 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 |
$23.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.36
|
| Rate for Payer: Medical Associates Commercial |
$39.87
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.92
|
| Rate for Payer: Midlands Choice Commercial |
$37.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.51
|
| Rate for Payer: United Healthcare Commercial |
$47.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$31.36
|
|
