|
DRILL BIT 4.2X180MM AO SMALL
|
Facility
IP
|
$214.00
|
|
| Hospital Charge Code |
8046331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Aetna of IA Commercial |
$192.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$192.60
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$160.50
|
| Rate for Payer: Medical Associates Commercial |
$160.50
|
| Rate for Payer: Midlands Choice Commercial |
$149.80
|
| Rate for Payer: United Healthcare Commercial |
$192.60
|
|
|
DRILL BIT JUGGER KNOT 1.4MM SHORT SINGLE
|
Facility
IP
|
$198.00
|
|
| Hospital Charge Code |
8026375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
DRILL BIT JUGGER KNOT 1.4MM SHORT SINGLE
|
Facility
OP
|
$198.00
|
|
| Hospital Charge Code |
8026375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
DRILL PIN 2MM X 100MM
|
Facility
IP
|
$441.00
|
|
| Hospital Charge Code |
8046948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$308.70 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna of IA Commercial |
$396.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$396.90
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$330.75
|
| Rate for Payer: Medical Associates Commercial |
$330.75
|
| Rate for Payer: Midlands Choice Commercial |
$308.70
|
| Rate for Payer: United Healthcare Commercial |
$396.90
|
|
|
DRILL PIN 2MM X 100MM
|
Facility
OP
|
$441.00
|
|
| Hospital Charge Code |
8046948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.41 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna of IA Commercial |
$396.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$396.90
|
| Rate for Payer: Aetna of IA Medicare |
$251.37
|
| Rate for Payer: Amerigroup Medicaid |
$222.57
|
| Rate for Payer: Amerigroup Medicare |
$222.70
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$330.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$220.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$220.41
|
| Rate for Payer: Medical Associates Commercial |
$330.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$220.50
|
| Rate for Payer: Midlands Choice Commercial |
$308.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$223.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$330.75
|
| Rate for Payer: United Healthcare Commercial |
$396.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$260.19
|
|
|
DRILL PIN II
|
Facility
OP
|
$207.00
|
|
| Hospital Charge Code |
8026406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$186.30 |
| Rate for Payer: Aetna of IA Commercial |
$186.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$186.30
|
| Rate for Payer: Aetna of IA Medicare |
$117.99
|
| Rate for Payer: Amerigroup Medicaid |
$104.47
|
| Rate for Payer: Amerigroup Medicare |
$104.54
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$155.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$103.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$103.46
|
| Rate for Payer: Medical Associates Commercial |
$155.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$103.50
|
| Rate for Payer: Midlands Choice Commercial |
$144.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$105.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$155.25
|
| Rate for Payer: United Healthcare Commercial |
$186.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$122.13
|
|
|
DRILL PIN II
|
Facility
IP
|
$207.00
|
|
| Hospital Charge Code |
8026406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$186.30 |
| Rate for Payer: Aetna of IA Commercial |
$186.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$186.30
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$155.25
|
| Rate for Payer: Medical Associates Commercial |
$155.25
|
| Rate for Payer: Midlands Choice Commercial |
$144.90
|
| Rate for Payer: United Healthcare Commercial |
$186.30
|
|
|
DRILL SPEEDGUIDE AO DIA 2.6MM
|
Facility
IP
|
$253.00
|
|
| Hospital Charge Code |
8046967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.10 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Aetna of IA Commercial |
$227.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$227.70
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.75
|
| Rate for Payer: Medical Associates Commercial |
$189.75
|
| Rate for Payer: Midlands Choice Commercial |
$177.10
|
| Rate for Payer: United Healthcare Commercial |
$227.70
|
|
|
DRILL SPEEDGUIDE AO DIA 2.6MM
|
Facility
OP
|
$253.00
|
|
| Hospital Charge Code |
8046967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Aetna of IA Commercial |
$227.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$227.70
|
| Rate for Payer: Aetna of IA Medicare |
$144.21
|
| Rate for Payer: Amerigroup Medicaid |
$127.69
|
| Rate for Payer: Amerigroup Medicare |
$127.76
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$126.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.45
|
| Rate for Payer: Medical Associates Commercial |
$189.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$126.50
|
| Rate for Payer: Midlands Choice Commercial |
$177.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$189.75
|
| Rate for Payer: United Healthcare Commercial |
$227.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$149.27
|
|
|
