|
PACLitaxel 6 mg/mL 25ml MDV
|
Facility
OP
|
$194.64
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
43706701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.28 |
| Max. Negotiated Rate |
$175.18 |
| Rate for Payer: Aetna of IA Commercial |
$175.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$175.18
|
| Rate for Payer: Aetna of IA Medicare |
$110.94
|
| Rate for Payer: Amerigroup Medicaid |
$98.23
|
| Rate for Payer: Amerigroup Medicare |
$98.29
|
| Rate for Payer: Cash Price |
$155.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$145.98
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$97.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$97.28
|
| Rate for Payer: Medical Associates Commercial |
$145.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$97.32
|
| Rate for Payer: Midlands Choice Commercial |
$136.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$98.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$145.98
|
| Rate for Payer: United Healthcare Commercial |
$175.18
|
| Rate for Payer: United Healthcare Managed Medicare |
$114.84
|
|
|
PACLitaxel 6 mg/mL 25ml MDV
|
Facility
IP
|
$194.64
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
43706701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.25 |
| Max. Negotiated Rate |
$175.18 |
| Rate for Payer: Aetna of IA Commercial |
$175.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$175.18
|
| Rate for Payer: Cash Price |
$155.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$145.98
|
| Rate for Payer: Medical Associates Commercial |
$145.98
|
| Rate for Payer: Midlands Choice Commercial |
$136.25
|
| Rate for Payer: United Healthcare Commercial |
$175.18
|
|
|
PACLitaxel 6 mg/mL 50 ml MDV Sol
|
Facility
IP
|
$171.72
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
43706698
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.20 |
| Max. Negotiated Rate |
$154.55 |
| Rate for Payer: Aetna of IA Commercial |
$154.55
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$154.55
|
| Rate for Payer: Cash Price |
$137.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$128.79
|
| Rate for Payer: Medical Associates Commercial |
$128.79
|
| Rate for Payer: Midlands Choice Commercial |
$120.20
|
| Rate for Payer: United Healthcare Commercial |
$154.55
|
|
|
PACLitaxel 6 mg/mL 50 ml MDV Sol
|
Facility
OP
|
$171.72
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
43706698
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.83 |
| Max. Negotiated Rate |
$154.55 |
| Rate for Payer: Aetna of IA Commercial |
$154.55
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$154.55
|
| Rate for Payer: Aetna of IA Medicare |
$97.88
|
| Rate for Payer: Amerigroup Medicaid |
$86.67
|
| Rate for Payer: Amerigroup Medicare |
$86.72
|
| Rate for Payer: Cash Price |
$137.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$128.79
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$85.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$85.83
|
| Rate for Payer: Medical Associates Commercial |
$128.79
|
| Rate for Payer: Medical Associates Managed Medicare |
$85.86
|
| Rate for Payer: Midlands Choice Commercial |
$120.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$87.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$128.79
|
| Rate for Payer: United Healthcare Commercial |
$154.55
|
| Rate for Payer: United Healthcare Managed Medicare |
$101.31
|
|
|
PACLitaxel 6 mg/mL 5 ml MDV Vial
|
Facility
IP
|
$77.96
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
43707615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.57 |
| Max. Negotiated Rate |
$70.16 |
| Rate for Payer: Aetna of IA Commercial |
$70.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$70.16
|
| Rate for Payer: Cash Price |
$62.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.47
|
| Rate for Payer: Medical Associates Commercial |
$58.47
|
| Rate for Payer: Midlands Choice Commercial |
$54.57
|
| Rate for Payer: United Healthcare Commercial |
$70.16
|
|
|
PACLitaxel 6 mg/mL 5 ml MDV Vial
|
Facility
OP
|
$77.96
|
|
|
Service Code
|
CPT J9267
|
| Hospital Charge Code |
43707615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.96 |
| Max. Negotiated Rate |
$70.16 |
| Rate for Payer: Aetna of IA Commercial |
$70.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$70.16
|
| Rate for Payer: Aetna of IA Medicare |
$44.44
|
| Rate for Payer: Amerigroup Medicaid |
$39.35
|
| Rate for Payer: Amerigroup Medicare |
$39.37
|
| Rate for Payer: Cash Price |
$62.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.47
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.96
|
| Rate for Payer: Medical Associates Commercial |
$58.47
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.98
|
| Rate for Payer: Midlands Choice Commercial |
$54.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$58.47
|
| Rate for Payer: United Healthcare Commercial |
$70.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$46.00
|
|
|
PACLitaxel protein-bound 100 mg SDV
|
Facility
OP
|
$5,916.64
|
|
|
Service Code
|
CPT J9264
|
| Hospital Charge Code |
43700514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,957.14 |
| Max. Negotiated Rate |
$5,324.98 |
| Rate for Payer: Aetna of IA Commercial |
$5,324.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,324.98
|
| Rate for Payer: Aetna of IA Medicare |
$3,372.48
|
| Rate for Payer: Amerigroup Medicaid |
$2,986.13
|
| Rate for Payer: Amerigroup Medicare |
$2,987.90
|
| Rate for Payer: Cash Price |
$4,733.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,437.48
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,958.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,957.14
|
