|
ECMO or Tracheostomy With MV >96 Hours or Principal Diagnosis Except Face, Mouth and Neck With Major O.R. Procedures
|
Facility
IP
|
$152,360.59
|
|
|
Service Code
|
MS-DRG 003
|
| Hospital Charge Code |
694
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$152,360.59 |
| Rate for Payer: Amerigroup Medicaid |
$151,624.55
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$150,152.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$152,360.59
|
|
|
EKG ROUTINE
|
Facility
IP
|
$161.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
8026968
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
|
|
EKG ROUTINE
|
Facility
OP
|
$161.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
8026968
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$80.47 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Aetna of IA Medicare |
$91.77
|
| Rate for Payer: Amerigroup Medicaid |
$81.26
|
| Rate for Payer: Amerigroup Medicare |
$81.30
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$80.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.47
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.50
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$120.75
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.99
|
| Rate for Payer: Wellmark IA HMO |
$83.08
|
| Rate for Payer: Wellmark IA PPO |
$91.39
|
|
|
EKG SUBQU SAME DR
|
Facility
IP
|
$161.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
8026969
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
|
|
EKG SUBQU SAME DR
|
Facility
OP
|
$161.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
8026969
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$80.47 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Aetna of IA Medicare |
$91.77
|
| Rate for Payer: Amerigroup Medicaid |
$81.26
|
| Rate for Payer: Amerigroup Medicare |
$81.30
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$80.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.47
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.50
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$120.75
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.99
|
| Rate for Payer: Wellmark IA HMO |
$83.08
|
| Rate for Payer: Wellmark IA PPO |
$91.39
|
|
|
EKG SUBSQ DIFF DR
|
Facility
IP
|
$161.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
8026970
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
|
|
EKG SUBSQ DIFF DR
|
Facility
OP
|
$161.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
8026970
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$80.47 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Aetna of IA Medicare |
$91.77
|
| Rate for Payer: Amerigroup Medicaid |
$81.26
|
| Rate for Payer: Amerigroup Medicare |
$81.30
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$80.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.47
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.50
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$120.75
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.99
|
| Rate for Payer: Wellmark IA HMO |
$83.08
|
| Rate for Payer: Wellmark IA PPO |
$91.39
|
|
|
ELEC STIM MAN 15 MIN
|
Facility
OP
|
$121.00
|
|
|
Service Code
|
CPT 97032 GP
|
| Hospital Charge Code |
1374009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna of IA Commercial |
$108.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$108.90
|
| Rate for Payer: Aetna of IA Medicare |
$68.97
|
| Rate for Payer: Amerigroup Medicaid |
$61.07
|
| Rate for Payer: Amerigroup Medicare |
$61.10
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$90.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$60.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$60.48
|
| Rate for Payer: Medical Associates Commercial |
$90.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$60.50
|
| Rate for Payer: Midlands Choice Commercial |
$84.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$61.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$90.75
|
| Rate for Payer: United Healthcare Commercial |
$108.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$71.39
|
|
|
ELEC STIM MAN 15 MIN
|
Facility
IP
|
$121.00
|
|
|
Service Code
|
CPT 97032 GP
|
| Hospital Charge Code |
1374009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna of IA Commercial |
$108.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$108.90
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$90.75
|
| Rate for Payer: Medical Associates Commercial |
$90.75
|
| Rate for Payer: Midlands Choice Commercial |
$84.70
|
| Rate for Payer: United Healthcare Commercial |
$108.90
|
|
|
ELECTROLYTES
|
Facility
IP
|
$86.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
633610
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
ELECTROLYTES
|
Facility
OP
|
$86.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
633610
|
|
Hospital Revenue Code
|
301
|
| 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: 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: Partners Health Alliance Commercial |
$64.50
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.74
|
| Rate for Payer: Wellmark IA HMO |
$52.08
|
| Rate for Payer: Wellmark IA PPO |
$57.29
|
|
|
ELECT STIM MANUAL PER 15 MIN
|
Facility
OP
|
$121.00
|
|
|
Service Code
|
CPT 97032 GO
|
| Hospital Charge Code |
