|
methylnaltrexone 12 mg/0.6 mL Inj Sol SDV
|
Facility
OP
|
$586.04
|
|
|
Service Code
|
CPT J2212
|
| Hospital Charge Code |
43706688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$292.90 |
| Max. Negotiated Rate |
$527.44 |
| Rate for Payer: Aetna of IA Commercial |
$527.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$527.44
|
| Rate for Payer: Aetna of IA Medicare |
$334.04
|
| Rate for Payer: Amerigroup Medicaid |
$295.77
|
| Rate for Payer: Amerigroup Medicare |
$295.95
|
| Rate for Payer: Cash Price |
$468.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$439.53
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$293.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$292.90
|
| Rate for Payer: Medical Associates Commercial |
$439.53
|
| Rate for Payer: Medical Associates Managed Medicare |
$293.02
|
| Rate for Payer: Midlands Choice Commercial |
$410.23
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$297.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$439.53
|
| Rate for Payer: United Healthcare Commercial |
$527.44
|
| Rate for Payer: United Healthcare Managed Medicare |
$345.76
|
|
|
methylnaltrexone 12 mg/0.6 mL Inj Sol SDV
|
Facility
IP
|
$586.04
|
|
|
Service Code
|
CPT J2212
|
| Hospital Charge Code |
43706688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$410.23 |
| Max. Negotiated Rate |
$527.44 |
| Rate for Payer: Aetna of IA Commercial |
$527.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$527.44
|
| Rate for Payer: Cash Price |
$468.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$439.53
|
| Rate for Payer: Medical Associates Commercial |
$439.53
|
| Rate for Payer: Midlands Choice Commercial |
$410.23
|
| Rate for Payer: United Healthcare Commercial |
$527.44
|
|
|
methylphenidate 5 mg Tab
|
Facility
IP
|
$3.15
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701898
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna of IA Commercial |
$2.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.84
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.36
|
| Rate for Payer: Medical Associates Commercial |
$2.36
|
| Rate for Payer: Midlands Choice Commercial |
$2.20
|
| Rate for Payer: United Healthcare Commercial |
$2.84
|
|
|
methylphenidate 5 mg Tab
|
Facility
OP
|
$3.15
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701898
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna of IA Commercial |
$2.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.84
|
| Rate for Payer: Aetna of IA Medicare |
$1.80
|
| Rate for Payer: Amerigroup Medicaid |
$1.59
|
| Rate for Payer: Amerigroup Medicare |
$1.59
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.57
|
| Rate for Payer: Medical Associates Commercial |
$2.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.58
|
| Rate for Payer: Midlands Choice Commercial |
$2.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.36
|
| Rate for Payer: United Healthcare Commercial |
$2.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.86
|
|
|
methylPREDNISolone 125 mg preservative-free Pow
|
Facility
IP
|
$50.46
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
43701168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.32 |
| Max. Negotiated Rate |
$45.41 |
| Rate for Payer: Aetna of IA Commercial |
$45.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.41
|
| Rate for Payer: Cash Price |
$40.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.84
|
| Rate for Payer: Medical Associates Commercial |
$37.84
|
| Rate for Payer: Midlands Choice Commercial |
$35.32
|
| Rate for Payer: United Healthcare Commercial |
$45.41
|
|
|
methylPREDNISolone 125 mg preservative-free Pow
|
Facility
OP
|
$50.46
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
43701168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$45.41 |
| Rate for Payer: Aetna of IA Commercial |
$45.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.41
|
| Rate for Payer: Aetna of IA Medicare |
$28.76
|
| Rate for Payer: Amerigroup Medicaid |
$25.47
|
| Rate for Payer: Amerigroup Medicare |
$25.48
|
| Rate for Payer: Cash Price |
$40.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.84
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.23
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.22
|
| Rate for Payer: Medical Associates Commercial |
$37.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.23
|
| Rate for Payer: Midlands Choice Commercial |
$35.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$37.84
|
| Rate for Payer: United Healthcare Commercial |
$45.41
|
| Rate for Payer: United Healthcare Managed Medicare |
$29.77
|
|
|
methylPREDNISolone 1gm PF SDV Pow
|
Facility
IP
|
$228.28
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
43701192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$159.80 |
| Max. Negotiated Rate |
$205.45 |
| Rate for Payer: Aetna of IA Commercial |
$205.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$205.45
|
| Rate for Payer: Cash Price |
$182.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$171.21
|
| Rate for Payer: Medical Associates Commercial |
$171.21
|
| Rate for Payer: Midlands Choice Commercial |
$159.80
|
| Rate for Payer: United Healthcare Commercial |
$205.45
|
|
|
methylPREDNISolone 1gm PF SDV Pow
|
Facility
OP
|
$228.28
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
43701192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.09 |
| Max. Negotiated Rate |
$205.45 |
| Rate for Payer: Aetna of IA Commercial |
$205.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$205.45
|
| Rate for Payer: Aetna of IA Medicare |
$130.12
|