| Rate for Payer: Medical Associates Commercial |
$4,437.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,958.32
|
| Rate for Payer: Midlands Choice Commercial |
$4,141.65
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,002.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,437.48
|
| Rate for Payer: United Healthcare Commercial |
$5,324.98
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,490.82
|
|
|
PACLitaxel protein-bound 100 mg SDV
|
Facility
IP
|
$5,916.64
|
|
|
Service Code
|
CPT J9264
|
| Hospital Charge Code |
43700514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,141.65 |
| Max. Negotiated Rate |
$5,324.98 |
| Rate for Payer: Aetna of IA Commercial |
$5,324.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,324.98
|
| Rate for Payer: Cash Price |
$4,733.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,437.48
|
| Rate for Payer: Medical Associates Commercial |
$4,437.48
|
| Rate for Payer: Midlands Choice Commercial |
$4,141.65
|
| Rate for Payer: United Healthcare Commercial |
$5,324.98
|
|
|
Pain Clinic Survey Urine DMCL
|
Facility
OP
|
$94.00
|
|
|
Service Code
|
CPT 80364
|
| Hospital Charge Code |
8539461
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of IA Commercial |
$84.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$84.60
|
| Rate for Payer: Aetna of IA Medicare |
$53.58
|
| Rate for Payer: Amerigroup Medicaid |
$47.44
|
| Rate for Payer: Amerigroup Medicare |
$47.47
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$70.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$47.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$46.98
|
| Rate for Payer: Medical Associates Commercial |
$70.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.00
|
| Rate for Payer: Midlands Choice Commercial |
$65.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$47.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$70.50
|
| Rate for Payer: United Healthcare Commercial |
$84.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$55.46
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
Pain Clinic Survey Urine DMCL
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
8539276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
Pain Clinic Survey Urine DMCL
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
8539276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.47 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$102.92
|
| Rate for Payer: Wellmark IA PPO |
$113.21
|
|
|
Pain Clinic Survey Urine DMCL
|
Facility
IP
|
$94.00
|
|
|
Service Code
|
CPT 80364
|
| Hospital Charge Code |
8539461
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of IA Commercial |
$84.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$84.60
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$70.50
|
| Rate for Payer: Medical Associates Commercial |
$70.50
|
| Rate for Payer: Midlands Choice Commercial |
$65.80
|
| Rate for Payer: United Healthcare Commercial |
$84.60
|
|
|
paliperidone palmitate 1560 mg/5 mL Sus
|
Facility
IP
|
$37,769.90
|
|
|
Service Code
|
CPT J2427
|
| Hospital Charge Code |
43799937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26,438.93 |
| Max. Negotiated Rate |
$33,992.91 |
| Rate for Payer: Aetna of IA Commercial |
$33,992.91
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33,992.91
|
| Rate for Payer: Cash Price |
$30,215.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28,327.42
|
| Rate for Payer: Medical Associates Commercial |
$28,327.42
|
| Rate for Payer: Midlands Choice Commercial |
$26,438.93
|
| Rate for Payer: United Healthcare Commercial |
$33,992.91
|
|
|
paliperidone palmitate 1560 mg/5 mL Sus
|
Facility
OP
|
$37,769.90
|
|
|
Service Code
|
CPT J2427
|
| Hospital Charge Code |
43799937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,877.40 |
| Max. Negotiated Rate |
$33,992.91 |
| Rate for Payer: Aetna of IA Commercial |
$33,992.91
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33,992.91
|
| Rate for Payer: Aetna of IA Medicare |
$21,528.84
|
| Rate for Payer: Amerigroup Medicaid |
$19,062.47
|
| Rate for Payer: Amerigroup Medicare |
$19,073.80
|
| Rate for Payer: Cash Price |
$30,215.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28,327.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18,884.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18,877.40
|
| Rate for Payer: Medical Associates Commercial |
$28,327.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$18,884.95
|
| Rate for Payer: Midlands Choice Commercial |
$26,438.93
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19,168.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$28,327.42
|
| Rate for Payer: United Healthcare Commercial |
$33,992.91
|
| Rate for Payer: United Healthcare Managed Medicare |
$22,284.24
|
|
|
palonosetron 0.25 mg/5 mL SDV
|
Facility
OP
|
$203.96
|
|
|
Service Code
|
CPT J2469
|
| Hospital Charge Code |
43706690
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$183.56 |
| Rate for Payer: Aetna of IA Commercial |
$183.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$183.56
|
| Rate for Payer: Aetna of IA Medicare |
$116.26
|
| Rate for Payer: Amerigroup Medicaid |
$102.94
|
| Rate for Payer: Amerigroup Medicare |
$103.00
|
| Rate for Payer: Cash Price |
$163.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$152.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$101.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$101.94
|
| Rate for Payer: Medical Associates Commercial |
$152.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$101.98
|
| Rate for Payer: Midlands Choice Commercial |
$142.77
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$103.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$152.97
