|
PLATE TUBULAR LOCKING 4 HOLE L50MM-1
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
|
|
PLATE TUBULAR LOCKING 6 HOLE L50MM
|
Facility
IP
|
$271.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Aetna of IA Commercial |
$243.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.90
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$203.25
|
| Rate for Payer: Medical Associates Commercial |
$203.25
|
| Rate for Payer: Midlands Choice Commercial |
$189.70
|
| Rate for Payer: United Healthcare Commercial |
$243.90
|
|
|
PLATE TUBULAR LOCKING 6 HOLE L50MM
|
Facility
OP
|
$271.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.45 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Aetna of IA Commercial |
$243.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.90
|
| Rate for Payer: Aetna of IA Medicare |
$154.47
|
| Rate for Payer: Amerigroup Medicaid |
$136.77
|
| Rate for Payer: Amerigroup Medicare |
$136.86
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$203.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$135.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$135.45
|
| Rate for Payer: Medical Associates Commercial |
$203.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$135.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$137.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$203.25
|
| Rate for Payer: United Healthcare Commercial |
$243.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.89
|
|
|
Pleural Effusion With CC
|
Facility
IP
|
$9,694.78
|
|
|
Service Code
|
MS-DRG 187
|
| Hospital Charge Code |
58
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,694.78 |
| Rate for Payer: Amerigroup Medicaid |
$9,647.95
|
| 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 |
$9,554.28
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,694.78
|
|
|
Pleural Effusion With MCC
|
Facility
IP
|
$12,616.01
|
|
|
Service Code
|
MS-DRG 186
|
| Hospital Charge Code |
57
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$12,616.01 |
| Rate for Payer: Amerigroup Medicaid |
$12,555.06
|
| 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 |
$12,433.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,616.01
|
|
|
Pleural Effusion Without CC/MCC
|
Facility
IP
|
$5,404.47
|
|
|
Service Code
|
MS-DRG 188
|
| Hospital Charge Code |
59
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,404.47 |
| Rate for Payer: Amerigroup Medicaid |
$5,378.36
|
| 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 |
$5,326.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,404.47
|
|
|
pneumococcal 13-valent vaccine inj Dip CR Syr 0.5ml
|
Facility
IP
|
$407.42
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
43700304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$285.19 |
| Max. Negotiated Rate |
$366.68 |
| Rate for Payer: Aetna of IA Commercial |
$366.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$366.68
|
| Rate for Payer: Cash Price |
$325.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$305.56
|
| Rate for Payer: Medical Associates Commercial |
$305.56
|
| Rate for Payer: Midlands Choice Commercial |
$285.19
|
| Rate for Payer: United Healthcare Commercial |
$366.68
|
|
|
pneumococcal 13-valent vaccine inj Dip CR Syr 0.5ml
|
Facility
OP
|
$407.42
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
43700304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$203.63 |
| Max. Negotiated Rate |
$366.68 |
| Rate for Payer: Aetna of IA Commercial |
$366.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$366.68
|
| Rate for Payer: Aetna of IA Medicare |
$232.23
|
| Rate for Payer: Amerigroup Medicaid |
$205.62
|
| Rate for Payer: Amerigroup Medicare |
$205.75
|
| Rate for Payer: Cash Price |
$325.93
|
| Rate for Payer: Cash Price |
$325.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$305.56
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$203.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$203.63
|
| Rate for Payer: Medical Associates Commercial |
$305.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$203.71
|
| Rate for Payer: Midlands Choice Commercial |
$285.19
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$206.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$305.56
|
| Rate for Payer: United Healthcare Commercial |
$366.68
|
| Rate for Payer: United Healthcare Managed Medicare |
$240.38
|
| Rate for Payer: Wellmark IA HMO |
$207.70
|
| Rate for Payer: Wellmark IA PPO |
$228.47
|
|
|
pneumococcal 20-valent vaccine inj Dip CR Syr 0.5ml
|
Facility
OP
|
$458.11
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
43705930
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$228.96 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna of IA Commercial |
$412.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$412.30
|
| Rate for Payer: Aetna of IA Medicare |
$261.12
|
| Rate for Payer: Amerigroup Medicaid |
$231.21
|
| Rate for Payer: Amerigroup Medicare |
$231.35
|
| Rate for Payer: Cash Price |
$366.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$343.58
