|
MALLEOLUS IMPLANT 4.5MM X 65MM
|
Facility
IP
|
$4,095.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8924289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,866.50 |
| Max. Negotiated Rate |
$3,685.50 |
| Rate for Payer: Aetna of IA Commercial |
$3,685.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,685.50
|
| Rate for Payer: Cash Price |
$3,276.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,071.25
|
| Rate for Payer: Medical Associates Commercial |
$3,071.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,866.50
|
| Rate for Payer: United Healthcare Commercial |
$3,685.50
|
|
|
mannitol 20% IV Sol 500 ml
|
Facility
OP
|
$70.56
|
|
|
Service Code
|
CPT J7799
|
| Hospital Charge Code |
43700255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.27 |
| Max. Negotiated Rate |
$63.50 |
| Rate for Payer: Aetna of IA Commercial |
$63.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.50
|
| Rate for Payer: Aetna of IA Medicare |
$40.22
|
| Rate for Payer: Amerigroup Medicaid |
$35.61
|
| Rate for Payer: Amerigroup Medicare |
$35.63
|
| Rate for Payer: Cash Price |
$56.45
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.92
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.27
|
| Rate for Payer: Medical Associates Commercial |
$52.92
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.28
|
| Rate for Payer: Midlands Choice Commercial |
$49.39
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$52.92
|
| Rate for Payer: United Healthcare Commercial |
$63.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.63
|
|
|
mannitol 20% IV Sol 500 ml
|
Facility
IP
|
$70.56
|
|
|
Service Code
|
CPT J7799
|
| Hospital Charge Code |
43700255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.39 |
| Max. Negotiated Rate |
$63.50 |
| Rate for Payer: Aetna of IA Commercial |
$63.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.50
|
| Rate for Payer: Cash Price |
$56.45
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.92
|
| Rate for Payer: Medical Associates Commercial |
$52.92
|
| Rate for Payer: Midlands Choice Commercial |
$49.39
|
| Rate for Payer: United Healthcare Commercial |
$63.50
|
|
|
MANUAL THERAPY PER 15 MINUTES
|
Facility
IP
|
$111.00
|
|
|
Service Code
|
CPT 97140 GP
|
| Hospital Charge Code |
1373910
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna of IA Commercial |
$99.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.90
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$83.25
|
| Rate for Payer: Medical Associates Commercial |
$83.25
|
| Rate for Payer: Midlands Choice Commercial |
$77.70
|
| Rate for Payer: United Healthcare Commercial |
$99.90
|
|
|
MANUAL THERAPY PER 15 MINUTES
|
Facility
OP
|
$111.00
|
|
|
Service Code
|
CPT 97140 GO
|
| Hospital Charge Code |
750909
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.48 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna of IA Commercial |
$99.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.90
|
| Rate for Payer: Aetna of IA Medicare |
$63.27
|
| Rate for Payer: Amerigroup Medicaid |
$56.02
|
| Rate for Payer: Amerigroup Medicare |
$56.06
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$83.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$55.48
|
| Rate for Payer: Medical Associates Commercial |
$83.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$56.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$83.25
|
| Rate for Payer: United Healthcare Commercial |
$99.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$65.49
|
|
|
MANUAL THERAPY PER 15 MINUTES
|
Facility
OP
|
$111.00
|
|
|
Service Code
|
CPT 97140 GP
|
| Hospital Charge Code |
1373910
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.48 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna of IA Commercial |
$99.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.90
|
| Rate for Payer: Aetna of IA Medicare |
$63.27
|
| Rate for Payer: Amerigroup Medicaid |
$56.02
|
| Rate for Payer: Amerigroup Medicare |
$56.06
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$83.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$55.48
|
| Rate for Payer: Medical Associates Commercial |
$83.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$56.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$83.25
|
| Rate for Payer: United Healthcare Commercial |
$99.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$65.49
|
|
|
MANUAL THERAPY PER 15 MINUTES
|
Facility
IP
|
$111.00
|
|
|
Service Code
|
CPT 97140 GO
|
| Hospital Charge Code |
750909
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna of IA Commercial |
$99.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.90
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$83.25
|
| Rate for Payer: Medical Associates Commercial |
$83.25
|
| Rate for Payer: Midlands Choice Commercial |
$77.70
|
| Rate for Payer: United Healthcare Commercial |
$99.90
|
|
|
Mastectomy for Malignancy With CC/MCC
|
Facility
IP
|
$15,394.52
|
|
|
Service Code
|
MS-DRG 582
|
| Hospital Charge Code |
386
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$15,394.52 |
| Rate for Payer: Amerigroup Medicaid |
$15,320.15
|
| 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 |
$15,171.41
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15,394.52
|
|
|
Mastectomy for Malignancy Without CC/MCC
|
Facility
IP
|
$15,292.16
|
|
|
Service Code
|
MS-DRG 583
|
| Hospital Charge Code |
387
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$15,292.16 |
| Rate for Payer: Amerigroup Medicaid |
