|
medroxyPROGESTERone 2.5 mg Tab
|
Facility
OP
|
$1.37
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of IA Commercial |
$1.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.23
|
| 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 |
$1.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.03
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.69
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.68
|
| Rate for Payer: Medical Associates Commercial |
$1.03
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.69
|
| Rate for Payer: Midlands Choice Commercial |
$0.96
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.03
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.81
|
|
|
medroxyPROGESTERone 2.5 mg Tab
|
Facility
IP
|
$1.37
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of IA Commercial |
$1.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.23
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.03
|
| Rate for Payer: Medical Associates Commercial |
$1.03
|
| Rate for Payer: Midlands Choice Commercial |
$0.96
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
|
|
Med/Surg
|
Facility
IP
|
$1,400.00
|
|
| Hospital Charge Code |
4903043
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$980.00 |
| Max. Negotiated Rate |
$2,339.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,260.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,260.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,258.00
|
| Rate for Payer: Amerigroup Medicare |
$2,054.34
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,050.00
|
| Rate for Payer: Medical Associates Commercial |
$1,050.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,034.00
|
| Rate for Payer: Midlands Choice Commercial |
$980.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,339.10
|
| Rate for Payer: United Healthcare Commercial |
$1,260.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,306.00
|
|
|
megestrol 40 mg/mL 10ml cup Sus
|
Facility
OP
|
$13.16
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna of IA Commercial |
$11.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.84
|
| Rate for Payer: Aetna of IA Medicare |
$7.50
|
| Rate for Payer: Amerigroup Medicaid |
$6.64
|
| Rate for Payer: Amerigroup Medicare |
$6.65
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.87
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.58
|
| Rate for Payer: Medical Associates Commercial |
$9.87
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.58
|
| Rate for Payer: Midlands Choice Commercial |
$9.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.87
|
| Rate for Payer: United Healthcare Commercial |
$11.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.76
|
|
|
megestrol 40 mg/mL 10ml cup Sus
|
Facility
IP
|
$13.16
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna of IA Commercial |
$11.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.84
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.87
|
| Rate for Payer: Medical Associates Commercial |
$9.87
|
| Rate for Payer: Midlands Choice Commercial |
$9.21
|
| Rate for Payer: United Healthcare Commercial |
$11.84
|
|
|
megestrol 40 mg Tab
|
Facility
IP
|
$1.62
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Aetna of IA Commercial |
$1.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.46
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.22
|
| Rate for Payer: Medical Associates Commercial |
$1.22
|
| Rate for Payer: Midlands Choice Commercial |
$1.13
|
| Rate for Payer: United Healthcare Commercial |
$1.46
|
|
|
megestrol 40 mg Tab
|
Facility
OP
|
$1.62
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Aetna of IA Commercial |
$1.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.46
|
| Rate for Payer: Aetna of IA Medicare |
$0.92
|
| Rate for Payer: Amerigroup Medicaid |
$0.82
|
| Rate for Payer: Amerigroup Medicare |
$0.82
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.81
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.81
|
| Rate for Payer: Medical Associates Commercial |
$1.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.81
|
| Rate for Payer: Midlands Choice Commercial |
$1.13
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$1.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.96
|
|
|
melatonin 3 mg Tab
|
Facility
IP
|
$1.45
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43792345
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna of IA Commercial |
$1.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.30
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.09
|
| Rate for Payer: Medical Associates Commercial |
$1.09
|
| Rate for Payer: Midlands Choice Commercial |
$1.02
|
| Rate for Payer: United Healthcare Commercial |
$1.30
|
|
|
melatonin 3 mg Tab
|
Facility
OP
|
$1.45
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43792345
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna of IA Commercial |
$1.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.30
|
| Rate for Payer: Aetna of IA Medicare |
$0.83
|
| Rate for Payer: Amerigroup Medicaid |
$0.73
|
| Rate for Payer: Amerigroup Medicare |
$0.73
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.09
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.72
|
| Rate for Payer: Medical Associates Commercial |
$1.09
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.73
|
| Rate for Payer: Midlands Choice Commercial |
$1.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.09
|
| Rate for Payer: United Healthcare Commercial |
$1.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.86
|
|
|
meloxicam 30 mg/mL 1ml DSP SDV
|
Facility
OP
|
$359.00
|
|
|
Service Code
|
CPT J1738