1373442
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna of IA Commercial |
$108.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$108.90
|
| Rate for Payer: Aetna of IA Medicare |
$68.97
|
| Rate for Payer: Amerigroup Medicaid |
$61.07
|
| Rate for Payer: Amerigroup Medicare |
$61.10
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$90.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$60.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$60.48
|
| Rate for Payer: Medical Associates Commercial |
$90.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$60.50
|
| Rate for Payer: Midlands Choice Commercial |
$84.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$61.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$90.75
|
| Rate for Payer: United Healthcare Commercial |
$108.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$71.39
|
|
|
ELECT STIM MANUAL PER 15 MIN
|
Facility
IP
|
$121.00
|
|
|
Service Code
|
CPT 97032 GO
|
| Hospital Charge Code |
1373442
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna of IA Commercial |
$108.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$108.90
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$90.75
|
| Rate for Payer: Medical Associates Commercial |
$90.75
|
| Rate for Payer: Midlands Choice Commercial |
$84.70
|
| Rate for Payer: United Healthcare Commercial |
$108.90
|
|
|
EMERGENCY INTUBATION
|
Facility
IP
|
$488.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
5338936
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$341.60 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of IA Commercial |
$439.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$439.20
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$366.00
|
| Rate for Payer: Medical Associates Commercial |
$366.00
|
| Rate for Payer: Midlands Choice Commercial |
$341.60
|
| Rate for Payer: United Healthcare Commercial |
$439.20
|
|
|
EMERGENCY INTUBATION
|
Facility
OP
|
$285.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
8059060
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$142.44 |
| Max. Negotiated Rate |
$1,815.48 |
| Rate for Payer: Aetna of IA Commercial |
$256.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$256.50
|
| Rate for Payer: Aetna of IA Medicare |
$162.45
|
| Rate for Payer: Amerigroup Medicaid |
$143.84
|
| Rate for Payer: Amerigroup Medicare |
$143.92
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$213.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$142.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$142.44
|
| Rate for Payer: Medical Associates Commercial |
$213.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$142.50
|
| Rate for Payer: Midlands Choice Commercial |
$199.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$144.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$213.75
|
| Rate for Payer: United Healthcare Commercial |
$256.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$168.15
|
| Rate for Payer: Wellmark IA HMO |
$1,650.44
|
| Rate for Payer: Wellmark IA PPO |
$1,815.48
|
|
|
EMERGENCY INTUBATION
|
Facility
IP
|
$285.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
8059060
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna of IA Commercial |
$256.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$256.50
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$213.75
|
| Rate for Payer: Medical Associates Commercial |
$213.75
|
| Rate for Payer: Midlands Choice Commercial |
$199.50
|
| Rate for Payer: United Healthcare Commercial |
$256.50
|
|
|
EMERGENCY INTUBATION
|
Facility
OP
|
$488.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
5338936
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$243.90 |
| Max. Negotiated Rate |
$1,815.48 |
| Rate for Payer: Aetna of IA Commercial |
$439.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$439.20
|
| Rate for Payer: Aetna of IA Medicare |
$278.16
|
| Rate for Payer: Amerigroup Medicaid |
$246.29
|
| Rate for Payer: Amerigroup Medicare |
$246.44
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$366.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$244.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$243.90
|
| Rate for Payer: Medical Associates Commercial |
$366.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$244.00
|
| Rate for Payer: Midlands Choice Commercial |
$341.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$247.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$366.00
|
| Rate for Payer: United Healthcare Commercial |
$439.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$287.92
|
| Rate for Payer: Wellmark IA HMO |
$1,650.44
|
| Rate for Payer: Wellmark IA PPO |
$1,815.48
|
|
|
emollients, topical
|
Facility
IP
|
$64.04
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43722901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.83 |
| Max. Negotiated Rate |
$57.64 |
| Rate for Payer: Aetna of IA Commercial |
$57.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.64
|
| Rate for Payer: Cash Price |
$51.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.03
|
| Rate for Payer: Medical Associates Commercial |
$48.03
|
| Rate for Payer: Midlands Choice Commercial |
$44.83
|
| Rate for Payer: United Healthcare Commercial |
