|
GUIDEWIRE BALLTIP 3.0X800MM
|
Facility
OP
|
$196.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8046329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.96 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna of IA Commercial |
$176.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$176.40
|
| Rate for Payer: Aetna of IA Medicare |
$111.72
|
| Rate for Payer: Amerigroup Medicaid |
$98.92
|
| Rate for Payer: Amerigroup Medicare |
$98.98
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$98.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$97.96
|
| Rate for Payer: Medical Associates Commercial |
$147.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$98.00
|
| Rate for Payer: Midlands Choice Commercial |
$137.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$99.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$147.00
|
| Rate for Payer: United Healthcare Commercial |
$176.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$115.64
|
|
|
GUIDEWIRE BENTSON .035X150
|
Facility
IP
|
$33.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8046312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of IA Commercial |
$29.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.70
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.75
|
| Rate for Payer: Medical Associates Commercial |
$24.75
|
| Rate for Payer: Midlands Choice Commercial |
$23.10
|
| Rate for Payer: United Healthcare Commercial |
$29.70
|
|
|
GUIDEWIRE BENTSON .035X150
|
Facility
OP
|
$33.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8046312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.49 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of IA Commercial |
$29.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.70
|
| Rate for Payer: Aetna of IA Medicare |
$18.81
|
| Rate for Payer: Amerigroup Medicaid |
$16.66
|
| Rate for Payer: Amerigroup Medicare |
$16.66
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.49
|
| Rate for Payer: Medical Associates Commercial |
$24.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.50
|
| Rate for Payer: Midlands Choice Commercial |
$23.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.75
|
| Rate for Payer: United Healthcare Commercial |
$29.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$19.47
|
|
|
GUIDEWIRE EZ GLIDER ANGLE TIP
|
Facility
OP
|
$60.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8026115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of IA Commercial |
$54.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.00
|
| Rate for Payer: Aetna of IA Medicare |
$34.20
|
| Rate for Payer: Amerigroup Medicaid |
$30.28
|
| Rate for Payer: Amerigroup Medicare |
$30.30
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.99
|
| Rate for Payer: Medical Associates Commercial |
$45.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.00
|
| Rate for Payer: Midlands Choice Commercial |
$42.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.00
|
| Rate for Payer: United Healthcare Commercial |
$54.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.40
|
|
|
GUIDEWIRE EZ GLIDER ANGLE TIP
|
Facility
IP
|
$60.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8026115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of IA Commercial |
$54.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.00
|
| Rate for Payer: Medical Associates Commercial |
$45.00
|
| Rate for Payer: Midlands Choice Commercial |
$42.00
|
| Rate for Payer: United Healthcare Commercial |
$54.00
|
|
|
GUIDEWIRE E-Z GLIDER STRAIGHT TIP
|
Facility
IP
|
$522.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8046626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.40 |
| Max. Negotiated Rate |
$469.80 |
| Rate for Payer: Aetna of IA Commercial |
$469.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$469.80
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$391.50
|
| Rate for Payer: Medical Associates Commercial |
$391.50
|
| Rate for Payer: Midlands Choice Commercial |
$365.40
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
|
|
GUIDEWIRE E-Z GLIDER STRAIGHT TIP
|
Facility
OP
|
$522.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8046626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$260.90 |
| Max. Negotiated Rate |
$469.80 |
| Rate for Payer: Aetna of IA Commercial |
$469.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$469.80
|
| Rate for Payer: Aetna of IA Medicare |
$297.54
|
| Rate for Payer: Amerigroup Medicaid |
$263.45
|
| Rate for Payer: Amerigroup Medicare |
$263.61
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$391.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$261.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$260.90
|
| Rate for Payer: Medical Associates Commercial |
$391.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$261.00
|
| Rate for Payer: Midlands Choice Commercial |
$365.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$264.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$391.50
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$307.98
|
|
|
GUIDEWIRE KNEE BALLTIP 3.0X800MM
|
Facility
OP
|
$231.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8046330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.45 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna of IA Commercial |
$207.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.90
|
| Rate for Payer: Aetna of IA Medicare |
$131.67
|
| Rate for Payer: Amerigroup Medicaid |
$116.59
|
| Rate for Payer: Amerigroup Medicare |
$116.66
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$173.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$115.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$115.45
|
| Rate for Payer: Medical Associates Commercial |
$173.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$115.50
|