| Rate for Payer: Amerigroup Medicaid |
$115.21
|
| Rate for Payer: Amerigroup Medicare |
$115.28
|
| Rate for Payer: Cash Price |
$182.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$171.21
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$114.14
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$114.09
|
| Rate for Payer: Medical Associates Commercial |
$171.21
|
| Rate for Payer: Medical Associates Managed Medicare |
$114.14
|
| Rate for Payer: Midlands Choice Commercial |
$159.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$115.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$171.21
|
| Rate for Payer: United Healthcare Commercial |
$205.45
|
| Rate for Payer: United Healthcare Managed Medicare |
$134.69
|
|
|
methylPREDNISolone 40 mg preservative-free Pow
|
Facility
IP
|
$37.92
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
43701166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$34.13 |
| Rate for Payer: Aetna of IA Commercial |
$34.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.13
|
| Rate for Payer: Cash Price |
$30.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.44
|
| Rate for Payer: Medical Associates Commercial |
$28.44
|
| Rate for Payer: Midlands Choice Commercial |
$26.54
|
| Rate for Payer: United Healthcare Commercial |
$34.13
|
|
|
methylPREDNISolone 40 mg preservative-free Pow
|
Facility
OP
|
$37.92
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
43701166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$34.13 |
| Rate for Payer: Aetna of IA Commercial |
$34.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.13
|
| Rate for Payer: Aetna of IA Medicare |
$21.61
|
| Rate for Payer: Amerigroup Medicaid |
$19.14
|
| Rate for Payer: Amerigroup Medicare |
$19.15
|
| Rate for Payer: Cash Price |
$30.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.95
|
| Rate for Payer: Medical Associates Commercial |
$28.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.96
|
| Rate for Payer: Midlands Choice Commercial |
$26.54
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.44
|
| Rate for Payer: United Healthcare Commercial |
$34.13
|
| Rate for Payer: United Healthcare Managed Medicare |
$22.37
|
|
|
methylPREDNISolone 4 mg Tab
|
Facility
IP
|
$1.89
|
|
|
Service Code
|
CPT J7509
|
| Hospital Charge Code |
43700005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: United Healthcare Commercial |
$1.70
|
| Rate for Payer: Aetna of IA Commercial |
$1.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.70
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.42
|
| Rate for Payer: Medical Associates Commercial |
$1.42
|
| Rate for Payer: Midlands Choice Commercial |
$1.32
|
|
|
methylPREDNISolone 4 mg Tab
|
Facility
OP
|
$1.89
|
|
|
Service Code
|
CPT J7509
|
| Hospital Charge Code |
43700005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Aetna of IA Commercial |
$1.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.70
|
| Rate for Payer: Aetna of IA Medicare |
$1.08
|
| Rate for Payer: Amerigroup Medicaid |
$0.95
|
| Rate for Payer: Amerigroup Medicare |
$0.95
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.94
|
| Rate for Payer: Medical Associates Commercial |
$1.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.95
|
| Rate for Payer: Midlands Choice Commercial |
$1.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.42
|
| Rate for Payer: United Healthcare Commercial |
$1.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.12
|
|
|
methylPREDNISolone 80 mg/mL 1 ml Inj Susp
|
Facility
IP
|
$50.82
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
43701196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.57 |
| Max. Negotiated Rate |
$45.74 |
| Rate for Payer: Aetna of IA Commercial |
$45.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.74
|
| Rate for Payer: Cash Price |
$40.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.12
|
| Rate for Payer: Medical Associates Commercial |
$38.12
|
| Rate for Payer: Midlands Choice Commercial |
$35.57
|
| Rate for Payer: United Healthcare Commercial |
$45.74
|
|
|
methylPREDNISolone 80 mg/mL 1 ml Inj Susp
|
Facility
OP
|
$50.82
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
43701196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$45.74 |
| Rate for Payer: Aetna of IA Commercial |
$45.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.74
|
| Rate for Payer: Aetna of IA Medicare |
$28.97
|
| Rate for Payer: Amerigroup Medicaid |
$25.65
|
| Rate for Payer: Amerigroup Medicare |
$25.66
|
| Rate for Payer: Cash Price |
$40.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.40
|
| Rate for Payer: Medical Associates Commercial |
$38.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.41
|
| Rate for Payer: Midlands Choice Commercial |
$35.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$38.12
|
| Rate for Payer: United Healthcare Commercial |
$45.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$29.98
|
|
|
metoclopramide 10mg Tab
|
Facility
IP
|
$1.17
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702749
|
|
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
|
|
|
metoclopramide 10mg Tab
|
Facility
OP
|
$1.17
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702749
|
|
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
|
|
|
metoclopramide 5 mg/5 mL Oral Syrup
|
Facility
OP
|
$7.58
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43760411
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Aetna of IA Commercial |
$6.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.82
|
| Rate for Payer: Aetna of IA Medicare |
$4.32
|
