|
POST/WASHER TITANIUM 4.5MM X 50MM
|
Facility
OP
|
$180.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.96 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Aetna of IA Medicare |
$102.60
|
| Rate for Payer: Amerigroup Medicaid |
$90.85
|
| Rate for Payer: Amerigroup Medicare |
$90.90
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.96
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.20
|
|
|
POST/WASHER TITANIUM 4.5MM X 50MM
|
Facility
IP
|
$180.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
|
|
POST/WASH TITANIUM 4.5 MM X 52.2MM
|
Facility
IP
|
$180.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
|
|
POST/WASH TITANIUM 4.5 MM X 52.2MM
|
Facility
OP
|
$180.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.96 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Aetna of IA Medicare |
$102.60
|
| Rate for Payer: Amerigroup Medicaid |
$90.85
|
| Rate for Payer: Amerigroup Medicare |
$90.90
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.96
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.20
|
|
|
POTASSIUM
|
Facility
OP
|
$44.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
633616
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna of IA Commercial |
$39.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.60
|
| Rate for Payer: Aetna of IA Medicare |
$25.08
|
| Rate for Payer: Amerigroup Medicaid |
$22.21
|
| Rate for Payer: Amerigroup Medicare |
$22.22
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.99
|
| Rate for Payer: Medical Associates Commercial |
$33.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.00
|
| Rate for Payer: Midlands Choice Commercial |
$30.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$39.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.96
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
POTASSIUM
|
Facility
IP
|
$44.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
633616
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna of IA Commercial |
$39.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.00
|
| Rate for Payer: Medical Associates Commercial |
$33.00
|
| Rate for Payer: Midlands Choice Commercial |
$30.80
|
| Rate for Payer: United Healthcare Commercial |
$39.60
|
|
|
potassium chloride 10 mEq ER Cap
|
Facility
IP
|
$1.43
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna of IA Commercial |
$1.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.29
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.07
|
| Rate for Payer: Medical Associates Commercial |
$1.07
|
| Rate for Payer: Midlands Choice Commercial |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
|
|
potassium chloride 10 mEq ER Cap
|
Facility
OP
|
$1.43
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna of IA Commercial |
$1.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.29
|
| Rate for Payer: Aetna of IA Medicare |
$0.82
|
| Rate for Payer: Amerigroup Medicaid |
$0.72
|
| Rate for Payer: Amerigroup Medicare |
$0.72
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.07
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.71
|
| Rate for Payer: Medical Associates Commercial |
$1.07
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.72
|
| Rate for Payer: Midlands Choice Commercial |
$1.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.07
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.84
|
|
|
potassium chloride 20 mEq/15 mL Oral Liq
|
Facility
IP
|
$32.85
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43731480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$29.56 |
| Rate for Payer: Aetna of IA Commercial |
$29.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.56
|
| Rate for Payer: Cash Price |
$26.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.64
|
| Rate for Payer: Medical Associates Commercial |
$24.64
|
| Rate for Payer: Midlands Choice Commercial |
$23.00
|
| Rate for Payer: United Healthcare Commercial |
$29.56
|
|
|
potassium chloride 20 mEq/15 mL Oral Liq
|
Facility
OP
|
$32.85
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43731480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$29.56 |
| Rate for Payer: Aetna of IA Commercial |
$29.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.56
|
| Rate for Payer: Aetna of IA Medicare |
$18.72
|
| Rate for Payer: Amerigroup Medicaid |
$16.58
|
| Rate for Payer: Amerigroup Medicare |
$16.59
|
| Rate for Payer: Cash Price |
$26.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.42
|
| Rate for Payer: Medical Associates Commercial |
$24.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.42
|
| Rate for Payer: Midlands Choice Commercial |
$23.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.64
|
| Rate for Payer: United Healthcare Commercial |
$29.56
|
| Rate for Payer: United Healthcare Managed Medicare |
$19.38
|
|
|
potassium chloride 20 mEq ER Tab
|
Facility
IP
|
$1.84
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705786
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Aetna of IA Commercial |
$1.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.66
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.38
|
| Rate for Payer: Medical Associates Commercial |
