|
gabapentin 300 mg Cap
|
Facility
IP
|
$1.36
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705809
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of IA Commercial |
$1.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.22
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.02
|
| Rate for Payer: Medical Associates Commercial |
$1.02
|
| Rate for Payer: Midlands Choice Commercial |
$0.95
|
| Rate for Payer: United Healthcare Commercial |
$1.22
|
|
|
gabapentin 300 mg Cap
|
Facility
OP
|
$1.36
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705809
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of IA Commercial |
$1.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.22
|
| Rate for Payer: Aetna of IA Medicare |
$0.78
|
| Rate for Payer: Amerigroup Medicaid |
$0.69
|
| Rate for Payer: Amerigroup Medicare |
$0.69
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.02
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.68
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.68
|
| Rate for Payer: Medical Associates Commercial |
$1.02
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.68
|
| Rate for Payer: Midlands Choice Commercial |
$0.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.02
|
| Rate for Payer: United Healthcare Commercial |
$1.22
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.80
|
|
|
GAIT THERAPEUTIC TRAINING PER 15 MIN
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 97116 GP
|
| Hospital Charge Code |
1374013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
GAIT THERAPEUTIC TRAINING PER 15 MIN
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 97116 GP
|
| Hospital Charge Code |
1374013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$56.98 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$57.54
|
| Rate for Payer: Amerigroup Medicare |
$57.57
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.98
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
|
|
ganciclovir 50 mg/mL 10ml SDV
|
Facility
OP
|
$188.48
|
|
|
Service Code
|
CPT J1570
|
| Hospital Charge Code |
43700323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$169.63 |
| Rate for Payer: Aetna of IA Commercial |
$169.63
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$169.63
|
| Rate for Payer: Aetna of IA Medicare |
$107.43
|
| Rate for Payer: Amerigroup Medicaid |
$95.13
|
| Rate for Payer: Amerigroup Medicare |
$95.18
|
| Rate for Payer: Cash Price |
$150.78
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$141.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$94.24
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$94.20
|
| Rate for Payer: Medical Associates Commercial |
$141.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$94.24
|
| Rate for Payer: Midlands Choice Commercial |
$131.94
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$95.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$141.36
|
| Rate for Payer: United Healthcare Commercial |
$169.63
|
| Rate for Payer: United Healthcare Managed Medicare |
$111.20
|
|
|
ganciclovir 50 mg/mL 10ml SDV
|
Facility
IP
|
$188.48
|
|
|
Service Code
|
CPT J1570
|
| Hospital Charge Code |
43700323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.94 |
| Max. Negotiated Rate |
$169.63 |
| Rate for Payer: Aetna of IA Commercial |
$169.63
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$169.63
|
| Rate for Payer: Cash Price |
$150.78
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$141.36
|
| Rate for Payer: Medical Associates Commercial |
$141.36
|
| Rate for Payer: Midlands Choice Commercial |
$131.94
|
| Rate for Payer: United Healthcare Commercial |
$169.63
|
|
|
Gastrointestinal Hemorrhage With CC
|
Facility
IP
|
$9,102.27
|
|
|
Service Code
|
MS-DRG 378
|
| Hospital Charge Code |
219
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,102.27 |
| Rate for Payer: Amerigroup Medicaid |
$9,058.29
|
| 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 |
$8,970.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,102.27
|
|
|
Gastrointestinal Hemorrhage With MCC
|
Facility
IP
|
$13,888.63
|
|
|
Service Code
|
MS-DRG 377
|
| Hospital Charge Code |
218
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$13,888.63 |
| Rate for Payer: Amerigroup Medicaid |
$13,821.54
|
| 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 |
$13,687.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,888.63
|
|
|
Gastrointestinal Hemorrhage Without CC/MCC
|
Facility
IP
|
$5,780.45
|
|
|
Service Code
|
MS-DRG 379
|
| Hospital Charge Code |
220
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,780.45 |
| Rate for Payer: Amerigroup Medicaid |
$5,752.53
|
| 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 |
$5,696.68
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,780.45
|
|
|
Gastrointestinal Obstruction With CC
|
Facility
IP
|
$7,544.21
|
|
|
Service Code
|
MS-DRG 389
|
| Hospital Charge Code |
230
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,544.21 |
| Rate for Payer: Amerigroup Medicaid |
$7,507.76
|
| 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 |
$7,434.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,544.21
|
|
|