| Rate for Payer: Amerigroup Medicaid |
$3.83
|
| Rate for Payer: Amerigroup Medicare |
$3.83
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.68
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.79
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.79
|
| Rate for Payer: Medical Associates Commercial |
$5.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.79
|
| Rate for Payer: Midlands Choice Commercial |
$5.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$5.68
|
| Rate for Payer: United Healthcare Commercial |
$6.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$4.47
|
|
|
metoclopramide 5 mg/5 mL Oral Syrup
|
Facility
IP
|
$7.58
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43760411
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Aetna of IA Commercial |
$6.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.82
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.68
|
| Rate for Payer: Medical Associates Commercial |
$5.68
|
| Rate for Payer: Midlands Choice Commercial |
$5.31
|
| Rate for Payer: United Healthcare Commercial |
$6.82
|
|
|
metoclopramide 5 mg/mL 2 ML Inj Sol
|
Facility
IP
|
$23.77
|
|
|
Service Code
|
CPT J2765
|
| Hospital Charge Code |
43776593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$21.39 |
| Rate for Payer: Aetna of IA Commercial |
$21.39
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.39
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.83
|
| Rate for Payer: Medical Associates Commercial |
$17.83
|
| Rate for Payer: Midlands Choice Commercial |
$16.64
|
| Rate for Payer: United Healthcare Commercial |
$21.39
|
|
|
metoclopramide 5 mg/mL 2 ML Inj Sol
|
Facility
OP
|
$23.77
|
|
|
Service Code
|
CPT J2765
|
| Hospital Charge Code |
43776593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$21.39 |
| Rate for Payer: Aetna of IA Commercial |
$21.39
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.39
|
| Rate for Payer: Aetna of IA Medicare |
$13.55
|
| Rate for Payer: Amerigroup Medicaid |
$12.00
|
| Rate for Payer: Amerigroup Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.83
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.88
|
| Rate for Payer: Medical Associates Commercial |
$17.83
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.88
|
| Rate for Payer: Midlands Choice Commercial |
$16.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$17.83
|
| Rate for Payer: United Healthcare Commercial |
$21.39
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.02
|
|
|
metolazone 5 mg Tab
|
Facility
OP
|
$2.10
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702240
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Aetna of IA Commercial |
$1.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.89
|
| Rate for Payer: Aetna of IA Medicare |
$1.20
|
| Rate for Payer: Amerigroup Medicaid |
$1.06
|
| Rate for Payer: Amerigroup Medicare |
$1.06
|
| Rate for Payer: Cash Price |
$1.68
|
| 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 |
$1.05
|
| 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 |
$1.05
|
| Rate for Payer: Midlands Choice Commercial |
$1.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.58
|
| Rate for Payer: United Healthcare Commercial |
$1.89
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.24
|
|
|
metolazone 5 mg Tab
|
Facility
IP
|
$2.10
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702240
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Aetna of IA Commercial |
$1.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.89
|
| Rate for Payer: Cash Price |
$1.68
|
| 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 |
$1.47
|
| Rate for Payer: United Healthcare Commercial |
$1.89
|
|
|
metoprolol 5 mg/5mL SDV Inj Sol
|
Facility
OP
|
$22.61
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43701274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$20.35 |
| Rate for Payer: Aetna of IA Commercial |
$20.35
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.35
|
| Rate for Payer: Aetna of IA Medicare |
$12.89
|
| Rate for Payer: Amerigroup Medicaid |
$11.41
|
| Rate for Payer: Amerigroup Medicare |
$11.42
|
| Rate for Payer: Cash Price |
$18.09
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.96
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.30
|
| Rate for Payer: Medical Associates Commercial |
$16.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.30
|
| Rate for Payer: Midlands Choice Commercial |
$15.83
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.96
|
| Rate for Payer: United Healthcare Commercial |
$20.35
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.34
|
|
|
metoprolol 5 mg/5mL SDV Inj Sol
|
Facility
IP
|
$22.61
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43701274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.83 |
| Max. Negotiated Rate |
$20.35 |
| Rate for Payer: Aetna of IA Commercial |
$20.35
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.35
|
| Rate for Payer: Cash Price |
$18.09
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.96
|
| Rate for Payer: Medical Associates Commercial |
$16.96
|
| Rate for Payer: Midlands Choice Commercial |
$15.83
|
| Rate for Payer: United Healthcare Commercial |
$20.35
|
|
|
metoprolol SUC XL 24 HR 25 mg ER Tab
|
Facility
IP
|
$1.25
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna of IA Commercial |
$1.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.12
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.94
|
| Rate for Payer: Medical Associates Commercial |
$0.94
|
| Rate for Payer: Midlands Choice Commercial |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
|
