|
metoclopramide 5 mg/mL 2 ML Inj Sol [VDMC]
|
Facility
|
OP
|
$23.86
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
10405183
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna of IA Commercial |
$21.48
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.48
|
| Rate for Payer: Aetna of IA Medicare |
$13.60
|
| Rate for Payer: Amerigroup Medicaid |
$13.76
|
| Rate for Payer: Amerigroup Medicare |
$10.85
|
| Rate for Payer: Cash Price |
$19.09
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.90
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.74
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.63
|
| Rate for Payer: Medical Associates Commercial |
$17.90
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.74
|
| Rate for Payer: Midlands Choice Commercial |
$16.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.35
|
| Rate for Payer: United Healthcare Commercial |
$21.48
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.08
|
|
|
metolazone 5 mg Tab [VDMC]
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10405323
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.95 |
| 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 |
$1.21
|
| Rate for Payer: Amerigroup Medicare |
$0.96
|
| 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 |
$0.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.20
|
| Rate for Payer: Medical Associates Commercial |
$1.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.95
|
| Rate for Payer: Midlands Choice Commercial |
$1.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.09
|
| Rate for Payer: United Healthcare Commercial |
$1.89
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.24
|
|
|
metolazone 5 mg Tab [VDMC]
|
Facility
|
IP
|
$2.10
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10405323
|
|
Hospital Revenue Code
|
259
|
| 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 [VDMC]
|
Facility
|
OP
|
$21.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10405392
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$19.69 |
| Rate for Payer: Aetna of IA Commercial |
$19.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.69
|
| Rate for Payer: Aetna of IA Medicare |
$12.47
|
| Rate for Payer: Amerigroup Medicaid |
$12.62
|
| Rate for Payer: Amerigroup Medicare |
$9.94
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9.84
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.50
|
| Rate for Payer: Medical Associates Commercial |
$16.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.84
|
| Rate for Payer: Midlands Choice Commercial |
$15.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.32
|
| Rate for Payer: United Healthcare Commercial |
$19.69
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.91
|
|
|
metoprolol 5 mg/5mL SDV Inj Sol [VDMC]
|
Facility
|
IP
|
$21.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10405392
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$19.69 |
| Rate for Payer: Aetna of IA Commercial |
$19.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.69
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.41
|
| Rate for Payer: Medical Associates Commercial |
$16.41
|
| Rate for Payer: Midlands Choice Commercial |
$15.31
|
| Rate for Payer: United Healthcare Commercial |
$19.69
|
|
|
metoprolol SUC XL 24 HR 25 mg ER Tab [VDMC]
|
Facility
|
OP
|
$2.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10405463
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna of IA Commercial |
$1.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.95
|
| Rate for Payer: Aetna of IA Medicare |
$1.24
|
| Rate for Payer: Amerigroup Medicaid |
$1.25
|
| Rate for Payer: Amerigroup Medicare |
$0.99
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.63
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.24
|
| Rate for Payer: Medical Associates Commercial |
$1.63
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.98
|
| Rate for Payer: Midlands Choice Commercial |
$1.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.12
|
| Rate for Payer: United Healthcare Commercial |
$1.95
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.28
|
|
|
metoprolol SUC XL 24 HR 25 mg ER Tab [VDMC]
|
Facility
|
IP
|
$2.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10405463
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna of IA Commercial |
$1.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.95
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.63
|
| Rate for Payer: Medical Associates Commercial |
$1.63
|
| Rate for Payer: Midlands Choice Commercial |
$1.52
|
| Rate for Payer: United Healthcare Commercial |
$1.95
|
|
|
metoprolol SUC XL 24 HR 50 mg ER Tab [VDMC]
|
Facility
|
IP
|
$1.94
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10405534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Aetna of IA Commercial |
$1.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.75
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.46
|
| Rate for Payer: Medical Associates Commercial |
$1.46
|
| Rate for Payer: Midlands Choice Commercial |
$1.36
|
| Rate for Payer: United Healthcare Commercial |
$1.75
|
|
|
metoprolol SUC XL 24 HR 50 mg ER Tab [VDMC]
|
Facility
|
OP
|
$1.94
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10405534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Aetna of IA Commercial |
$1.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.75
|
| Rate for Payer: Aetna of IA Medicare |
$1.11
|
| Rate for Payer: Amerigroup Medicaid |
$1.12
|
| Rate for Payer: Amerigroup Medicare |
$0.88
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.46
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.87
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.11
|
| Rate for Payer: Medical Associates Commercial |
$1.46
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.87
|
| Rate for Payer: Midlands Choice Commercial |
$1.36
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.13
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.01
|
| Rate for Payer: United Healthcare Commercial |
$1.75
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.15
|
|
|
metoprolol TARTRATE 25 mg tab [VDMC]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10405605
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna of IA Commercial |
$1.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.08
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.90
|
| Rate for Payer: Medical Associates Commercial |
$0.90
|
| Rate for Payer: Midlands Choice Commercial |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.08
|
|
|
metoprolol TARTRATE 25 mg tab [VDMC]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10405605
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna of IA Commercial |
$1.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.08
|
| Rate for Payer: Aetna of IA Medicare |
$0.68
|
| Rate for Payer: Amerigroup Medicaid |
$0.69
|
| Rate for Payer: Amerigroup Medicare |
$0.55
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.90
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.69
|
| Rate for Payer: Medical Associates Commercial |
$0.90
