multivitamin with minerals Therapeutic Multiple Vitamins with Minerals Tab[VDMC]
|
Facility
|
OP
|
$1.11
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
11361372
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.50 |
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 |
$0.64
|
Rate for Payer: Amerigroup Medicare |
$0.51
|
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 |
$0.50
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$0.64
|
Rate for Payer: Medical Associates Commercial |
$0.83
|
Rate for Payer: Medical Associates Managed Medicare |
$0.50
|
Rate for Payer: Midlands Choice Commercial |
$0.78
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$0.64
|
Rate for Payer: Partners Health Alliance Commercial |
$0.58
|
Rate for Payer: United Healthcare Commercial |
$1.00
|
Rate for Payer: United Healthcare Managed Medicare |
$0.66
|
|
multivitamin with minerals Therapeutic Multiple Vitamins with Minerals Tab[VDMC]
|
Facility
|
IP
|
$1.11
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
11361372
|
Hospital Revenue Code
|
259
|
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
|
|
Mumps Virus IgG Antibody DMCL
|
Facility
|
OP
|
$124.00
|
|
Service Code
|
CPT 86735
|
Hospital Charge Code |
8037744
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$41.83 |
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 |
$71.52
|
Rate for Payer: Amerigroup Medicare |
$56.36
|
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 |
$55.80
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$70.83
|
Rate for Payer: Medical Associates Commercial |
$93.00
|
Rate for Payer: Medical Associates Managed Medicare |
$55.80
|
Rate for Payer: Midlands Choice Commercial |
$86.80
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$71.87
|
Rate for Payer: Partners Health Alliance Commercial |
$64.17
|
Rate for Payer: United Healthcare Commercial |
$111.60
|
Rate for Payer: United Healthcare Managed Medicare |
$73.16
|
Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
Rate for Payer: Wellmark IA PPO |
$46.08
|
|
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 |
$18.45 |
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 |
$23.65
|
Rate for Payer: Amerigroup Medicare |
$18.63
|
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 |
$18.45
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$23.42
|
Rate for Payer: Medical Associates Commercial |
$30.75
|
Rate for Payer: Medical Associates Managed Medicare |
$18.45
|
Rate for Payer: Midlands Choice Commercial |
$28.70
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$23.76
|
Rate for Payer: Partners Health Alliance Commercial |
$21.22
|
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 [VDMC]
|
Facility
|
IP
|
$31.96
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10436449
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$22.37 |
Max. Negotiated Rate |
$28.76 |
Rate for Payer: Aetna of IA Commercial |
$28.76
|
Rate for Payer: Aetna of IA Medical Rental Products |
$28.76
|
Rate for Payer: Cash Price |
$25.57
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.97
|
Rate for Payer: Medical Associates Commercial |
$23.97
|
Rate for Payer: Midlands Choice Commercial |
$22.37
|
Rate for Payer: United Healthcare Commercial |
$28.76
|
|
mupirocin Top 2% Oint [VDMC]
|
Facility
|
OP
|
$31.96
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10436449
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$14.38 |
Max. Negotiated Rate |
$28.76 |
Rate for Payer: Aetna of IA Commercial |
$28.76
|
Rate for Payer: Aetna of IA Medical Rental Products |
$28.76
|
Rate for Payer: Aetna of IA Medicare |
$18.22
|
Rate for Payer: Amerigroup Medicaid |
$18.43
|
Rate for Payer: Amerigroup Medicare |
$14.53
|
Rate for Payer: Cash Price |
$25.57
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.97
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.38
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$18.26
|
Rate for Payer: Medical Associates Commercial |
$23.97
|
Rate for Payer: Medical Associates Managed Medicare |
$14.38
|
Rate for Payer: Midlands Choice Commercial |
$22.37
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$18.52
|
Rate for Payer: Partners Health Alliance Commercial |
$16.54
|
Rate for Payer: United Healthcare Commercial |
$28.76
|
Rate for Payer: United Healthcare Managed Medicare |
$18.86
|
|
mycophenolate mofetil 250 mg Cap [VDMC]
|
Facility
|
IP
|
$2.45
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10407718
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.71 |
Max. Negotiated Rate |
$2.20 |
Rate for Payer: Aetna of IA Commercial |
$2.20
|
Rate for Payer: Aetna of IA Medical Rental Products |
$2.20
|
Rate for Payer: Cash Price |
$1.96
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.84
|
Rate for Payer: Medical Associates Commercial |
$1.84
|
Rate for Payer: Midlands Choice Commercial |
$1.71
|
Rate for Payer: United Healthcare Commercial |
$2.20
|
|
mycophenolate mofetil 250 mg Cap [VDMC]
|
Facility
|
OP
|
$2.45