| Rate for Payer: Midlands Choice Commercial |
$161.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$117.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$173.25
|
| Rate for Payer: United Healthcare Commercial |
$207.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$136.29
|
|
|
GUIDEWIRE KNEE BALLTIP 3.0X800MM
|
Facility
IP
|
$231.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8046330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna of IA Commercial |
$207.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.90
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$173.25
|
| Rate for Payer: Medical Associates Commercial |
$173.25
|
| Rate for Payer: Midlands Choice Commercial |
$161.70
|
| Rate for Payer: United Healthcare Commercial |
$207.90
|
|
|
GUIDEWIRE PARTIALLY THREADED
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8046428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Aetna of IA Medicare |
$19.38
|
| Rate for Payer: Amerigroup Medicaid |
$17.16
|
| Rate for Payer: Amerigroup Medicare |
$17.17
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.99
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.00
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$25.50
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.06
|
|
|
GUIDEWIRE PARTIALLY THREADED
|
Facility
IP
|
$34.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8046428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
|
|
GUIDEWIRE SUPER STIFF .035 AMPLATZ
|
Facility
OP
|
$62.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8046320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.99 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna of IA Commercial |
$55.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$55.80
|
| Rate for Payer: Aetna of IA Medicare |
$35.34
|
| Rate for Payer: Amerigroup Medicaid |
$31.29
|
| Rate for Payer: Amerigroup Medicare |
$31.31
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.99
|
| Rate for Payer: Medical Associates Commercial |
$46.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.00
|
| Rate for Payer: Midlands Choice Commercial |
$43.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$31.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$46.50
|
| Rate for Payer: United Healthcare Commercial |
$55.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$36.58
|
|
|
GUIDEWIRE SUPER STIFF .035 AMPLATZ
|
Facility
IP
|
$62.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8046320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna of IA Commercial |
$55.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$55.80
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.50
|
| Rate for Payer: Medical Associates Commercial |
$46.50
|
| Rate for Payer: Midlands Choice Commercial |
$43.40
|
| Rate for Payer: United Healthcare Commercial |
$55.80
|
|
|
haemophilus b conjugate (PRP-OMP) vaccine 7.5 mcg-125 mcg/0.5 mL Sus
|
Facility
OP
|
$70.09
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
43700467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.03 |
| Max. Negotiated Rate |
$68.20 |
| Rate for Payer: Aetna of IA Commercial |
$63.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.08
|
| Rate for Payer: Aetna of IA Medicare |
$39.95
|
| Rate for Payer: Amerigroup Medicaid |
$35.37
|
| Rate for Payer: Amerigroup Medicare |
$35.40
|
| Rate for Payer: Cash Price |
$56.07
|
| Rate for Payer: Cash Price |
$56.07
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.57
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.03
|
| Rate for Payer: Medical Associates Commercial |
$52.57
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.04
|
| Rate for Payer: Midlands Choice Commercial |
$49.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$52.57
|
| Rate for Payer: United Healthcare Commercial |
$63.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.35
|
| Rate for Payer: Wellmark IA HMO |
$62.00
|
| Rate for Payer: Wellmark IA PPO |
$68.20
|
|
|
haemophilus b conjugate (PRP-OMP) vaccine 7.5 mcg-125 mcg/0.5 mL Sus
|
Facility
IP
|
$70.09
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
43700467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.06 |
| Max. Negotiated Rate |
$63.08 |
| Rate for Payer: Aetna of IA Commercial |
$63.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.08
|
| Rate for Payer: Cash Price |
$56.07
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.57
|
| Rate for Payer: Medical Associates Commercial |
$52.57
|
| Rate for Payer: Midlands Choice Commercial |
$49.06
|
| Rate for Payer: United Healthcare Commercial |
$63.08
|
|
|
haemophilus b conjugate (PRP-T) vaccine - Pow SDV
|
Facility
IP
|
$40.79
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
43700490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.55 |
| Max. Negotiated Rate |
$36.71 |
| Rate for Payer: Aetna of IA Commercial |
$36.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.71
|
| Rate for Payer: Cash Price |
$32.63
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.59
|
| Rate for Payer: Medical Associates Commercial |
$30.59
|
| Rate for Payer: Midlands Choice Commercial |
$28.55
|
| Rate for Payer: United Healthcare Commercial |
$36.71
|
|
|
haemophilus b conjugate (PRP-T) vaccine - Pow SDV
|
Facility
OP
|
$40.79
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
43700490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.39 |
| Max. Negotiated Rate |
$68.20 |
| Rate for Payer: Aetna of IA Commercial |
$36.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.71
|
| Rate for Payer: Aetna of IA Medicare |
$23.25
|
| Rate for Payer: Amerigroup Medicaid |
$20.59
|
| Rate for Payer: Amerigroup Medicare |
$20.60
|
| Rate for Payer: Cash Price |
$32.63
|
| Rate for Payer: Cash Price |
$32.63
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.59