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$229.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$228.96
|
| Rate for Payer: Medical Associates Commercial |
$343.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$229.06
|
| Rate for Payer: Midlands Choice Commercial |
$320.68
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$232.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$343.58
|
| Rate for Payer: United Healthcare Commercial |
$412.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$270.28
|
|
|
pneumococcal 20-valent vaccine inj Dip CR Syr 0.5ml
|
Facility
IP
|
$458.11
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
43705930
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$320.68 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna of IA Commercial |
$412.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$412.30
|
| Rate for Payer: Cash Price |
$366.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$343.58
|
| Rate for Payer: Medical Associates Commercial |
$343.58
|
| Rate for Payer: Midlands Choice Commercial |
$320.68
|
| Rate for Payer: United Healthcare Commercial |
$412.30
|
|
|
pneumococcal 23-valent vaccine Inj Sol 0.5ml
|
Facility
OP
|
$227.88
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
43701070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$205.09 |
| Rate for Payer: Aetna of IA Commercial |
$205.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$205.09
|
| Rate for Payer: Aetna of IA Medicare |
$129.89
|
| Rate for Payer: Amerigroup Medicaid |
$115.01
|
| Rate for Payer: Amerigroup Medicare |
$115.08
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$170.91
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$113.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.89
|
| Rate for Payer: Medical Associates Commercial |
$170.91
|
| Rate for Payer: Medical Associates Managed Medicare |
$113.94
|
| Rate for Payer: Midlands Choice Commercial |
$159.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$115.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$170.91
|
| Rate for Payer: United Healthcare Commercial |
$205.09
|
| Rate for Payer: United Healthcare Managed Medicare |
$134.45
|
| Rate for Payer: Wellmark IA HMO |
$62.00
|
| Rate for Payer: Wellmark IA PPO |
$68.20
|
|
|
pneumococcal 23-valent vaccine Inj Sol 0.5ml
|
Facility
IP
|
$227.88
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
43701070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$159.52 |
| Max. Negotiated Rate |
$205.09 |
| Rate for Payer: Aetna of IA Commercial |
$205.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$205.09
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$170.91
|
| Rate for Payer: Medical Associates Commercial |
$170.91
|
| Rate for Payer: Midlands Choice Commercial |
$159.52
|
| Rate for Payer: United Healthcare Commercial |
$205.09
|
|
|
Pneumothorax With CC
|
Facility
IP
|
$8,081.61
|
|
|
Service Code
|
MS-DRG 200
|
| Hospital Charge Code |
71
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,081.61 |
| Rate for Payer: Amerigroup Medicaid |
$8,042.57
|
| 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 |
$7,964.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,081.61
|
|
|
Pneumothorax With MCC
|
Facility
IP
|
$12,289.24
|
|
|
Service Code
|
MS-DRG 199
|
| Hospital Charge Code |
70
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$12,289.24 |
| Rate for Payer: Amerigroup Medicaid |
$12,229.87
|
| 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 |
$12,111.13
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,289.24
|
|
|
Pneumothorax Without CC/MCC
|
Facility
IP
|
$6,688.90
|
|
|
Service Code
|
MS-DRG 201
|
| Hospital Charge Code |
72
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,688.90 |
| Rate for Payer: Amerigroup Medicaid |
$6,656.59
|
| 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 |
$6,591.96
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,688.90
|
|
|
Poisoning and Toxic Effects of Drugs With MCC
|
Facility
IP
|
$9,934.93
|
|
|
Service Code
|
MS-DRG 917
|
| Hospital Charge Code |
635
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,934.93 |
| Rate for Payer: Amerigroup Medicaid |
$9,886.94
|
| 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 |
$9,790.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,934.93
|
|
|
Poisoning and Toxic Effects of Drugs Without MCC
|
Facility
IP
|
$5,087.54
|
|
|
Service Code
|
MS-DRG 918
|
| Hospital Charge Code |
636
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,087.54 |
| Rate for Payer: Amerigroup Medicaid |
$5,062.96
|
| 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 |
$5,013.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,087.54
|
|
|
poliovirus vaccine, inactivated - Sus MDV
|
Facility
OP
|
$98.56
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
43700519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.26 |
| Max. Negotiated Rate |
$88.70 |
| Rate for Payer: Aetna of IA Commercial |
$88.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.70
|
| Rate for Payer: Aetna of IA Medicare |
$56.18
|
