|
Oxcarbazepine Trileptal DMCL
|
Facility
OP
|
$131.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
8037746
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Aetna of IA Commercial |
$117.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.90
|
| Rate for Payer: Aetna of IA Medicare |
$74.67
|
| Rate for Payer: Amerigroup Medicaid |
$66.12
|
| Rate for Payer: Amerigroup Medicare |
$66.16
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$98.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$65.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.47
|
| Rate for Payer: Medical Associates Commercial |
$98.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$65.50
|
| Rate for Payer: Midlands Choice Commercial |
$91.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$98.25
|
| Rate for Payer: United Healthcare Commercial |
$117.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$77.29
|
| Rate for Payer: Wellmark IA HMO |
$49.60
|
| Rate for Payer: Wellmark IA PPO |
$54.56
|
|
|
OXIMETRY, PULSE CONTINUOUS OVERNIGHT
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
6658828
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$282.35 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Aetna of IA Medicare |
$148.20
|
| Rate for Payer: Amerigroup Medicaid |
$131.22
|
| Rate for Payer: Amerigroup Medicare |
$131.30
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$130.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$129.95
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$130.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$131.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$195.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.40
|
| Rate for Payer: Wellmark IA HMO |
$256.68
|
| Rate for Payer: Wellmark IA PPO |
$282.35
|
|
|
OXIMETRY, PULSE CONTINUOUS OVERNIGHT
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
6658828
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
|
|
oxybutynin 5 mg Tab
|
Facility
IP
|
$2.18
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702574
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Aetna of IA Commercial |
$1.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.96
|
| Rate for Payer: Cash Price |
$1.75
|
| 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 |
$1.96
|
|
|
oxybutynin 5 mg Tab
|
Facility
OP
|
$2.18
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702574
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Aetna of IA Commercial |
$1.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.96
|
| Rate for Payer: Aetna of IA Medicare |
$1.24
|
| Rate for Payer: Amerigroup Medicaid |
$1.10
|
| Rate for Payer: Amerigroup Medicare |
$1.10
|
| Rate for Payer: Cash Price |
$1.75
|
| 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 |
$1.09
|
| 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 |
$1.09
|
| 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 |
$1.96
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.29
|
|
|
oxybutynin ER 5 mg/24 hours Tab
|
Facility
OP
|
$1.28
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Aetna of IA Commercial |
$1.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.15
|
| Rate for Payer: Aetna of IA Medicare |
$0.73
|
| Rate for Payer: Amerigroup Medicaid |
$0.65
|
| Rate for Payer: Amerigroup Medicare |
$0.65
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.96
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.64
|
| Rate for Payer: Medical Associates Commercial |
$0.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.64
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.96
|
| Rate for Payer: United Healthcare Commercial |
$1.15
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.76
|
|
|
oxybutynin ER 5 mg/24 hours Tab
|
Facility
IP
|
$1.28
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Aetna of IA Commercial |
$1.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.15
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.96
|
| Rate for Payer: Medical Associates Commercial |
$0.96
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.15
|
|
|
oxyCODONE 10 mg ER Tab
|
Facility
IP
|
$21.48
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705891
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$19.33 |
| Rate for Payer: Aetna of IA Commercial |
$19.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.33
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.11
|
| Rate for Payer: Medical Associates Commercial |
$16.11
|
| Rate for Payer: Midlands Choice Commercial |
$15.04
|
| Rate for Payer: United Healthcare Commercial |
$19.33
|
|
|
oxyCODONE 10 mg ER Tab
|
Facility
OP
|
$21.48
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705891
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$19.33 |
| Rate for Payer: Aetna of IA Commercial |
$19.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.33
|
| Rate for Payer: Aetna of IA Medicare |
$12.24
|
| Rate for Payer: Amerigroup Medicaid |
$10.84
|
| Rate for Payer: Amerigroup Medicare |
$10.85
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.11
|
| 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 |
$10.74
|
| Rate for Payer: Medical Associates Commercial |
$16.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.74
|
| Rate for Payer: Midlands Choice Commercial |
$15.04
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.11
|
| Rate for Payer: United Healthcare Commercial |
$19.33
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.67
|
|
|
oxyCODONE 20 mg/mL Con
|
Facility
OP
|
$142.32
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.13 |
| Max. Negotiated Rate |
$128.09 |