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10407718
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.10 |
Max. Negotiated Rate |
$2.20 |
Rate for Payer: Aetna of IA Commercial |
$2.20
|
Rate for Payer: Aetna of IA Medical Rental Products |
$2.20
|
Rate for Payer: Aetna of IA Medicare |
$1.39
|
Rate for Payer: Amerigroup Medicaid |
$1.41
|
Rate for Payer: Amerigroup Medicare |
$1.11
|
Rate for Payer: Cash Price |
$1.96
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.84
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.10
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$1.40
|
Rate for Payer: Medical Associates Commercial |
$1.84
|
Rate for Payer: Medical Associates Managed Medicare |
$1.10
|
Rate for Payer: Midlands Choice Commercial |
$1.71
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$1.42
|
Rate for Payer: Partners Health Alliance Commercial |
$1.27
|
Rate for Payer: United Healthcare Commercial |
$2.20
|
Rate for Payer: United Healthcare Managed Medicare |
$1.44
|
|
Mycoplasma Pneumonia antibody
|
Facility
|
OP
|
$114.00
|
|
Service Code
|
CPT 86738
|
Hospital Charge Code |
4108792
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$41.83 |
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 |
$65.76
|
Rate for Payer: Amerigroup Medicare |
$51.81
|
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 |
$51.30
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$65.12
|
Rate for Payer: Medical Associates Commercial |
$85.50
|
Rate for Payer: Medical Associates Managed Medicare |
$51.30
|
Rate for Payer: Midlands Choice Commercial |
$79.80
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$66.07
|
Rate for Payer: Partners Health Alliance Commercial |
$59.00
|
Rate for Payer: United Healthcare Commercial |
$102.60
|
Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
Rate for Payer: Wellmark IA PPO |
$46.08
|
|
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
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$23,553.19
|
|
Service Code
|
MSDRG 827
|
Min. Negotiated Rate |
$23,211.83 |
Max. Negotiated Rate |
$23,553.19 |
Rate for Payer: Amerigroup Medicaid |
$23,439.39
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$23,211.83
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$23,553.19
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$56,727.85
|
|
Service Code
|
MSDRG 826
|
Min. Negotiated Rate |
$55,905.68 |
Max. Negotiated Rate |
$56,727.85 |
Rate for Payer: Amerigroup Medicaid |
$56,453.77
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$55,905.68
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$56,727.85
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$15,881.91
|
|
Service Code
|
MSDRG 828
|
Min. Negotiated Rate |
$15,651.73 |
Max. Negotiated Rate |
$15,881.91 |
Rate for Payer: Amerigroup Medicaid |
$15,805.17
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$15,651.73
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$15,881.91
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$22,661.41
|
|
Service Code
|
MSDRG 829
|
Min. Negotiated Rate |
$22,332.98 |
Max. Negotiated Rate |
$22,661.41 |
Rate for Payer: Amerigroup Medicaid |
$22,551.93
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$22,332.98
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$22,661.41
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$15,815.47
|
|
Service Code
|
MSDRG 830
|
Min. Negotiated Rate |
$15,586.26 |
Max. Negotiated Rate |
$15,815.47 |
Rate for Payer: Amerigroup Medicaid |
$15,739.06
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$15,586.26
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$15,815.47
|
|
nabumetone 500 mg Tab [VDMC]
|
Facility
|
OP
|
$1.34
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10407789
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.60 |
Max. Negotiated Rate |
$1.20 |
Rate for Payer: Aetna of IA Commercial |
$1.20
|
Rate for Payer: Aetna of IA Medical Rental Products |
$1.20
|
Rate for Payer: Aetna of IA Medicare |
$0.76
|
Rate for Payer: Amerigroup Medicaid |
$0.77
|
Rate for Payer: Amerigroup Medicare |
$0.61
|
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 |
$0.60
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$0.76
|
Rate for Payer: Medical Associates Commercial |
$1.00
|
Rate for Payer: Medical Associates Managed Medicare |
$0.60
|
Rate for Payer: Midlands Choice Commercial |
$0.94
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$0.77
|
Rate for Payer: Partners Health Alliance Commercial |
$0.69
|
Rate for Payer: United Healthcare Commercial |
$1.20
|
Rate for Payer: United Healthcare Managed Medicare |
$0.79
|
|
nabumetone 500 mg Tab [VDMC]
|
Facility
|
IP
|
$1.34
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
10407789
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.94 |
Max. Negotiated Rate |
$1.20 |
Rate for Payer: Aetna of IA Commercial |
$1.20
|
Rate for Payer: Aetna of IA Medical Rental Products |
$1.20
|
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 |
$1.20
|
|
naloxone 0.4 mg/mL 1 ml Inj Sol [VDMC]