DRILL SPEEDGUIDE AO DIA 2.6MM-1
|
Facility
IP
|
$253.00
|
|
| Hospital Charge Code |
8046968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.10 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Aetna of IA Commercial |
$227.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$227.70
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.75
|
| Rate for Payer: Medical Associates Commercial |
$189.75
|
| Rate for Payer: Midlands Choice Commercial |
$177.10
|
| Rate for Payer: United Healthcare Commercial |
$227.70
|
|
|
DRILL SPEEDGUIDE AO DIA 2.6MM-1
|
Facility
OP
|
$253.00
|
|
| Hospital Charge Code |
8046968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Aetna of IA Commercial |
$227.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$227.70
|
| Rate for Payer: Aetna of IA Medicare |
$144.21
|
| Rate for Payer: Amerigroup Medicaid |
$127.69
|
| Rate for Payer: Amerigroup Medicare |
$127.76
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$126.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.45
|
| Rate for Payer: Medical Associates Commercial |
$189.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$126.50
|
| Rate for Payer: Midlands Choice Commercial |
$177.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$189.75
|
| Rate for Payer: United Healthcare Commercial |
$227.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$149.27
|
|
|
DRILL TWIST 1.9 DIAM AO END 105MM L41MM
|
Facility
IP
|
$70.00
|
|
| Hospital Charge Code |
8046887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of IA Commercial |
$63.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.50
|
| Rate for Payer: Medical Associates Commercial |
$52.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.00
|
| Rate for Payer: United Healthcare Commercial |
$63.00
|
|
|
DRILL TWIST 1.9 DIAM AO END 105MM L41MM
|
Facility
OP
|
$70.00
|
|
| Hospital Charge Code |
8046887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of IA Commercial |
$63.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.00
|
| Rate for Payer: Aetna of IA Medicare |
$39.90
|
| Rate for Payer: Amerigroup Medicaid |
$35.33
|
| Rate for Payer: Amerigroup Medicare |
$35.35
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.99
|
| Rate for Payer: Medical Associates Commercial |
$52.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.00
|
| Rate for Payer: Midlands Choice Commercial |
$49.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$52.50
|
| Rate for Payer: United Healthcare Commercial |
$63.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.30
|
|
|
DRILL TWIST2.0 DIAM AO END 105MM L41MM
|
Facility
IP
|
$70.00
|
|
| Hospital Charge Code |
8046888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of IA Commercial |
$63.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.50
|
| Rate for Payer: Medical Associates Commercial |
$52.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.00
|
| Rate for Payer: United Healthcare Commercial |
$63.00
|
|
|
DRILL TWIST2.0 DIAM AO END 105MM L41MM
|
Facility
OP
|
$70.00
|
|
| Hospital Charge Code |
8046888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of IA Commercial |
$63.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.00
|
| Rate for Payer: Aetna of IA Medicare |
$39.90
|
| Rate for Payer: Amerigroup Medicaid |
$35.33
|
| Rate for Payer: Amerigroup Medicare |
$35.35
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.99
|
| Rate for Payer: Medical Associates Commercial |
$52.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.00
|
| Rate for Payer: Midlands Choice Commercial |
$49.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$52.50
|
| Rate for Payer: United Healthcare Commercial |
$63.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.30
|
|
|
DRUG SCREEN-TRIAGE
|
Facility
OP
|
$148.00
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
4022799
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna of IA Commercial |
$133.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$133.20
|
| Rate for Payer: Aetna of IA Medicare |
$84.36
|
| Rate for Payer: Amerigroup Medicaid |
$74.70
|
| Rate for Payer: Amerigroup Medicare |
$74.74
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$74.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.97
|
| Rate for Payer: Medical Associates Commercial |
$111.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$74.00
|
| Rate for Payer: Midlands Choice Commercial |
$103.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.00
|
| Rate for Payer: United Healthcare Commercial |
$133.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.32
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
DRUG SCREEN-TRIAGE
|
Facility
IP
|
$148.00
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
4022799
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna of IA Commercial |
$133.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$133.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.00
|
| Rate for Payer: Medical Associates Commercial |
$111.00
|
| Rate for Payer: Midlands Choice Commercial |
$103.60
|
| Rate for Payer: United Healthcare Commercial |
$133.20
|
|
|
DRVVT LUPUS ANTICOAGULANT
|
Facility
OP
|