| Rate for Payer: Aetna of IA Commercial |
$128.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$128.09
|
| Rate for Payer: Aetna of IA Medicare |
$81.12
|
| Rate for Payer: Amerigroup Medicaid |
$71.83
|
| Rate for Payer: Amerigroup Medicare |
$71.87
|
| Rate for Payer: Cash Price |
$113.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$106.74
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$71.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.13
|
| Rate for Payer: Medical Associates Commercial |
$106.74
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.16
|
| Rate for Payer: Midlands Choice Commercial |
$99.62
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$72.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$106.74
|
| Rate for Payer: United Healthcare Commercial |
$128.09
|
| Rate for Payer: United Healthcare Managed Medicare |
$83.97
|
|
|
oxyCODONE 20 mg/mL Con
|
Facility
IP
|
$142.32
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.62 |
| Max. Negotiated Rate |
$128.09 |
| Rate for Payer: Aetna of IA Commercial |
$128.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$128.09
|
| Rate for Payer: Cash Price |
$113.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$106.74
|
| Rate for Payer: Medical Associates Commercial |
$106.74
|
| Rate for Payer: Midlands Choice Commercial |
$99.62
|
| Rate for Payer: United Healthcare Commercial |
$128.09
|
|
|
oxyCODONE 20mg Tab
|
Facility
OP
|
$3.57
|
|
|
Service Code
|
CPT CN101
|
| Hospital Charge Code |
43701091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna of IA Commercial |
$3.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.21
|
| Rate for Payer: Aetna of IA Medicare |
$2.03
|
| Rate for Payer: Amerigroup Medicaid |
$1.80
|
| Rate for Payer: Amerigroup Medicare |
$1.80
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.68
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.78
|
| Rate for Payer: Medical Associates Commercial |
$2.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.78
|
| Rate for Payer: Midlands Choice Commercial |
$2.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.68
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.11
|
|
|
oxyCODONE 20mg Tab
|
Facility
IP
|
$3.57
|
|
|
Service Code
|
CPT CN101
|
| Hospital Charge Code |
43701091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna of IA Commercial |
$3.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.21
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.68
|
| Rate for Payer: Medical Associates Commercial |
$2.68
|
| Rate for Payer: Midlands Choice Commercial |
$2.50
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
|
|
oxyCODONE 40 mg ER Tab
|
Facility
OP
|
$31.43
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705878
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.71 |
| Max. Negotiated Rate |
$28.29 |
| Rate for Payer: Aetna of IA Commercial |
$28.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.29
|
| Rate for Payer: Aetna of IA Medicare |
$17.92
|
| Rate for Payer: Amerigroup Medicaid |
$15.86
|
| Rate for Payer: Amerigroup Medicare |
$15.87
|
| Rate for Payer: Cash Price |
$25.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.57
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.71
|
| Rate for Payer: Medical Associates Commercial |
$23.57
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.72
|
| Rate for Payer: Midlands Choice Commercial |
$22.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.57
|
| Rate for Payer: United Healthcare Commercial |
$28.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.54
|
|
|
oxyCODONE 40 mg ER Tab
|
Facility
IP
|
$31.43
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705878
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$28.29 |
| Rate for Payer: Aetna of IA Commercial |
$28.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.29
|
| Rate for Payer: Cash Price |
$25.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.57
|
| Rate for Payer: Medical Associates Commercial |
$23.57
|
| Rate for Payer: Midlands Choice Commercial |
$22.00
|
| Rate for Payer: United Healthcare Commercial |
$28.29
|
|
|
oxyCODONE 5 mg Tab
|
Facility
IP
|
$3.90
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna of IA Commercial |
$3.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.51
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.92
|
| Rate for Payer: Medical Associates Commercial |
$2.92
|
| Rate for Payer: Midlands Choice Commercial |
$2.73
|
| Rate for Payer: United Healthcare Commercial |
$3.51
|
|
|
oxyCODONE 5 mg Tab
|
Facility
OP
|
$3.90
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna of IA Commercial |
$3.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.51
|
| Rate for Payer: Aetna of IA Medicare |
$2.22
|
| Rate for Payer: Amerigroup Medicaid |
$1.97
|
| Rate for Payer: Amerigroup Medicare |
$1.97
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.92
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.95
|
| Rate for Payer: Medical Associates Commercial |
$2.92
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.95
|
| Rate for Payer: Midlands Choice Commercial |
$2.73
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.92
|
| Rate for Payer: United Healthcare Commercial |
$3.51
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.30
|
|
|
OXYGEN/DAY
|
Facility
IP
|
$130.00
|
|
| Hospital Charge Code |
7760561
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of IA Commercial |
$117.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$97.50
|
| Rate for Payer: Medical Associates Commercial |
$97.50
|
| Rate for Payer: Midlands Choice Commercial |