|
| Hospital Charge Code |
43700541
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$179.43 |
| Max. Negotiated Rate |
$323.10 |
| Rate for Payer: Aetna of IA Commercial |
$323.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$323.10
|
| Rate for Payer: Aetna of IA Medicare |
$204.63
|
| Rate for Payer: Amerigroup Medicaid |
$181.19
|
| Rate for Payer: Amerigroup Medicare |
$181.30
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$269.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$179.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$179.43
|
| Rate for Payer: Medical Associates Commercial |
$269.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$179.50
|
| Rate for Payer: Midlands Choice Commercial |
$251.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$182.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$269.25
|
| Rate for Payer: United Healthcare Commercial |
$323.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$211.81
|
|
|
meloxicam 30 mg/mL 1ml DSP SDV
|
Facility
IP
|
$359.00
|
|
|
Service Code
|
CPT J1738
|
| Hospital Charge Code |
43700541
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$251.30 |
| Max. Negotiated Rate |
$323.10 |
| Rate for Payer: Aetna of IA Commercial |
$323.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$323.10
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$269.25
|
| Rate for Payer: Medical Associates Commercial |
$269.25
|
| Rate for Payer: Midlands Choice Commercial |
$251.30
|
| Rate for Payer: United Healthcare Commercial |
$323.10
|
|
|
meloxicam 7.5 mg Tab
|
Facility
IP
|
$1.34
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43729718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Aetna of IA Commercial |
$1.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.21
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.00
|
| Rate for Payer: Medical Associates Commercial |
$1.00
|
| Rate for Payer: Midlands Choice Commercial |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$1.21
|
|
|
meloxicam 7.5 mg Tab
|
Facility
OP
|
$1.34
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43729718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Aetna of IA Commercial |
$1.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.21
|
| Rate for Payer: Aetna of IA Medicare |
$0.76
|
| Rate for Payer: Amerigroup Medicaid |
$0.68
|
| Rate for Payer: Amerigroup Medicare |
$0.68
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.67
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.67
|
| Rate for Payer: Medical Associates Commercial |
$1.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.67
|
| Rate for Payer: Midlands Choice Commercial |
$0.94
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$1.21
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.79
|
|
|
memantine 10 mg Tab
|
Facility
OP
|
$2.02
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43720187
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of IA Commercial |
$1.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.82
|
| Rate for Payer: Aetna of IA Medicare |
$1.15
|
| Rate for Payer: Amerigroup Medicaid |
$1.02
|
| Rate for Payer: Amerigroup Medicare |
$1.02
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.01
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.01
|
| Rate for Payer: Medical Associates Commercial |
$1.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.01
|
| Rate for Payer: Midlands Choice Commercial |
$1.41
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.52
|
| Rate for Payer: United Healthcare Commercial |
$1.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.19
|
|
|
memantine 10 mg Tab
|
Facility
IP
|
$2.02
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43720187
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of IA Commercial |
$1.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.82
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.52
|
| Rate for Payer: Medical Associates Commercial |
$1.52
|
| Rate for Payer: Midlands Choice Commercial |
$1.41
|
| Rate for Payer: United Healthcare Commercial |
$1.82
|
|
|
meningococcal conjugate vaccine
|
Facility
IP
|
$220.93
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
43700571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.65 |
| Max. Negotiated Rate |
$198.84 |
| Rate for Payer: Aetna of IA Commercial |
$198.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.84
|
| Rate for Payer: Cash Price |
$176.75
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.70
|
| Rate for Payer: Medical Associates Commercial |
$165.70
|
| Rate for Payer: Midlands Choice Commercial |
$154.65
|
| Rate for Payer: United Healthcare Commercial |
$198.84
|
|
|
meningococcal conjugate vaccine
|
Facility
OP
|
$220.93
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
43700571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.42 |
| Max. Negotiated Rate |
$228.47 |
| Rate for Payer: Aetna of IA Commercial |
$198.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.84
|
| Rate for Payer: Aetna of IA Medicare |
$125.93
|
| Rate for Payer: Amerigroup Medicaid |
$111.50
|
| Rate for Payer: Amerigroup Medicare |
$111.57
|
| Rate for Payer: Cash Price |
$176.75
|
| Rate for Payer: Cash Price |
$176.75
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.70
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$110.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$110.42
|
| Rate for Payer: Medical Associates Commercial |
$165.70
|
| Rate for Payer: Medical Associates Managed Medicare |
$110.46
|
| Rate for Payer: Midlands Choice Commercial |
$154.65
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$112.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$165.70