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.54
|
| Rate for Payer: Midlands Choice Commercial |
$0.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.62
|
| Rate for Payer: United Healthcare Commercial |
$1.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.71
|
|
|
metoprolol TARTRATE 50 mg Tab [VDMC]
|
Facility
|
OP
|
$1.25
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10405670
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| 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: Aetna of IA Medicare |
$0.71
|
| Rate for Payer: Amerigroup Medicaid |
$0.72
|
| Rate for Payer: Amerigroup Medicare |
$0.57
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.94
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.71
|
| Rate for Payer: Medical Associates Commercial |
$0.94
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.56
|
| Rate for Payer: Midlands Choice Commercial |
$0.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.65
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.74
|
|
|
metoprolol TARTRATE 50 mg Tab [VDMC]
|
Facility
|
IP
|
$1.25
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10405670
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| 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 |
$0.87
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
|
|
metroNIDAZOLE 500 mg/100 mL IV Sol [VDMC]
|
Facility
|
OP
|
$58.43
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
10405812
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$52.59 |
| Rate for Payer: Aetna of IA Commercial |
$52.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.59
|
| Rate for Payer: Aetna of IA Medicare |
$33.31
|
| Rate for Payer: Amerigroup Medicaid |
$33.70
|
| Rate for Payer: Amerigroup Medicare |
$26.56
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.29
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.38
|
| Rate for Payer: Medical Associates Commercial |
$43.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.29
|
| Rate for Payer: Midlands Choice Commercial |
$40.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.24
|
| Rate for Payer: United Healthcare Commercial |
$52.59
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.47
|
|
|
metroNIDAZOLE 500 mg/100 mL IV Sol [VDMC]
|
Facility
|
IP
|
$58.43
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
10405812
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$40.90 |
| Max. Negotiated Rate |
$52.59 |
| Rate for Payer: Aetna of IA Commercial |
$52.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.59
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.82
|
| Rate for Payer: Medical Associates Commercial |
$43.82
|
| Rate for Payer: Midlands Choice Commercial |
$40.90
|
| Rate for Payer: United Healthcare Commercial |
$52.59
|
|
|
metroNIDAZOLE 500 mg Tab [VDMC]
|
Facility
|
OP
|
$1.26
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10405741
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of IA Commercial |
$1.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.13
|
| Rate for Payer: Aetna of IA Medicare |
$0.72
|
| Rate for Payer: Amerigroup Medicaid |
$0.72
|
| Rate for Payer: Amerigroup Medicare |
$0.57
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.94
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.72
|
| Rate for Payer: Medical Associates Commercial |
$0.94
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.56
|
| Rate for Payer: Midlands Choice Commercial |
$0.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.65
|
| Rate for Payer: United Healthcare Commercial |
$1.13
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.74
|
|
|
metroNIDAZOLE 500 mg Tab [VDMC]
|
Facility
|
IP
|
$1.26
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10405741
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of IA Commercial |
$1.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.13
|
| 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 |
$1.13
|
|
|
MG Breast Tissue Specimen Left
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 76098 LT
|
| Hospital Charge Code |
6800837
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Aetna of IA Medicare |
$86.07
|
| Rate for Payer: Amerigroup Medicaid |
$87.10
|
| Rate for Payer: Amerigroup Medicare |
$68.63
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$86.25
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.95
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$87.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.14
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$89.09
|
|
|
MG Breast Tissue Specimen Left
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 76098 LT
|
| Hospital Charge Code |
6800837
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
|
|
MG Breast Tissue Specimen Left.
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 76098 LT
|
| Hospital Charge Code |
969777
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Aetna of IA Medicare |
$86.07
|
| Rate for Payer: Amerigroup Medicaid |
$87.10
|
| Rate for Payer: Amerigroup Medicare |
$68.63
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$86.25
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.95
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$87.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.14
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$89.09
|
|
|
MG Breast Tissue Specimen Left.
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 76098 LT
|
| Hospital Charge Code |
969777
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
|
|
MG Breast Tissue Specimen Right
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 76098 RT
|
| Hospital Charge Code |
6800840
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Aetna of IA Medicare |
$86.07
|
| Rate for Payer: Amerigroup Medicaid |
$87.10
|
| Rate for Payer: Amerigroup Medicare |
$68.63
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$86.25
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.95
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$87.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.14
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$89.09
|
|
|
MG Breast Tissue Specimen Right
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 76098 RT
|
| Hospital Charge Code |
6800840
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
|
|
MG Breast Tissue Specimen Right.
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 76098 RT
|
| Hospital Charge Code |
969780
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Aetna of IA Medicare |
$86.07
|
| Rate for Payer: Amerigroup Medicaid |
$87.10
|
| Rate for Payer: Amerigroup Medicare |
$68.63
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$86.25
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.95
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$87.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.14
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$89.09
|
|
|
MG Breast Tissue Specimen Right.
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 76098 RT
|
| Hospital Charge Code |
969780
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
|