$1.38
|
| Rate for Payer: Midlands Choice Commercial |
$1.29
|
| Rate for Payer: United Healthcare Commercial |
$1.66
|
|
|
potassium chloride 20 mEq ER Tab
|
Facility
OP
|
$1.84
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705786
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Aetna of IA Commercial |
$1.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.66
|
| Rate for Payer: Aetna of IA Medicare |
$1.05
|
| Rate for Payer: Amerigroup Medicaid |
$0.93
|
| Rate for Payer: Amerigroup Medicare |
$0.93
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.92
|
| Rate for Payer: Medical Associates Commercial |
$1.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.92
|
| Rate for Payer: Midlands Choice Commercial |
$1.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.38
|
| Rate for Payer: United Healthcare Commercial |
$1.66
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.09
|
|
|
potassium chloride 20 mEq Oral Pwdr
|
Facility
OP
|
$9.97
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$8.97 |
| Rate for Payer: Aetna of IA Commercial |
$8.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8.97
|
| Rate for Payer: Aetna of IA Medicare |
$5.68
|
| Rate for Payer: Amerigroup Medicaid |
$5.03
|
| Rate for Payer: Amerigroup Medicare |
$5.03
|
| Rate for Payer: Cash Price |
$7.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.48
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4.98
|
| Rate for Payer: Medical Associates Commercial |
$7.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$4.98
|
| Rate for Payer: Midlands Choice Commercial |
$6.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.48
|
| Rate for Payer: United Healthcare Commercial |
$8.97
|
| Rate for Payer: United Healthcare Managed Medicare |
$5.88
|
|
|
potassium chloride 20 mEq Oral Pwdr
|
Facility
IP
|
$9.97
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$8.97 |
| Rate for Payer: Aetna of IA Commercial |
$8.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8.97
|
| Rate for Payer: Cash Price |
$7.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.48
|
| Rate for Payer: Medical Associates Commercial |
$7.48
|
| Rate for Payer: Midlands Choice Commercial |
$6.98
|
| Rate for Payer: United Healthcare Commercial |
$8.97
|
|
|
potassium chloride 2 mEq/mL 10ml SDV
|
Facility
OP
|
$23.55
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
43713654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Aetna of IA Commercial |
$21.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.20
|
| Rate for Payer: Aetna of IA Medicare |
$13.42
|
| Rate for Payer: Amerigroup Medicaid |
$11.89
|
| Rate for Payer: Amerigroup Medicare |
$11.89
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.66
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.77
|
| Rate for Payer: Medical Associates Commercial |
$17.66
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.78
|
| Rate for Payer: Midlands Choice Commercial |
$16.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$17.66
|
| Rate for Payer: United Healthcare Commercial |
$21.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.89
|
|
|
potassium chloride 2 mEq/mL 10ml SDV
|
Facility
IP
|
$23.55
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
43713654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.48 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Aetna of IA Commercial |
$21.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.20
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.66
|
| Rate for Payer: Medical Associates Commercial |
$17.66
|
| Rate for Payer: Midlands Choice Commercial |
$16.48
|
| Rate for Payer: United Healthcare Commercial |
$21.20
|
|
|
potassium chloride 2 mEq/mL 20ml SDV
|
Facility
OP
|
$25.02
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
43700023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$22.52 |
| Rate for Payer: Aetna of IA Commercial |
$22.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.52
|
| Rate for Payer: Aetna of IA Medicare |
$14.26
|
| Rate for Payer: Amerigroup Medicaid |
$12.63
|
| Rate for Payer: Amerigroup Medicare |
$12.64
|
| Rate for Payer: Cash Price |
$20.01
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.76
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.51
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.50
|
| Rate for Payer: Medical Associates Commercial |
$18.76
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.51
|
| Rate for Payer: Midlands Choice Commercial |
$17.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.76
|
| Rate for Payer: United Healthcare Commercial |
$22.52
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.76
|
|
|
potassium chloride 2 mEq/mL 20ml SDV
|
Facility
IP
|
$25.02
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
43700023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$22.52 |
| Rate for Payer: Aetna of IA Commercial |
$22.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.52
|
| Rate for Payer: Cash Price |
$20.01
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.76
|
| Rate for Payer: Medical Associates Commercial |
$18.76
|
| Rate for Payer: Midlands Choice Commercial |
