|
multivitamin
|
Facility
OP
|
$22.95
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$20.66 |
| Rate for Payer: Aetna of IA Commercial |
$20.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.66
|
| Rate for Payer: Aetna of IA Medicare |
$13.08
|
| Rate for Payer: Amerigroup Medicaid |
$11.58
|
| Rate for Payer: Amerigroup Medicare |
$11.59
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.21
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.47
|
| Rate for Payer: Medical Associates Commercial |
$17.21
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.48
|
| Rate for Payer: Midlands Choice Commercial |
$16.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$17.21
|
| Rate for Payer: United Healthcare Commercial |
$20.66
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.54
|
|
|
multivitamin
|
Facility
IP
|
$22.95
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$20.66 |
| Rate for Payer: Aetna of IA Commercial |
$20.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.66
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.21
|
| Rate for Payer: Medical Associates Commercial |
$17.21
|
| Rate for Payer: Midlands Choice Commercial |
$16.06
|
| Rate for Payer: United Healthcare Commercial |
$20.66
|
|
|
multivitamin, Prenatal
|
Facility
IP
|
$1.30
|
|
|
Service Code
|
CPT S0197
|
| Hospital Charge Code |
43701928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Aetna of IA Commercial |
$1.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.17
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.98
|
| Rate for Payer: Medical Associates Commercial |
$0.98
|
| Rate for Payer: Midlands Choice Commercial |
$0.91
|
| Rate for Payer: United Healthcare Commercial |
$1.17
|
|
|
multivitamin, Prenatal
|
Facility
OP
|
$1.30
|
|
|
Service Code
|
CPT S0197
|
| Hospital Charge Code |
43701928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Aetna of IA Commercial |
$1.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.17
|
| Rate for Payer: Aetna of IA Medicare |
$0.74
|
| Rate for Payer: Amerigroup Medicaid |
$0.66
|
| Rate for Payer: Amerigroup Medicare |
$0.66
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.98
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.65
|
| Rate for Payer: Medical Associates Commercial |
$0.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.65
|
| Rate for Payer: Midlands Choice Commercial |
$0.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.98
|
| Rate for Payer: United Healthcare Commercial |
$1.17
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.77
|
|
|
multivitamin with minerals Therapeutic Multiple Vitamins with Minerals Tab
|
Facility
IP
|
$1.11
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of IA Commercial |
$1.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.00
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.83
|
| Rate for Payer: Medical Associates Commercial |
$0.83
|
| Rate for Payer: Midlands Choice Commercial |
$0.78
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
|
|
multivitamin with minerals Therapeutic Multiple Vitamins with Minerals Tab
|
Facility
OP
|
$1.11
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of IA Commercial |
$1.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.00
|
| Rate for Payer: Aetna of IA Medicare |
$0.63
|
| Rate for Payer: Amerigroup Medicaid |
$0.56
|
| Rate for Payer: Amerigroup Medicare |
$0.56
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.83
|
| 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 |
$0.55
|
| Rate for Payer: Medical Associates Commercial |
$0.83
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.56
|
| Rate for Payer: Midlands Choice Commercial |
$0.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.83
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.65
|
|
|
Mumps Virus IgG Antibody DMCL
|
Facility
OP
|
$124.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
8037744
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna of IA Commercial |
$111.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$111.60
|
| Rate for Payer: Aetna of IA Medicare |
$70.68
|
| Rate for Payer: Amerigroup Medicaid |
$62.58
|
| Rate for Payer: Amerigroup Medicare |
$62.62
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$62.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.98
|
| Rate for Payer: Medical Associates Commercial |
$93.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.00
|
| Rate for Payer: Midlands Choice Commercial |
$86.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.00
|
| Rate for Payer: United Healthcare Commercial |
$111.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$73.16
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Mumps Virus IgG Antibody DMCL
|
Facility
IP
|
$124.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
8037744
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna of IA Commercial |
$111.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$111.60
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.00
|
| Rate for Payer: Medical Associates Commercial |
$93.00
|
| Rate for Payer: Midlands Choice Commercial |
$86.80
|
| Rate for Payer: United Healthcare Commercial |
$111.60
|
|
|
MUPIROCIN 2% OINTMENT
|
Facility
OP
|
$41.00
|
|
| Hospital Charge Code |
8013713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.49 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Aetna of IA Medicare |
$23.37
|
| Rate for Payer: Amerigroup Medicaid |
$20.69
|
| Rate for Payer: Amerigroup Medicare |
$20.70
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.49
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.50
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.75
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.19
|
|
|
MUPIROCIN 2% OINTMENT
|
Facility
IP
|
$41.00
|
|
| Hospital Charge Code |
8013713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
|
|
mupirocin Top 2% Oint
|
Facility
IP
|
$25.40
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$22.86 |
| Rate for Payer: Aetna of IA Commercial |
$22.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.86
|
| Rate for Payer: Cash Price |
$20.32
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.05
|
| Rate for Payer: Medical Associates Commercial |
$19.05
|
| Rate for Payer: Midlands Choice Commercial |
$17.78
|
| Rate for Payer: United Healthcare Commercial |
$22.86
|
|
|
mupirocin Top 2% Oint
|
Facility
OP
|
$25.40
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.69 |
| Max. Negotiated Rate |
$22.86 |
| Rate for Payer: Aetna of IA Commercial |