$15,218.28
|
| 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 |
$15,070.53
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15,292.16
|
|
|
MAXIMUM BREATHING CAPACITY
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
CPT 94200
|
| Hospital Charge Code |
5338937
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$282.35 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Aetna of IA Medicare |
$148.20
|
| Rate for Payer: Amerigroup Medicaid |
$131.22
|
| Rate for Payer: Amerigroup Medicare |
$131.30
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$130.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$129.95
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$130.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$131.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$195.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.40
|
| Rate for Payer: Wellmark IA HMO |
$256.68
|
| Rate for Payer: Wellmark IA PPO |
$282.35
|
|
|
MAXIMUM BREATHING CAPACITY
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
CPT 94200
|
| Hospital Charge Code |
5338937
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
|
|
MCL Referred Isolate DMCL
|
Facility
IP
|
$59.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
8037732
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna of IA Commercial |
$53.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.10
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.25
|
| Rate for Payer: Medical Associates Commercial |
$44.25
|
| Rate for Payer: Midlands Choice Commercial |
$41.30
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
|
|
MCL Referred Isolate DMCL
|
Facility
OP
|
$59.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
8037732
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna of IA Commercial |
$53.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.10
|
| Rate for Payer: Aetna of IA Medicare |
$33.63
|
| Rate for Payer: Amerigroup Medicaid |
$29.78
|
| Rate for Payer: Amerigroup Medicare |
$29.80
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.49
|
| Rate for Payer: Medical Associates Commercial |
$44.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.50
|
| Rate for Payer: Midlands Choice Commercial |
$41.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.25
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.81
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
measles/mumps/rubella/varicella virus vaccine SDV - Pow UD
|
Facility
OP
|
$508.42
|
|
|
Service Code
|
CPT 90710
|
| Hospital Charge Code |
43700455
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$457.58 |
| Rate for Payer: Aetna of IA Commercial |
$457.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$457.58
|
| Rate for Payer: Aetna of IA Medicare |
$289.80
|
| Rate for Payer: Amerigroup Medicaid |
$256.60
|
| Rate for Payer: Amerigroup Medicare |
$256.75
|
| Rate for Payer: Cash Price |
$406.74
|
| Rate for Payer: Cash Price |
$406.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$381.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$254.21
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$254.11
|
| Rate for Payer: Medical Associates Commercial |
$381.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$254.21
|
| Rate for Payer: Midlands Choice Commercial |
$355.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$258.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$381.32
|
| Rate for Payer: United Healthcare Commercial |
$457.58
|
| Rate for Payer: United Healthcare Managed Medicare |
$299.97
|
| Rate for Payer: Wellmark IA HMO |
$62.00
|
| Rate for Payer: Wellmark IA PPO |
$68.20
|
|
|
measles/mumps/rubella/varicella virus vaccine SDV - Pow UD
|
Facility
IP
|
$508.42
|
|
|
Service Code
|
CPT 90710
|
| Hospital Charge Code |
43700455
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$355.89 |
| Max. Negotiated Rate |
$457.58 |
| Rate for Payer: Aetna of IA Commercial |
$457.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$457.58
|
| Rate for Payer: Cash Price |
$406.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$381.32
|
| Rate for Payer: Medical Associates Commercial |
$381.32
|
| Rate for Payer: Midlands Choice Commercial |
$355.89
|
| Rate for Payer: United Healthcare Commercial |
$457.58
|
|
|
mEAsles/mumps/rubella virus vaccine SubQ Inj
|
Facility
OP
|
$187.39
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
43701110
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$168.65 |
| Rate for Payer: Aetna of IA Commercial |
$168.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$168.65
|
| Rate for Payer: Aetna of IA Medicare |
$106.81
|
| Rate for Payer: Amerigroup Medicaid |
$94.58
|
| Rate for Payer: Amerigroup Medicare |
$94.63
|
| Rate for Payer: Cash Price |
$149.91
|
| Rate for Payer: Cash Price |
$149.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$140.54
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$93.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$93.66
|
| Rate for Payer: Medical Associates Commercial |
$140.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$93.70
|
| Rate for Payer: Midlands Choice Commercial |
$131.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$95.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$140.54
|
| Rate for Payer: United Healthcare Commercial |
$168.65
|
| Rate for Payer: United Healthcare Managed Medicare |
$110.56
|
| Rate for Payer: Wellmark IA HMO |
$62.00
|
| Rate for Payer: Wellmark IA PPO |
$68.20
|
|
|
mEAsles/mumps/rubella virus vaccine SubQ Inj