$17.51
|
| Rate for Payer: United Healthcare Commercial |
$22.52
|
|
|
potassium citrate 10 mEq ER Tab
|
Facility
OP
|
$8.73
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$7.86 |
| Rate for Payer: Aetna of IA Commercial |
$7.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7.86
|
| Rate for Payer: Aetna of IA Medicare |
$4.98
|
| Rate for Payer: Amerigroup Medicaid |
$4.41
|
| Rate for Payer: Amerigroup Medicare |
$4.41
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6.55
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4.36
|
| Rate for Payer: Medical Associates Commercial |
$6.55
|
| Rate for Payer: Medical Associates Managed Medicare |
$4.36
|
| Rate for Payer: Midlands Choice Commercial |
$6.11
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$6.55
|
| Rate for Payer: United Healthcare Commercial |
$7.86
|
| Rate for Payer: United Healthcare Managed Medicare |
$5.15
|
|
|
potassium citrate 10 mEq ER Tab
|
Facility
IP
|
$8.73
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$7.86 |
| Rate for Payer: Aetna of IA Commercial |
$7.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7.86
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6.55
|
| Rate for Payer: Medical Associates Commercial |
$6.55
|
| Rate for Payer: Midlands Choice Commercial |
$6.11
|
| Rate for Payer: United Healthcare Commercial |
$7.86
|
|
|
potassium phosphate-sodium phosphate 250 mg-280 mg-160 mg Pow UD
|
Facility
OP
|
$4.43
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43799451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$3.99 |
| Rate for Payer: Aetna of IA Commercial |
$3.99
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.99
|
| Rate for Payer: Aetna of IA Medicare |
$2.53
|
| Rate for Payer: Amerigroup Medicaid |
$2.24
|
| Rate for Payer: Amerigroup Medicare |
$2.24
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.21
|
| Rate for Payer: Medical Associates Commercial |
$3.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.22
|
| Rate for Payer: Midlands Choice Commercial |
$3.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.32
|
| Rate for Payer: United Healthcare Commercial |
$3.99
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.61
|
|
|
potassium phosphate-sodium phosphate 250 mg-280 mg-160 mg Pow UD
|
Facility
IP
|
$4.43
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43799451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$3.99 |
| Rate for Payer: Aetna of IA Commercial |
$3.99
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.99
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.32
|
| Rate for Payer: Medical Associates Commercial |
$3.32
|
| Rate for Payer: Midlands Choice Commercial |
$3.10
|
| Rate for Payer: United Healthcare Commercial |
$3.99
|
|
|
povidone iodine topical 10% Oin
|
Facility
OP
|
$12.89
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$11.60 |
| Rate for Payer: Aetna of IA Commercial |
$11.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.60
|
| Rate for Payer: Aetna of IA Medicare |
$7.35
|
| Rate for Payer: Amerigroup Medicaid |
$6.51
|
| Rate for Payer: Amerigroup Medicare |
$6.51
|
| Rate for Payer: Cash Price |
$10.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.67
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.44
|
| Rate for Payer: Medical Associates Commercial |
$9.67
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.44
|
| Rate for Payer: Midlands Choice Commercial |
$9.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.67
|
| Rate for Payer: United Healthcare Commercial |
$11.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.61
|
|
|
povidone iodine topical 10% Oin
|
Facility
IP
|
$12.89
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$11.60 |
| Rate for Payer: Aetna of IA Commercial |
$11.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.60
|
| Rate for Payer: Cash Price |
$10.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.67
|
| Rate for Payer: Medical Associates Commercial |
$9.67
|
| Rate for Payer: Midlands Choice Commercial |
$9.02
|
| Rate for Payer: United Healthcare Commercial |
$11.60
|
|
|
POWER PORT INFUSAPORT
|
Facility
OP
|
$580.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
8026269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$289.88 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of IA Commercial |
$522.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$522.00
|
| Rate for Payer: Aetna of IA Medicare |
$330.60
|
| Rate for Payer: Amerigroup Medicaid |
$292.73
|
| Rate for Payer: Amerigroup Medicare |
$292.90
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$435.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$290.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$289.88
|
| Rate for Payer: Medical Associates Commercial |
$435.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$290.00
|
| Rate for Payer: Midlands Choice Commercial |
$406.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$294.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$435.00
|
| Rate for Payer: United Healthcare Commercial |
$522.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$342.20
|
|