|
Facility
|
OP
|
$30.67
|
|
Service Code
|
HCPCS J2310
|
Hospital Charge Code |
10408193
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$13.80 |
Max. Negotiated Rate |
$27.60 |
Rate for Payer: Aetna of IA Commercial |
$27.60
|
Rate for Payer: Aetna of IA Medical Rental Products |
$27.60
|
Rate for Payer: Aetna of IA Medicare |
$17.48
|
Rate for Payer: Amerigroup Medicaid |
$17.69
|
Rate for Payer: Amerigroup Medicare |
$13.94
|
Rate for Payer: Cash Price |
$24.54
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.00
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.80
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$17.52
|
Rate for Payer: Medical Associates Commercial |
$23.00
|
Rate for Payer: Medical Associates Managed Medicare |
$13.80
|
Rate for Payer: Midlands Choice Commercial |
$21.47
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$17.78
|
Rate for Payer: Partners Health Alliance Commercial |
$15.87
|
Rate for Payer: United Healthcare Commercial |
$27.60
|
Rate for Payer: United Healthcare Managed Medicare |
$18.10
|
|
naloxone 0.4 mg/mL 1 ml Inj Sol [VDMC]
|
Facility
|
IP
|
$30.67
|
|
Service Code
|
HCPCS J2310
|
Hospital Charge Code |
10408193
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$21.47 |
Max. Negotiated Rate |
$27.60 |
Rate for Payer: Aetna of IA Commercial |
$27.60
|
Rate for Payer: Aetna of IA Medical Rental Products |
$27.60
|
Rate for Payer: Cash Price |
$24.54
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.00
|
Rate for Payer: Medical Associates Commercial |
$23.00
|
Rate for Payer: Midlands Choice Commercial |
$21.47
|
Rate for Payer: United Healthcare Commercial |
$27.60
|
|
naloxone 1 mg/mL Inj Sol [VDMC]
|
Facility
|
OP
|
$141.42
|
|
Service Code
|
HCPCS J2310
|
Hospital Charge Code |
10408262
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$63.64 |
Max. Negotiated Rate |
$127.27 |
Rate for Payer: Aetna of IA Commercial |
$127.27
|
Rate for Payer: Aetna of IA Medical Rental Products |
$127.27
|
Rate for Payer: Aetna of IA Medicare |
$80.61
|
Rate for Payer: Amerigroup Medicaid |
$81.57
|
Rate for Payer: Amerigroup Medicare |
$64.27
|
Rate for Payer: Cash Price |
$113.13
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$106.06
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$63.64
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$80.78
|
Rate for Payer: Medical Associates Commercial |
$106.06
|
Rate for Payer: Medical Associates Managed Medicare |
$63.64
|
Rate for Payer: Midlands Choice Commercial |
$98.99
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$81.96
|
Rate for Payer: Partners Health Alliance Commercial |
$73.18
|
Rate for Payer: United Healthcare Commercial |
$127.27
|
Rate for Payer: United Healthcare Managed Medicare |
$83.44
|
|
naloxone 1 mg/mL Inj Sol [VDMC]
|
Facility
|
IP
|
$141.42
|
|
Service Code
|
HCPCS J2310
|
Hospital Charge Code |
10408262
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$98.99 |
Max. Negotiated Rate |
$127.27 |
Rate for Payer: Aetna of IA Commercial |
$127.27
|
Rate for Payer: Aetna of IA Medical Rental Products |
$127.27
|
Rate for Payer: Cash Price |
$113.13
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$106.06
|
Rate for Payer: Medical Associates Commercial |
$106.06
|
Rate for Payer: Midlands Choice Commercial |
$98.99
|
Rate for Payer: United Healthcare Commercial |
$127.27
|
|
naltrexone 50 mg Tab[VDMC]
|
Facility
|
OP
|
$9.55
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
11391896
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$4.30 |
Max. Negotiated Rate |
$8.60 |
Rate for Payer: Aetna of IA Commercial |
$8.60
|
Rate for Payer: Aetna of IA Medical Rental Products |
$8.60
|
Rate for Payer: Aetna of IA Medicare |
$5.44
|
Rate for Payer: Amerigroup Medicaid |
$5.51
|
Rate for Payer: Amerigroup Medicare |
$4.34
|
Rate for Payer: Cash Price |
$7.64
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.16
|
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4.30
|
Rate for Payer: Iowa Total Care Managed Medicaid |
$5.46
|
Rate for Payer: Medical Associates Commercial |
$7.16
|
Rate for Payer: Medical Associates Managed Medicare |
$4.30
|
Rate for Payer: Midlands Choice Commercial |
$6.69
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$5.54
|
Rate for Payer: Partners Health Alliance Commercial |
$4.94
|
Rate for Payer: United Healthcare Commercial |
$8.60
|
Rate for Payer: United Healthcare Managed Medicare |
$5.64
|
|
naltrexone 50 mg Tab[VDMC]
|
Facility
|
IP
|
$9.55
|
|
Service Code
|
HCPCS A9270
|
Hospital Charge Code |
11391896
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$6.69 |
Max. Negotiated Rate |
$8.60 |
Rate for Payer: Aetna of IA Commercial |
$8.60
|
Rate for Payer: Aetna of IA Medical Rental Products |
$8.60
|
Rate for Payer: Cash Price |
$7.64
|
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.16
|
Rate for Payer: Medical Associates Commercial |
$7.16
|
Rate for Payer: Midlands Choice Commercial |
$6.69
|
Rate for Payer: United Healthcare Commercial |
$8.60
|
|