|
Mesna 100 mg/mL 10 ml MDV inj
|
Facility
OP
|
$50.92
|
|
|
Service Code
|
CPT J9209
|
| Hospital Charge Code |
43700249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$45.83 |
| Rate for Payer: Aetna of IA Commercial |
$45.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.83
|
| Rate for Payer: Aetna of IA Medicare |
$29.02
|
| Rate for Payer: Amerigroup Medicaid |
$25.70
|
| Rate for Payer: Amerigroup Medicare |
$25.71
|
| Rate for Payer: Cash Price |
$40.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.19
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.45
|
| Rate for Payer: Medical Associates Commercial |
$38.19
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.46
|
| Rate for Payer: Midlands Choice Commercial |
$35.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$38.19
|
| Rate for Payer: United Healthcare Commercial |
$45.83
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.04
|
|
|
metaxalone 800 mg Tab
|
Facility
OP
|
$3.21
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43716632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna of IA Commercial |
$2.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.89
|
| Rate for Payer: Aetna of IA Medicare |
$1.83
|
| Rate for Payer: Amerigroup Medicaid |
$1.62
|
| Rate for Payer: Amerigroup Medicare |
$1.62
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.60
|
| Rate for Payer: Medical Associates Commercial |
$2.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.60
|
| Rate for Payer: Midlands Choice Commercial |
$2.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.41
|
| Rate for Payer: United Healthcare Commercial |
$2.89
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.89
|
|
|
metaxalone 800 mg Tab
|
Facility
IP
|
$3.21
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43716632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna of IA Commercial |
$2.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.89
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.41
|
| Rate for Payer: Medical Associates Commercial |
$2.41
|
| Rate for Payer: Midlands Choice Commercial |
$2.25
|
| Rate for Payer: United Healthcare Commercial |
$2.89
|
|
|
metFORMIN 500 mg 24 HR ER Tab
|
Facility
OP
|
$2.19
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Aetna of IA Commercial |
$1.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.97
|
| Rate for Payer: Aetna of IA Medicare |
$1.25
|
| Rate for Payer: Amerigroup Medicaid |
$1.11
|
| Rate for Payer: Amerigroup Medicare |
$1.11
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.09
|
| Rate for Payer: Medical Associates Commercial |
$1.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.10
|
| Rate for Payer: Midlands Choice Commercial |
$1.53
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.64
|
| Rate for Payer: United Healthcare Commercial |
$1.97
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.29
|
|
|
metFORMIN 500 mg 24 HR ER Tab
|
Facility
IP
|
$2.19
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Aetna of IA Commercial |
$1.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.97
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.64
|
| Rate for Payer: Medical Associates Commercial |
$1.64
|
| Rate for Payer: Midlands Choice Commercial |
$1.53
|
| Rate for Payer: United Healthcare Commercial |
$1.97
|
|
|
metFORMIN 500 mg Tab
|
Facility
IP
|
$1.48
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Aetna of IA Commercial |
$1.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.33
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.11
|
| Rate for Payer: Medical Associates Commercial |
$1.11
|
| Rate for Payer: Midlands Choice Commercial |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.33
|
|
|
metFORMIN 500 mg Tab
|
Facility
OP
|
$1.48
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Aetna of IA Commercial |
$1.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.33
|
| Rate for Payer: Aetna of IA Medicare |
$0.84
|
| Rate for Payer: Amerigroup Medicaid |
$0.75
|
| Rate for Payer: Amerigroup Medicare |
$0.75
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.11
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.74
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.74
|
| Rate for Payer: Medical Associates Commercial |
$1.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.74
|
| Rate for Payer: Midlands Choice Commercial |
$1.04
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.11
|
| Rate for Payer: United Healthcare Commercial |
$1.33
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.87
|
|
|
methadone 5 mg Tab
|
Facility
OP
|
$4.17
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43722139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna of IA Commercial |
$3.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.75
|
| Rate for Payer: Aetna of IA Medicare |
$2.38
|
| Rate for Payer: Amerigroup Medicaid |
$2.10
|
| Rate for Payer: Amerigroup Medicare |
$2.11
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.13
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.08
|
| Rate for Payer: Medical Associates Commercial |
$3.13
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.08
|
| Rate for Payer: Midlands Choice Commercial |
$2.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.13
|
| Rate for Payer: United Healthcare Commercial |
$3.75
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.46
|
|
|
methadone 5 mg Tab
|
Facility
IP
|
$4.17