$57.64
|
|
|
emollients, topical
|
Facility
OP
|
$64.04
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43722901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.01 |
| Max. Negotiated Rate |
$57.64 |
| Rate for Payer: Aetna of IA Commercial |
$57.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.64
|
| Rate for Payer: Aetna of IA Medicare |
$36.50
|
| Rate for Payer: Amerigroup Medicaid |
$32.32
|
| Rate for Payer: Amerigroup Medicare |
$32.34
|
| Rate for Payer: Cash Price |
$51.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.03
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.01
|
| Rate for Payer: Medical Associates Commercial |
$48.03
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.02
|
| Rate for Payer: Midlands Choice Commercial |
$44.83
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.03
|
| Rate for Payer: United Healthcare Commercial |
$57.64
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.78
|
|
|
empagliflozin 10 mg Tab
|
Facility
OP
|
$60.58
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$54.52 |
| Rate for Payer: Aetna of IA Commercial |
$54.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.52
|
| Rate for Payer: Aetna of IA Medicare |
$34.53
|
| Rate for Payer: Amerigroup Medicaid |
$30.57
|
| Rate for Payer: Amerigroup Medicare |
$30.59
|
| Rate for Payer: Cash Price |
$48.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.29
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.28
|
| Rate for Payer: Medical Associates Commercial |
$45.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.29
|
| Rate for Payer: Midlands Choice Commercial |
$42.41
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.44
|
| Rate for Payer: United Healthcare Commercial |
$54.52
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.74
|
|
|
empagliflozin 10 mg Tab
|
Facility
IP
|
$60.58
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$54.52 |
| Rate for Payer: Aetna of IA Commercial |
$54.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.52
|
| Rate for Payer: Cash Price |
$48.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.44
|
| Rate for Payer: Medical Associates Commercial |
$45.44
|
| Rate for Payer: Midlands Choice Commercial |
$42.41
|
| Rate for Payer: United Healthcare Commercial |
$54.52
|
|
|
empagliflozin 25mg tab UD
|
Facility
OP
|
$60.58
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700564
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$54.52 |
| Rate for Payer: Aetna of IA Commercial |
$54.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.52
|
| Rate for Payer: Aetna of IA Medicare |
$34.53
|
| Rate for Payer: Amerigroup Medicaid |
$30.57
|
| Rate for Payer: Amerigroup Medicare |
$30.59
|
| Rate for Payer: Cash Price |
$48.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.29
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.28
|
| Rate for Payer: Medical Associates Commercial |
$45.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.29
|
| Rate for Payer: Midlands Choice Commercial |
$42.41
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.44
|
| Rate for Payer: United Healthcare Commercial |
$54.52
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.74
|
|
|
empagliflozin 25mg tab UD
|
Facility
IP
|
$60.58
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700564
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$54.52 |
| Rate for Payer: Aetna of IA Commercial |
$54.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.52
|
| Rate for Payer: Cash Price |
$48.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.44
|
| Rate for Payer: Medical Associates Commercial |
$45.44
|
| Rate for Payer: Midlands Choice Commercial |
$42.41
|
| Rate for Payer: United Healthcare Commercial |
$54.52
|
|
|
enalaprilat 1.25 mg/mL 1ml SDV
|
Facility
OP
|
$35.91
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43705840
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$32.32 |
| Rate for Payer: Aetna of IA Commercial |
$32.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.32
|
| Rate for Payer: Aetna of IA Medicare |
$20.47
|
| Rate for Payer: Amerigroup Medicaid |
$18.12
|
| Rate for Payer: Amerigroup Medicare |
$18.13
|
| Rate for Payer: Cash Price |
$28.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.93
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.95
|
| Rate for Payer: Medical Associates Commercial |
$26.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.96
|
| Rate for Payer: Midlands Choice Commercial |
$25.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.93
|
| Rate for Payer: United Healthcare Commercial |
$32.32
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.19
|
|
|
enalaprilat 1.25 mg/mL 1ml SDV
|
Facility
IP
|
$35.91
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43705840
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.14 |
| Max. Negotiated Rate |
$32.32 |
| Rate for Payer: Aetna of IA Commercial |
$32.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.32
|
| Rate for Payer: Cash Price |
$28.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.93
|
| Rate for Payer: Medical Associates Commercial |
$26.93
|
| Rate for Payer: Midlands Choice Commercial |
$25.14
|
| Rate for Payer: United Healthcare Commercial |
$32.32
|
|