$22.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.86
|
| Rate for Payer: Aetna of IA Medicare |
$14.48
|
| Rate for Payer: Amerigroup Medicaid |
$12.82
|
| Rate for Payer: Amerigroup Medicare |
$12.83
|
| Rate for Payer: Cash Price |
$20.32
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.05
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.69
|
| Rate for Payer: Medical Associates Commercial |
$19.05
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.70
|
| Rate for Payer: Midlands Choice Commercial |
$17.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.05
|
| Rate for Payer: United Healthcare Commercial |
$22.86
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.99
|
|
|
mycophenolate mofetil 250 mg Cap
|
Facility
OP
|
$1.54
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43725901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Aetna of IA Commercial |
$1.39
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.39
|
| Rate for Payer: Aetna of IA Medicare |
$0.88
|
| Rate for Payer: Amerigroup Medicaid |
$0.78
|
| Rate for Payer: Amerigroup Medicare |
$0.78
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.16
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.77
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.77
|
| Rate for Payer: Medical Associates Commercial |
$1.16
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.77
|
| Rate for Payer: Midlands Choice Commercial |
$1.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.16
|
| Rate for Payer: United Healthcare Commercial |
$1.39
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.91
|
|
|
mycophenolate mofetil 250 mg Cap
|
Facility
IP
|
$1.54
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43725901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Aetna of IA Commercial |
$1.39
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.39
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.16
|
| Rate for Payer: Medical Associates Commercial |
$1.16
|
| Rate for Payer: Midlands Choice Commercial |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.39
|
|
|
Mycoplasma Pneumonia antibody
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
4108792
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
Mycoplasma Pneumonia antibody
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
4108792
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$57.54
|
| Rate for Payer: Amerigroup Medicare |
$57.57
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.98
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Myeloproliferative Disorders or Poorly Differentiated Neoplasms With Major O.R. Procedures With CC
|
Facility
IP
|
$20,588.36
|
|
|
Service Code
|
MS-DRG 827
|
| Hospital Charge Code |
569
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$20,588.36 |
| Rate for Payer: Amerigroup Medicaid |
$20,488.90
|
| 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 |
$20,289.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20,588.36
|
|
|
Myeloproliferative Disorders or Poorly Differentiated Neoplasms With Major O.R. Procedures With MCC
|
Facility
IP
|
$49,587.07
|
|
|
Service Code
|
MS-DRG 826
|
| Hospital Charge Code |
568
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$49,587.07 |
| Rate for Payer: Amerigroup Medicaid |
$49,347.52
|
| 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 |
$48,868.41
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49,587.07
|
|
|
Myeloproliferative Disorders or Poorly Differentiated Neoplasms With Major O.R. Procedures Without CC/MCC
|
Facility
IP
|
$13,882.72
|
|
|
Service Code
|
MS-DRG 828
|
| Hospital Charge Code |
570
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$13,882.72 |
| Rate for Payer: Amerigroup Medicaid |
$13,815.66
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13,681.53
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,882.72
|
|
|
Myeloproliferative Disorders or Poorly Differentiated Neoplasms With Other Procedures With CC/MCC
|
Facility
IP
|
$19,808.84
|
|
|
Service Code
|
MS-DRG 829
|
| Hospital Charge Code |
571
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$19,808.84 |
| Rate for Payer: Amerigroup Medicaid |
$19,713.15
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19,521.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19,808.84
|
|
|
Myeloproliferative Disorders or Poorly Differentiated Neoplasms With Other Procedures Without CC/MCC
|
Facility
IP
|
$13,824.66
|
|
|
Service Code
|
MS-DRG 830
|
| Hospital Charge Code |
572
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$13,824.66 |
| Rate for Payer: Amerigroup Medicaid |
$13,757.87
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13,624.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,824.66
|
|
|
nabumetone 500 mg Tab
|
Facility
IP
|
$1.34
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701282
|
|
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
|
|
|
nabumetone 500 mg Tab
|
Facility
OP
|
$1.34
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701282
|
|
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
|
|
|
naloxone 0.4 mg/mL 1 ml Inj Sol
|
Facility
OP
|
$31.90
|
|
|
Service Code
|
CPT J2310
|
| Hospital Charge Code |
43702752
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$28.71 |
| Rate for Payer: Aetna of IA Commercial |
$28.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.71
|
| Rate for Payer: Aetna of IA Medicare |
$18.18
|
| Rate for Payer: Amerigroup Medicaid |
$16.10
|
| Rate for Payer: Amerigroup Medicare |
$16.11
|
| Rate for Payer: Cash Price |
$25.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.92
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.94
|
| Rate for Payer: Medical Associates Commercial |
$23.92
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.95
|
| Rate for Payer: Midlands Choice Commercial |
$22.33
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.92
|
| Rate for Payer: United Healthcare Commercial |
$28.71
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.82
|
|
|
naloxone 0.4 mg/mL 1 ml Inj Sol
|
Facility
IP
|
$31.90
|
|
|
Service Code
|
CPT J2310
|
| Hospital Charge Code |
43702752
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$28.71 |
| Rate for Payer: Aetna of IA Commercial |
$28.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.71
|
| Rate for Payer: Cash Price |
$25.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.92
|
| Rate for Payer: Medical Associates Commercial |
$23.92
|
| Rate for Payer: Midlands Choice Commercial |
$22.33
|
| Rate for Payer: United Healthcare Commercial |
$28.71
|
|