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43722139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna of IA Commercial |
$3.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.75
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.13
|
| Rate for Payer: Medical Associates Commercial |
$3.13
|
| Rate for Payer: Midlands Choice Commercial |
$2.92
|
| Rate for Payer: United Healthcare Commercial |
$3.75
|
|
|
methimazole 5 mg Tab
|
Facility
OP
|
$1.92
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna of IA Commercial |
$1.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.73
|
| Rate for Payer: Aetna of IA Medicare |
$1.09
|
| Rate for Payer: Amerigroup Medicaid |
$0.97
|
| Rate for Payer: Amerigroup Medicare |
$0.97
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.96
|
| Rate for Payer: Medical Associates Commercial |
$1.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.96
|
| Rate for Payer: Midlands Choice Commercial |
$1.34
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.44
|
| Rate for Payer: United Healthcare Commercial |
$1.73
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.13
|
|
|
methimazole 5 mg Tab
|
Facility
IP
|
$1.92
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna of IA Commercial |
$1.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.73
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.44
|
| Rate for Payer: Medical Associates Commercial |
$1.44
|
| Rate for Payer: Midlands Choice Commercial |
$1.34
|
| Rate for Payer: United Healthcare Commercial |
$1.73
|
|
|
methocarbamol 500 mg Tab
|
Facility
IP
|
$1.17
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43733128
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of IA Commercial |
$1.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.05
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.88
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.05
|
|
|
methocarbamol 500 mg Tab
|
Facility
OP
|
$1.17
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43733128
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of IA Commercial |
$1.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.05
|
| Rate for Payer: Aetna of IA Medicare |
$0.67
|
| Rate for Payer: Amerigroup Medicaid |
$0.59
|
| Rate for Payer: Amerigroup Medicare |
$0.59
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.88
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.59
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.58
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.59
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$1.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.69
|
|
|
methotrexate 25 mg/mL 2 ML PF SDV
|
Facility
IP
|
$58.08
|
|
|
Service Code
|
CPT J9250
|
| Hospital Charge Code |
43701980
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.66 |
| Max. Negotiated Rate |
$52.27 |
| Rate for Payer: Aetna of IA Commercial |
$52.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.27
|
| Rate for Payer: Cash Price |
$46.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.56
|
| Rate for Payer: Medical Associates Commercial |
$43.56
|
| Rate for Payer: Midlands Choice Commercial |
$40.66
|
| Rate for Payer: United Healthcare Commercial |
$52.27
|
|
|
methotrexate 25 mg/mL 2 ML PF SDV
|
Facility
OP
|
$58.08
|
|
|
Service Code
|
CPT J9250
|
| Hospital Charge Code |
43701980
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.03 |
| Max. Negotiated Rate |
$52.27 |
| Rate for Payer: Aetna of IA Commercial |
$52.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.27
|
| Rate for Payer: Aetna of IA Medicare |
$33.11
|
| Rate for Payer: Amerigroup Medicaid |
$29.31
|
| Rate for Payer: Amerigroup Medicare |
$29.33
|
| Rate for Payer: Cash Price |
$46.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.56
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.03
|
| Rate for Payer: Medical Associates Commercial |
$43.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.04
|
| Rate for Payer: Midlands Choice Commercial |
$40.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.56
|
| Rate for Payer: United Healthcare Commercial |
$52.27
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.27
|
|
|
methotrexate 25 mg/mL MDV 10ML
|
Facility
IP
|
$55.08
|
|
|
Service Code
|
CPT J9250
|
| Hospital Charge Code |
43700543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.56 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna of IA Commercial |
$49.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.57
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.31
|
| Rate for Payer: Medical Associates Commercial |
$41.31
|
| Rate for Payer: Midlands Choice Commercial |
$38.56
|
| Rate for Payer: United Healthcare Commercial |
$49.57
|
|
|
methotrexate 25 mg/mL MDV 10ML
|
Facility
OP
|
$55.08
|
|
|
Service Code
|
CPT J9250
|
| Hospital Charge Code |
43700543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.53 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna of IA Commercial |
$49.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.57
|
| Rate for Payer: Aetna of IA Medicare |
$31.40
|
| Rate for Payer: Amerigroup Medicaid |
$27.80
|
| Rate for Payer: Amerigroup Medicare |
$27.82
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.31
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.53
|
| Rate for Payer: Medical Associates Commercial |
$41.31
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.54
|
| Rate for Payer: Midlands Choice Commercial |
$38.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$41.31