Gastrointestinal Obstruction With MCC
|
Facility
IP
|
$9,929.02
|
|
|
Service Code
|
MS-DRG 388
|
| Hospital Charge Code |
229
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,929.02 |
| Rate for Payer: Amerigroup Medicaid |
$9,881.06
|
| 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 |
$9,785.13
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,929.02
|
|
|
Gastrointestinal Obstruction Without CC/MCC
|
Facility
IP
|
$5,162.34
|
|
|
Service Code
|
MS-DRG 390
|
| Hospital Charge Code |
231
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,162.34 |
| Rate for Payer: Amerigroup Medicaid |
$5,137.40
|
| 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 |
$5,087.53
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,162.34
|
|
|
Gastroscope Biopsy Charge
|
Facility
IP
|
$95.00
|
|
| Hospital Charge Code |
8051947
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
|
|
Gastroscope Biopsy Charge
|
Facility
OP
|
$95.00
|
|
| Hospital Charge Code |
8051947
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$47.48 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Aetna of IA Medicare |
$54.15
|
| Rate for Payer: Amerigroup Medicaid |
$47.95
|
| Rate for Payer: Amerigroup Medicare |
$47.98
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$47.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.48
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.50
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$48.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.25
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.05
|
|
|
Gastroscopy
|
Facility
OP
|
$2,615.00
|
|
| Hospital Charge Code |
7745193
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,306.98 |
| Max. Negotiated Rate |
$2,353.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,353.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,353.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,490.55
|
| Rate for Payer: Amerigroup Medicaid |
$1,319.79
|
| Rate for Payer: Amerigroup Medicare |
$1,320.58
|
| Rate for Payer: Cash Price |
$2,092.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,961.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,307.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,306.98
|
| Rate for Payer: Medical Associates Commercial |
$1,961.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,307.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,830.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,327.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,961.25
|
| Rate for Payer: United Healthcare Commercial |
$2,353.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,542.85
|
|
|
Gastroscopy
|
Facility
IP
|
$2,615.00
|
|
| Hospital Charge Code |
7745193
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,830.50 |
| Max. Negotiated Rate |
$2,353.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,353.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,353.50
|
| Rate for Payer: Cash Price |
$2,092.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,961.25
|
| Rate for Payer: Medical Associates Commercial |
$1,961.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,830.50
|
| Rate for Payer: United Healthcare Commercial |
$2,353.50
|
|
|
Gastroscopy Dilat Esophag Dial
|
Facility
OP
|
$2,615.00
|
|
| Hospital Charge Code |
7745192
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,306.98 |
| Max. Negotiated Rate |
$2,353.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,353.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,353.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,490.55
|
| Rate for Payer: Amerigroup Medicaid |
$1,319.79
|
| Rate for Payer: Amerigroup Medicare |
$1,320.58
|
| Rate for Payer: Cash Price |
$2,092.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,961.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,307.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,306.98
|
| Rate for Payer: Medical Associates Commercial |
$1,961.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,307.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,830.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,327.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,961.25
|
| Rate for Payer: United Healthcare Commercial |
$2,353.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,542.85
|
|
|
Gastroscopy Dilat Esophag Dial
|
Facility
IP
|
$2,615.00
|
|
| Hospital Charge Code |
7745192
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,830.50 |
| Max. Negotiated Rate |
$2,353.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,353.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,353.50
|
| Rate for Payer: Cash Price |
$2,092.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,961.25
|
| Rate for Payer: Medical Associates Commercial |
$1,961.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,830.50
|
| Rate for Payer: United Healthcare Commercial |
$2,353.50
|
|
|
Gastroscopy with Biopsy
|
Facility
OP
|
$2,615.00
|
|
| Hospital Charge Code |
8055105
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,306.98 |
| Max. Negotiated Rate |