|
| Rate for Payer: United Healthcare Commercial |
$183.56
|
| Rate for Payer: United Healthcare Managed Medicare |
$120.34
|
|
|
palonosetron 0.25 mg/5 mL SDV
|
Facility
IP
|
$203.96
|
|
|
Service Code
|
CPT J2469
|
| Hospital Charge Code |
43706690
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.77 |
| Max. Negotiated Rate |
$183.56 |
| Rate for Payer: Aetna of IA Commercial |
$183.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$183.56
|
| Rate for Payer: Cash Price |
$163.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$152.97
|
| Rate for Payer: Medical Associates Commercial |
$152.97
|
| Rate for Payer: Midlands Choice Commercial |
$142.77
|
| Rate for Payer: United Healthcare Commercial |
$183.56
|
|
|
pamidronate 3 mg/mL 10 ml SDV
|
Facility
IP
|
$54.24
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
43705820
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.97 |
| Max. Negotiated Rate |
$48.82 |
| Rate for Payer: Aetna of IA Commercial |
$48.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$48.82
|
| Rate for Payer: Cash Price |
$43.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$40.68
|
| Rate for Payer: Medical Associates Commercial |
$40.68
|
| Rate for Payer: Midlands Choice Commercial |
$37.97
|
| Rate for Payer: United Healthcare Commercial |
$48.82
|
|
|
pamidronate 3 mg/mL 10 ml SDV
|
Facility
OP
|
$54.24
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
43705820
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$48.82 |
| Rate for Payer: Aetna of IA Commercial |
$48.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$48.82
|
| Rate for Payer: Aetna of IA Medicare |
$30.92
|
| Rate for Payer: Amerigroup Medicaid |
$27.37
|
| Rate for Payer: Amerigroup Medicare |
$27.39
|
| Rate for Payer: Cash Price |
$43.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$40.68
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.12
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.11
|
| Rate for Payer: Medical Associates Commercial |
$40.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.12
|
| Rate for Payer: Midlands Choice Commercial |
$37.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$40.68
|
| Rate for Payer: United Healthcare Commercial |
$48.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$32.00
|
|
|
Pancreas, Liver and Shunt Procedures With CC
|
Facility
IP
|
$24,443.64
|
|
|
Service Code
|
MS-DRG 406
|
| Hospital Charge Code |
238
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$24,443.64 |
| Rate for Payer: Amerigroup Medicaid |
$24,325.55
|
| 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 |
$24,089.38
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24,443.64
|
|
|
Pancreas, Liver and Shunt Procedures With MCC
|
Facility
IP
|
$40,277.13
|
|
|
Service Code
|
MS-DRG 405
|
| Hospital Charge Code |
237
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$40,277.13 |
| Rate for Payer: Amerigroup Medicaid |
$40,082.55
|
| 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 |
$39,693.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$40,277.13
|
|
|
Pancreas, Liver and Shunt Procedures Without CC/MCC
|
Facility
IP
|
$17,272.45
|
|
|
Service Code
|
MS-DRG 407
|
| Hospital Charge Code |
239
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$17,272.45 |
| Rate for Payer: Amerigroup Medicaid |
$17,189.01
|
| 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 |
$17,022.13
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17,272.45
|
|
|
Pancreas Transplant
|
Facility
IP
|
$35,615.77
|
|
|
Service Code
|
MS-DRG 010
|
| Hospital Charge Code |
700
|
| Min. Negotiated Rate |
$35,099.60 |
| Max. Negotiated Rate |
$35,615.77 |
| Rate for Payer: Amerigroup Medicaid |
$35,443.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35,099.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35,615.77
|
|
|
pancrelipase
|
Facility
IP
|
$15.55
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700115
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna of IA Commercial |
$14.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.00
|
| Rate for Payer: Cash Price |
$12.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.66
|
| Rate for Payer: Medical Associates Commercial |
$11.66
|
| Rate for Payer: Midlands Choice Commercial |
$10.88
|
| Rate for Payer: United Healthcare Commercial |
$14.00
|
|
|
pancrelipase
|
Facility
OP
|
$15.55
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700115
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna of IA Commercial |
$14.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.00
|
| Rate for Payer: Aetna of IA Medicare |
$8.86
|
| Rate for Payer: Amerigroup Medicaid |
$7.85
|
| Rate for Payer: Amerigroup Medicare |
$7.85
|
| Rate for Payer: Cash Price |
$12.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.66
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.77
|
| Rate for Payer: Medical Associates Commercial |
$11.66
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.78
|
| Rate for Payer: Midlands Choice Commercial |
$10.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.66
|
| Rate for Payer: United Healthcare Commercial |
$14.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$9.17
|
|
|
pantoprazole 20 mg Oral DR Tab
|
Facility
IP
|
$1.13
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43772117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of IA Commercial |
$1.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.02
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.85
|
| Rate for Payer: Medical Associates Commercial |
$0.85
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
|