| Rate for Payer: Amerigroup Medicaid |
$49.74
|
| Rate for Payer: Amerigroup Medicare |
$49.77
|
| Rate for Payer: Cash Price |
$78.85
|
| Rate for Payer: Cash Price |
$78.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.92
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.26
|
| Rate for Payer: Medical Associates Commercial |
$73.92
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.28
|
| Rate for Payer: Midlands Choice Commercial |
$68.99
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$73.92
|
| Rate for Payer: United Healthcare Commercial |
$88.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.15
|
| Rate for Payer: Wellmark IA HMO |
$62.00
|
| Rate for Payer: Wellmark IA PPO |
$68.20
|
|
|
poliovirus vaccine, inactivated - Sus MDV
|
Facility
IP
|
$98.56
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
43700519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.99 |
| Max. Negotiated Rate |
$88.70 |
| Rate for Payer: Aetna of IA Commercial |
$88.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.70
|
| Rate for Payer: Cash Price |
$78.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.92
|
| Rate for Payer: Medical Associates Commercial |
$73.92
|
| Rate for Payer: Midlands Choice Commercial |
$68.99
|
| Rate for Payer: United Healthcare Commercial |
$88.70
|
|
|
polycarbophil 625 mg Tab
|
Facility
OP
|
$1.17
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701072
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of IA Commercial |
$1.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.05
|
| Rate for Payer: Aetna of IA Medicare |
$0.67
|
| Rate for Payer: Amerigroup Medicaid |
$0.59
|
| Rate for Payer: Amerigroup Medicare |
$0.59
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.88
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.59
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.58
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.59
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$1.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.69
|
|
|
polycarbophil 625 mg Tab
|
Facility
IP
|
$1.17
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701072
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of IA Commercial |
$1.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.05
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.88
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.05
|
|
|
polyethylene glycol 3350 Oral Pwdr for Recon
|
Facility
OP
|
$21.84
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43729772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna of IA Commercial |
$19.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.66
|
| Rate for Payer: Aetna of IA Medicare |
$12.45
|
| Rate for Payer: Amerigroup Medicaid |
$11.02
|
| Rate for Payer: Amerigroup Medicare |
$11.03
|
| Rate for Payer: Cash Price |
$17.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.92
|
| Rate for Payer: Medical Associates Commercial |
$16.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.92
|
| Rate for Payer: Midlands Choice Commercial |
$15.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$19.66
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.89
|
|
|
polyethylene glycol 3350 Oral Pwdr for Recon
|
Facility
IP
|
$21.84
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43729772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna of IA Commercial |
$19.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.66
|
| Rate for Payer: Cash Price |
$17.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.38
|
| Rate for Payer: Medical Associates Commercial |
$16.38
|
| Rate for Payer: Midlands Choice Commercial |
$15.29
|
| Rate for Payer: United Healthcare Commercial |
$19.66
|
|
|
polyethylene glycol 3350 - Pow 17 gm UD
|
Facility
IP
|
$5.96
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43716872
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna of IA Commercial |
$5.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.36
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.47
|
| Rate for Payer: Medical Associates Commercial |
$4.47
|
| Rate for Payer: Midlands Choice Commercial |
$4.17
|
| Rate for Payer: United Healthcare Commercial |
$5.36
|
|
|
polyethylene glycol 3350 - Pow 17 gm UD
|
Facility
OP
|
$5.96
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43716872
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna of IA Commercial |
$5.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.36
|
| Rate for Payer: Aetna of IA Medicare |
$3.40
|
| Rate for Payer: Amerigroup Medicaid |
$3.01
|
| Rate for Payer: Amerigroup Medicare |
$3.01
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.47
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.98
|
| Rate for Payer: Medical Associates Commercial |
$4.47
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.98
|
| Rate for Payer: Midlands Choice Commercial |
$4.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$4.47
|
| Rate for Payer: United Healthcare Commercial |
$5.36
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.52
|
|