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.39
|
| Rate for Payer: Medical Associates Commercial |
$30.59
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.40
|
| Rate for Payer: Midlands Choice Commercial |
$28.55
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.59
|
| Rate for Payer: United Healthcare Commercial |
$36.71
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.07
|
| Rate for Payer: Wellmark IA HMO |
$62.00
|
| Rate for Payer: Wellmark IA PPO |
$68.20
|
|
|
haloperidol 0.5 mg Tab
|
Facility
OP
|
$1.71
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702727
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of IA Commercial |
$1.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.54
|
| Rate for Payer: Aetna of IA Medicare |
$0.97
|
| Rate for Payer: Amerigroup Medicaid |
$0.86
|
| Rate for Payer: Amerigroup Medicare |
$0.86
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.85
|
| Rate for Payer: Medical Associates Commercial |
$1.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.86
|
| Rate for Payer: Midlands Choice Commercial |
$1.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.28
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.01
|
|
|
haloperidol 0.5 mg Tab
|
Facility
IP
|
$1.71
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702727
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of IA Commercial |
$1.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.54
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.28
|
| Rate for Payer: Medical Associates Commercial |
$1.28
|
| Rate for Payer: Midlands Choice Commercial |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
|
|
haloperidol 2 mg/mL 15ml Con
|
Facility
IP
|
$76.56
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43711405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.59 |
| Max. Negotiated Rate |
$68.90 |
| Rate for Payer: Aetna of IA Commercial |
$68.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.90
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.42
|
| Rate for Payer: Medical Associates Commercial |
$57.42
|
| Rate for Payer: Midlands Choice Commercial |
$53.59
|
| Rate for Payer: United Healthcare Commercial |
$68.90
|
|
|
haloperidol 2 mg/mL 15ml Con
|
Facility
OP
|
$76.56
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43711405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.26 |
| Max. Negotiated Rate |
$68.90 |
| Rate for Payer: Aetna of IA Commercial |
$68.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.90
|
| Rate for Payer: Aetna of IA Medicare |
$43.64
|
| Rate for Payer: Amerigroup Medicaid |
$38.64
|
| Rate for Payer: Amerigroup Medicare |
$38.66
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.26
|
| Rate for Payer: Medical Associates Commercial |
$57.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.28
|
| Rate for Payer: Midlands Choice Commercial |
$53.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$57.42
|
| Rate for Payer: United Healthcare Commercial |
$68.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.17
|
|
|
haloperidol 5 mg/mL 1 ml Inj SDV
|
Facility
IP
|
$22.24
|
|
|
Service Code
|
CPT J1630
|
| Hospital Charge Code |
43702428
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$20.02 |
| Rate for Payer: Aetna of IA Commercial |
$20.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.02
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.68
|
| Rate for Payer: Medical Associates Commercial |
$16.68
|
| Rate for Payer: Midlands Choice Commercial |
$15.57
|
| Rate for Payer: United Healthcare Commercial |
$20.02
|
|
|
haloperidol 5 mg/mL 1 ml Inj SDV
|
Facility
OP
|
$22.24
|
|
|
Service Code
|
CPT J1630
|
| Hospital Charge Code |
43702428
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$20.02 |
| Rate for Payer: Aetna of IA Commercial |
$20.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.02
|
| Rate for Payer: Aetna of IA Medicare |
$12.68
|
| Rate for Payer: Amerigroup Medicaid |
$11.22
|
| Rate for Payer: Amerigroup Medicare |
$11.23
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.68
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.12
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.12
|
| Rate for Payer: Medical Associates Commercial |
$16.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.12
|
| Rate for Payer: Midlands Choice Commercial |
$15.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.68
|
| Rate for Payer: United Healthcare Commercial |
$20.02
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.12
|
|
|
haloperidol 5 mg Tab
|
Facility
IP
|
$2.11
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701002
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of IA Commercial |
$1.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.90
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.58
|
| Rate for Payer: Medical Associates Commercial |
$1.58
|
| Rate for Payer: Midlands Choice Commercial |
$1.48
|
| Rate for Payer: United Healthcare Commercial |
$1.90
|
|
|
haloperidol 5 mg Tab
|
Facility
OP
|
$2.11
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701002
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of IA Commercial |
$1.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.90
|
| Rate for Payer: Aetna of IA Medicare |
$1.20
|
| Rate for Payer: Amerigroup Medicaid |
$1.06
|
| Rate for Payer: Amerigroup Medicare |
$1.07
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.58
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.05
|
| Rate for Payer: Medical Associates Commercial |
$1.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.06
|
| Rate for Payer: Midlands Choice Commercial |
$1.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.58
|
| Rate for Payer: United Healthcare Commercial |
$1.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.24
|
|