|
| Rate for Payer: United Healthcare Commercial |
$198.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$130.35
|
| Rate for Payer: Wellmark IA HMO |
$207.70
|
| Rate for Payer: Wellmark IA PPO |
$228.47
|
|
|
meningococcal group B vaccine recombinant, OMV, adjuvanted Sus 0.5ml SDS
|
Facility
OP
|
$332.80
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43700486
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.33 |
| Max. Negotiated Rate |
$299.52 |
| Rate for Payer: Aetna of IA Commercial |
$299.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.52
|
| Rate for Payer: Aetna of IA Medicare |
$189.70
|
| Rate for Payer: Amerigroup Medicaid |
$167.96
|
| Rate for Payer: Amerigroup Medicare |
$168.06
|
| Rate for Payer: Cash Price |
$266.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$166.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$166.33
|
| Rate for Payer: Medical Associates Commercial |
$249.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$166.40
|
| Rate for Payer: Midlands Choice Commercial |
$232.96
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$168.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$249.60
|
| Rate for Payer: United Healthcare Commercial |
$299.52
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.35
|
|
|
meningococcal group B vaccine recombinant, OMV, adjuvanted Sus 0.5ml SDS
|
Facility
IP
|
$332.80
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43700486
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$232.96 |
| Max. Negotiated Rate |
$299.52 |
| Rate for Payer: Aetna of IA Commercial |
$299.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.52
|
| Rate for Payer: Cash Price |
$266.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.60
|
| Rate for Payer: Medical Associates Commercial |
$249.60
|
| Rate for Payer: Midlands Choice Commercial |
$232.96
|
| Rate for Payer: United Healthcare Commercial |
$299.52
|
|
|
MENISCAL CINCH
|
Facility
IP
|
$513.00
|
|
| Hospital Charge Code |
8026234
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of IA Commercial |
$461.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$461.70
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$384.75
|
| Rate for Payer: Medical Associates Commercial |
$384.75
|
| Rate for Payer: Midlands Choice Commercial |
$359.10
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
|
|
MENISCAL CINCH
|
Facility
OP
|
$513.00
|
|
| Hospital Charge Code |
8026234
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.40 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of IA Commercial |
$461.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$461.70
|
| Rate for Payer: Aetna of IA Medicare |
$292.41
|
| Rate for Payer: Amerigroup Medicaid |
$258.91
|
| Rate for Payer: Amerigroup Medicare |
$259.06
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$384.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$256.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$256.40
|
| Rate for Payer: Medical Associates Commercial |
$384.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$256.50
|
| Rate for Payer: Midlands Choice Commercial |
$359.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$260.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$384.75
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$302.67
|
|
|
Menstrual and Other Female Reproductive System Disorders With CC/MCC
|
Facility
IP
|
$6,584.58
|
|
|
Service Code
|
MS-DRG 760
|
| Hospital Charge Code |
518
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,584.58 |
| Rate for Payer: Amerigroup Medicaid |
$6,552.77
|
| 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 |
$6,489.15
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,584.58
|
|
|
Menstrual and Other Female Reproductive System Disorders Without CC/MCC
|
Facility
IP
|
$3,795.23
|
|
|
Service Code
|
MS-DRG 761
|
| Hospital Charge Code |
519
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$3,795.23 |
| Rate for Payer: Amerigroup Medicaid |
$3,776.90
|
| 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 |
$3,740.23
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,795.23
|
|
|
Mentholatum/Camphor 9%-1.3% Ointment 28gm
|
Facility
OP
|
$12.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700393
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$11.27 |
| Rate for Payer: Aetna of IA Commercial |
$11.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.27
|
| Rate for Payer: Aetna of IA Medicare |
$7.14
|
| Rate for Payer: Amerigroup Medicaid |
$6.32
|
| Rate for Payer: Amerigroup Medicare |
$6.32
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.39
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.26
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.26
|
| Rate for Payer: Medical Associates Commercial |
$9.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.26
|
| Rate for Payer: Midlands Choice Commercial |
$8.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.39
|
| Rate for Payer: United Healthcare Commercial |
$11.27
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.39
|
|
|
Mentholatum/Camphor 9%-1.3% Ointment 28gm
|
Facility
IP
|
$12.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700393
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$11.27 |
| Rate for Payer: Aetna of IA Commercial |
$11.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.27
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.39
|
| Rate for Payer: Medical Associates Commercial |
$9.39
|
| Rate for Payer: Midlands Choice Commercial |
$8.76
|
| Rate for Payer: United Healthcare Commercial |
$11.27
|
|