$65.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
8093931
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna of IA Commercial |
$58.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.50
|
| Rate for Payer: Aetna of IA Medicare |
$37.05
|
| Rate for Payer: Amerigroup Medicaid |
$32.81
|
| Rate for Payer: Amerigroup Medicare |
$32.82
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.49
|
| Rate for Payer: Medical Associates Commercial |
$48.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.50
|
| Rate for Payer: Midlands Choice Commercial |
$45.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.75
|
| Rate for Payer: United Healthcare Commercial |
$58.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.35
|
| Rate for Payer: Wellmark IA HMO |
$24.18
|
| Rate for Payer: Wellmark IA PPO |
$26.60
|
|
|
DRVVT LUPUS ANTICOAGULANT
|
Facility
IP
|
$65.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
8093931
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna of IA Commercial |
$58.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.50
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.75
|
| Rate for Payer: Medical Associates Commercial |
$48.75
|
| Rate for Payer: Midlands Choice Commercial |
$45.50
|
| Rate for Payer: United Healthcare Commercial |
$58.50
|
|
|
DULoxetine 20 mg Cap
|
Facility
OP
|
$6.60
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43711789
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$5.94 |
| Rate for Payer: Aetna of IA Commercial |
$5.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.94
|
| Rate for Payer: Aetna of IA Medicare |
$3.76
|
| Rate for Payer: Amerigroup Medicaid |
$3.33
|
| Rate for Payer: Amerigroup Medicare |
$3.33
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.30
|
| Rate for Payer: Medical Associates Commercial |
$4.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.30
|
| Rate for Payer: Midlands Choice Commercial |
$4.62
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$4.95
|
| Rate for Payer: United Healthcare Commercial |
$5.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.89
|
|
|
DULoxetine 20 mg Cap
|
Facility
IP
|
$6.60
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43711789
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$5.94 |
| Rate for Payer: Aetna of IA Commercial |
$5.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.94
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.95
|
| Rate for Payer: Medical Associates Commercial |
$4.95
|
| Rate for Payer: Midlands Choice Commercial |
$4.62
|
| Rate for Payer: United Healthcare Commercial |
$5.94
|
|
|
DULoxetine DR 30 mg Cap
|
Facility
OP
|
$1.69
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43722014
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna of IA Commercial |
$1.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.52
|
| Rate for Payer: Aetna of IA Medicare |
$0.96
|
| Rate for Payer: Amerigroup Medicaid |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.27
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.84
|
| Rate for Payer: Medical Associates Commercial |
$1.27
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.85
|
| Rate for Payer: Midlands Choice Commercial |
$1.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.27
|
| Rate for Payer: United Healthcare Commercial |
$1.52
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.00
|
|
|
DULoxetine DR 30 mg Cap
|
Facility
IP
|
$1.69
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43722014
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna of IA Commercial |
$1.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.52
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.27
|
| Rate for Payer: Medical Associates Commercial |
$1.27
|
| Rate for Payer: Midlands Choice Commercial |
$1.18
|
| Rate for Payer: United Healthcare Commercial |
$1.52
|
|
|
DULoxetine DR 60 mg Cap
|
Facility
OP
|
$4.44
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43780122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna of IA Commercial |
$4.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.00
|
| Rate for Payer: Aetna of IA Medicare |
$2.53
|
| Rate for Payer: Amerigroup Medicaid |
$2.24
|
| Rate for Payer: Amerigroup Medicare |
$2.24
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.33
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.22
|
| Rate for Payer: Medical Associates Commercial |
$3.33
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.22
|
| Rate for Payer: Midlands Choice Commercial |
$3.11
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.33
|
| Rate for Payer: United Healthcare Commercial |
$4.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.62
|
|
|
DULoxetine DR 60 mg Cap
|
Facility
IP
|
$4.44
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43780122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna of IA Commercial |
$4.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.00
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.33
|
| Rate for Payer: Medical Associates Commercial |
$3.33
|
| Rate for Payer: Midlands Choice Commercial |
$3.11
|
| Rate for Payer: United Healthcare Commercial |
$4.00
|
|