|
Facility
IP
|
$187.39
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
43701110
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.17 |
| Max. Negotiated Rate |
$168.65 |
| Rate for Payer: Aetna of IA Commercial |
$168.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$168.65
|
| Rate for Payer: Cash Price |
$149.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$140.54
|
| Rate for Payer: Medical Associates Commercial |
$140.54
|
| Rate for Payer: Midlands Choice Commercial |
$131.17
|
| Rate for Payer: United Healthcare Commercial |
$168.65
|
|
|
meclizine 25 mg Tab
|
Facility
OP
|
$1.27
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702338
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna of IA Commercial |
$1.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.14
|
| Rate for Payer: Aetna of IA Medicare |
$0.72
|
| Rate for Payer: Amerigroup Medicaid |
$0.64
|
| Rate for Payer: Amerigroup Medicare |
$0.64
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.63
|
| Rate for Payer: Medical Associates Commercial |
$0.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.64
|
| Rate for Payer: Midlands Choice Commercial |
$0.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.95
|
| Rate for Payer: United Healthcare Commercial |
$1.14
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.75
|
|
|
meclizine 25 mg Tab
|
Facility
IP
|
$1.27
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702338
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna of IA Commercial |
$1.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.14
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.95
|
| Rate for Payer: Medical Associates Commercial |
$0.95
|
| Rate for Payer: Midlands Choice Commercial |
$0.89
|
| Rate for Payer: United Healthcare Commercial |
$1.14
|
|
|
Medical Back Problems With MCC
|
Facility
IP
|
$13,390.60
|
|
|
Service Code
|
MS-DRG 551
|
| Hospital Charge Code |
358
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$13,390.60 |
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,390.60
|
| Rate for Payer: Amerigroup Medicaid |
$13,325.91
|
| 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 |
$13,196.54
|
|
|
Medical Back Problems Without MCC
|
Facility
IP
|
$6,189.89
|
|
|
Service Code
|
MS-DRG 552
|
| Hospital Charge Code |
359
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,189.89 |
| Rate for Payer: Amerigroup Medicaid |
$6,159.99
|
| 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 |
$6,100.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,189.89
|
|
|
medroxyPROGESTERone 10 mg Tab
|
Facility
IP
|
$1.57
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701902
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of IA Commercial |
$1.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.41
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.18
|
| Rate for Payer: Medical Associates Commercial |
$1.18
|
| Rate for Payer: Midlands Choice Commercial |
$1.10
|
| Rate for Payer: United Healthcare Commercial |
$1.41
|
|
|
medroxyPROGESTERone 10 mg Tab
|
Facility
OP
|
$1.57
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701902
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of IA Commercial |
$1.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.41
|
| Rate for Payer: Aetna of IA Medicare |
$0.89
|
| Rate for Payer: Amerigroup Medicaid |
$0.79
|
| Rate for Payer: Amerigroup Medicare |
$0.79
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.18
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.79
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.78
|
| Rate for Payer: Medical Associates Commercial |
$1.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.79
|
| Rate for Payer: Midlands Choice Commercial |
$1.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.18
|
| Rate for Payer: United Healthcare Commercial |
$1.41
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.93
|
|
|
medroxyPROGESTERone 150 mg/mL IM Susp SDV
|
Facility
IP
|
$146.55
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
43701180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.58 |
| Max. Negotiated Rate |
$131.90 |
| Rate for Payer: Aetna of IA Commercial |
$131.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.90
|
| Rate for Payer: Cash Price |
$117.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.91
|
| Rate for Payer: Medical Associates Commercial |
$109.91
|
| Rate for Payer: Midlands Choice Commercial |
$102.58
|
| Rate for Payer: United Healthcare Commercial |
$131.90
|
|
|
medroxyPROGESTERone 150 mg/mL IM Susp SDV
|
Facility
OP
|
$146.55
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
43701180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.25 |
| Max. Negotiated Rate |
$131.90 |
| Rate for Payer: Aetna of IA Commercial |
$131.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.90
|
| Rate for Payer: Aetna of IA Medicare |
$83.53
|
| Rate for Payer: Amerigroup Medicaid |
$73.96
|
| Rate for Payer: Amerigroup Medicare |
$74.01
|
| Rate for Payer: Cash Price |
$117.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.91
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.25
|
| Rate for Payer: Medical Associates Commercial |
$109.91
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.28
|
| Rate for Payer: Midlands Choice Commercial |
$102.58
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$109.91
|
| Rate for Payer: United Healthcare Commercial |
$131.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.46
|
|