$91.00
|
| Rate for Payer: United Healthcare Commercial |
$117.00
|
|
|
OXYGEN/DAY
|
Facility
OP
|
$130.00
|
|
| Hospital Charge Code |
7760561
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of IA Commercial |
$117.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.00
|
| Rate for Payer: Aetna of IA Medicare |
$74.10
|
| Rate for Payer: Amerigroup Medicaid |
$65.61
|
| Rate for Payer: Amerigroup Medicare |
$65.65
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$97.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$65.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.97
|
| Rate for Payer: Medical Associates Commercial |
$97.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$65.00
|
| Rate for Payer: Midlands Choice Commercial |
$91.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$65.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$97.50
|
| Rate for Payer: United Healthcare Commercial |
$117.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.70
|
|
|
oxymetazoline Nasal 0.05% Spry
|
Facility
IP
|
$21.80
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702522
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.26 |
| Max. Negotiated Rate |
$19.62 |
| Rate for Payer: Aetna of IA Commercial |
$19.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.62
|
| Rate for Payer: Cash Price |
$17.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.35
|
| Rate for Payer: Medical Associates Commercial |
$16.35
|
| Rate for Payer: Midlands Choice Commercial |
$15.26
|
| Rate for Payer: United Healthcare Commercial |
$19.62
|
|
|
oxymetazoline Nasal 0.05% Spry
|
Facility
OP
|
$21.80
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702522
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$19.62 |
| Rate for Payer: Aetna of IA Commercial |
$19.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.62
|
| Rate for Payer: Aetna of IA Medicare |
$12.43
|
| Rate for Payer: Amerigroup Medicaid |
$11.00
|
| Rate for Payer: Amerigroup Medicare |
$11.01
|
| Rate for Payer: Cash Price |
$17.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.35
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.90
|
| Rate for Payer: Medical Associates Commercial |
$16.35
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.90
|
| Rate for Payer: Midlands Choice Commercial |
$15.26
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.35
|
| Rate for Payer: United Healthcare Commercial |
$19.62
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.86
|
|
|
oxytocin 10 units/mL 1 ml Sol
|
Facility
IP
|
$25.42
|
|
|
Service Code
|
CPT J2590
|
| Hospital Charge Code |
43701566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.79 |
| Max. Negotiated Rate |
$22.88 |
| Rate for Payer: Aetna of IA Commercial |
$22.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.88
|
| Rate for Payer: Cash Price |
$20.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.06
|
| Rate for Payer: Medical Associates Commercial |
$19.06
|
| Rate for Payer: Midlands Choice Commercial |
$17.79
|
| Rate for Payer: United Healthcare Commercial |
$22.88
|
|
|
oxytocin 10 units/mL 1 ml Sol
|
Facility
OP
|
$25.42
|
|
|
Service Code
|
CPT J2590
|
| Hospital Charge Code |
43701566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.70 |
| Max. Negotiated Rate |
$22.88 |
| Rate for Payer: Aetna of IA Commercial |
$22.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.88
|
| Rate for Payer: Aetna of IA Medicare |
$14.49
|
| Rate for Payer: Amerigroup Medicaid |
$12.83
|
| Rate for Payer: Amerigroup Medicare |
$12.84
|
| Rate for Payer: Cash Price |
$20.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.06
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.70
|
| Rate for Payer: Medical Associates Commercial |
$19.06
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.71
|
| Rate for Payer: Midlands Choice Commercial |
$17.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.06
|
| Rate for Payer: United Healthcare Commercial |
$22.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.00
|
|
|
PACLitaxel 6 mg/mL 16.7ml MDV
|
Facility
IP
|
$113.60
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
43700416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.52 |
| Max. Negotiated Rate |
$102.24 |
| Rate for Payer: Aetna of IA Commercial |
$102.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.24
|
| Rate for Payer: Cash Price |
$90.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.20
|
| Rate for Payer: Medical Associates Commercial |
$85.20
|
| Rate for Payer: Midlands Choice Commercial |
$79.52
|
| Rate for Payer: United Healthcare Commercial |
$102.24
|
|
|
PACLitaxel 6 mg/mL 16.7ml MDV
|
Facility
OP
|
$113.60
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
43700416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.78 |
| Max. Negotiated Rate |
$102.24 |
| Rate for Payer: Aetna of IA Commercial |
$102.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.24
|
| Rate for Payer: Aetna of IA Medicare |
$64.75
|
| Rate for Payer: Amerigroup Medicaid |
$57.33
|
| Rate for Payer: Amerigroup Medicare |
$57.37
|
| Rate for Payer: Cash Price |
$90.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.20
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$56.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.78
|
| Rate for Payer: Medical Associates Commercial |
$85.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.80
|
| Rate for Payer: Midlands Choice Commercial |
$79.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.20
|
| Rate for Payer: United Healthcare Commercial |
$102.24
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.02
|
|