$2,353.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,353.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,353.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,490.55
|
| Rate for Payer: Amerigroup Medicaid |
$1,319.79
|
| Rate for Payer: Amerigroup Medicare |
$1,320.58
|
| Rate for Payer: Cash Price |
$2,092.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,961.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,307.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,306.98
|
| Rate for Payer: Medical Associates Commercial |
$1,961.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,307.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,830.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,327.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,961.25
|
| Rate for Payer: United Healthcare Commercial |
$2,353.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,542.85
|
|
|
Gastroscopy with Biopsy
|
Facility
IP
|
$2,615.00
|
|
| Hospital Charge Code |
8055105
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,830.50 |
| Max. Negotiated Rate |
$2,353.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,353.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,353.50
|
| Rate for Payer: Cash Price |
$2,092.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,961.25
|
| Rate for Payer: Medical Associates Commercial |
$1,961.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,830.50
|
| Rate for Payer: United Healthcare Commercial |
$2,353.50
|
|
|
GC PROBE
|
Facility
IP
|
$128.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
8093934
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna of IA Commercial |
$115.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$115.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.00
|
| Rate for Payer: Medical Associates Commercial |
$96.00
|
| Rate for Payer: Midlands Choice Commercial |
$89.60
|
| Rate for Payer: United Healthcare Commercial |
$115.20
|
|
|
GC PROBE
|
Facility
OP
|
$128.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
8093934
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$63.97 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna of IA Commercial |
$115.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$115.20
|
| Rate for Payer: Aetna of IA Medicare |
$72.96
|
| Rate for Payer: Amerigroup Medicaid |
$64.60
|
| Rate for Payer: Amerigroup Medicare |
$64.64
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$63.97
|
| Rate for Payer: Medical Associates Commercial |
$96.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.00
|
| Rate for Payer: Midlands Choice Commercial |
$89.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$64.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$96.00
|
| Rate for Payer: United Healthcare Commercial |
$115.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$75.52
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
gemcitabine 100 mg/mL 20ml MDV
|
Facility
OP
|
$276.96
|
|
|
Service Code
|
CPT J9201
|
| Hospital Charge Code |
43700512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$138.42 |
| Max. Negotiated Rate |
$249.26 |
| Rate for Payer: Aetna of IA Commercial |
$249.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$249.26
|
| Rate for Payer: Aetna of IA Medicare |
$157.87
|
| Rate for Payer: Amerigroup Medicaid |
$139.78
|
| Rate for Payer: Amerigroup Medicare |
$139.86
|
| Rate for Payer: Cash Price |
$221.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$207.72
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$138.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$138.42
|
| Rate for Payer: Medical Associates Commercial |
$207.72
|
| Rate for Payer: Medical Associates Managed Medicare |
$138.48
|
| Rate for Payer: Midlands Choice Commercial |
$193.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$140.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$207.72
|
| Rate for Payer: United Healthcare Commercial |
$249.26
|
| Rate for Payer: United Healthcare Managed Medicare |
$163.41
|
|
|
gemcitabine 100 mg/mL 20ml MDV
|
Facility
IP
|
$276.96
|
|
|
Service Code
|
CPT J9201
|
| Hospital Charge Code |
43700512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$249.26 |
| Rate for Payer: Aetna of IA Commercial |
$249.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$249.26
|
| Rate for Payer: Cash Price |
$221.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$207.72
|
| Rate for Payer: Medical Associates Commercial |
$207.72
|
| Rate for Payer: Midlands Choice Commercial |
$193.87
|
| Rate for Payer: United Healthcare Commercial |
$249.26
|
|
|
gemcitabine 100 mg/mL 2ml MDV
|
Facility
IP
|
$69.44
|
|
|
Service Code
|
CPT J9201
|
| Hospital Charge Code |
43700515
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.61 |
| Max. Negotiated Rate |
$62.50 |
| Rate for Payer: Aetna of IA Commercial |
$62.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$62.50
|
| Rate for Payer: Cash Price |
$55.55
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.08
|
| Rate for Payer: Medical Associates Commercial |
$52.08
|
| Rate for Payer: Midlands Choice Commercial |
$48.61
|
| Rate for Payer: United Healthcare Commercial |
$62.50
|
|