|
| Rate for Payer: United Healthcare Commercial |
$49.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$32.50
|
|
|
methotrexate 2.5 mg Tab
|
Facility
IP
|
$3.20
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43714336
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Aetna of IA Commercial |
$2.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.88
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.40
|
| Rate for Payer: Medical Associates Commercial |
$2.40
|
| Rate for Payer: Midlands Choice Commercial |
$2.24
|
| Rate for Payer: United Healthcare Commercial |
$2.88
|
|
|
methotrexate 2.5 mg Tab
|
Facility
OP
|
$3.20
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43714336
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Aetna of IA Commercial |
$2.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.88
|
| Rate for Payer: Aetna of IA Medicare |
$1.82
|
| Rate for Payer: Amerigroup Medicaid |
$1.62
|
| Rate for Payer: Amerigroup Medicare |
$1.62
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.40
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.60
|
| Rate for Payer: Medical Associates Commercial |
$2.40
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.60
|
| Rate for Payer: Midlands Choice Commercial |
$2.24
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.40
|
| Rate for Payer: United Healthcare Commercial |
$2.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.89
|
|
|
methylene blue 5 mg/mL 10ml SDV inj
|
Facility
IP
|
$789.71
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43700409
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$552.80 |
| Max. Negotiated Rate |
$710.74 |
| Rate for Payer: Aetna of IA Commercial |
$710.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$710.74
|
| Rate for Payer: Cash Price |
$631.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$592.28
|
| Rate for Payer: Medical Associates Commercial |
$592.28
|
| Rate for Payer: Midlands Choice Commercial |
$552.80
|
| Rate for Payer: United Healthcare Commercial |
$710.74
|
|
|
methylene blue 5 mg/mL 10ml SDV inj
|
Facility
OP
|
$789.71
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43700409
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$394.70 |
| Max. Negotiated Rate |
$710.74 |
| Rate for Payer: Aetna of IA Commercial |
$710.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$710.74
|
| Rate for Payer: Aetna of IA Medicare |
$450.13
|
| Rate for Payer: Amerigroup Medicaid |
$398.57
|
| Rate for Payer: Amerigroup Medicare |
$398.80
|
| Rate for Payer: Cash Price |
$631.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$592.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$394.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$394.70
|
| Rate for Payer: Medical Associates Commercial |
$592.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$394.86
|
| Rate for Payer: Midlands Choice Commercial |
$552.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$400.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$592.28
|
| Rate for Payer: United Healthcare Commercial |
$710.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$465.93
|
|
|
methylergonovine 0.2 mg/mL Inj Sol
|
Facility
IP
|
$81.43
|
|
|
Service Code
|
CPT J2210
|
| Hospital Charge Code |
43705975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$73.29 |
| Rate for Payer: Aetna of IA Commercial |
$73.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.29
|
| Rate for Payer: Cash Price |
$65.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.07
|
| Rate for Payer: Medical Associates Commercial |
$61.07
|
| Rate for Payer: Midlands Choice Commercial |
$57.00
|
| Rate for Payer: United Healthcare Commercial |
$73.29
|
|
|
methylergonovine 0.2 mg/mL Inj Sol
|
Facility
OP
|
$81.43
|
|
|
Service Code
|
CPT J2210
|
| Hospital Charge Code |
43705975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$73.29 |
| Rate for Payer: Aetna of IA Commercial |
$73.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.29
|
| Rate for Payer: Aetna of IA Medicare |
$46.42
|
| Rate for Payer: Amerigroup Medicaid |
$41.10
|
| Rate for Payer: Amerigroup Medicare |
$41.12
|
| Rate for Payer: Cash Price |
$65.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.07
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$40.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.70
|
| Rate for Payer: Medical Associates Commercial |
$61.07
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.72
|
| Rate for Payer: Midlands Choice Commercial |
$57.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$61.07
|
| Rate for Payer: United Healthcare Commercial |
$73.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.04
|
|
|
Methylmalonic Acid DMCL
|
Facility
OP
|
$157.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
8037742
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Aetna of IA Medicare |
$89.49
|
| Rate for Payer: Amerigroup Medicaid |
$79.24
|
| Rate for Payer: Amerigroup Medicare |
$79.28
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$78.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$78.47
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$78.50
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$117.75
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.63
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Methylmalonic Acid DMCL
|
Facility
IP
|
$157.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
8037742
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
|
