|
POWER PORT INFUSAPORT
|
Facility
IP
|
$580.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
8026269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.00 |
| 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: Cash Price |
$464.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$435.00
|
| Rate for Payer: Medical Associates Commercial |
$435.00
|
| Rate for Payer: Midlands Choice Commercial |
$406.00
|
| Rate for Payer: United Healthcare Commercial |
$522.00
|
|
|
pralidoxime 1 g IV SDV Inj
|
Facility
IP
|
$349.46
|
|
|
Service Code
|
CPT J2730
|
| Hospital Charge Code |
43711287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$244.62 |
| Max. Negotiated Rate |
$314.51 |
| Rate for Payer: Aetna of IA Commercial |
$314.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$314.51
|
| Rate for Payer: Cash Price |
$279.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$262.10
|
| Rate for Payer: Medical Associates Commercial |
$262.10
|
| Rate for Payer: Midlands Choice Commercial |
$244.62
|
| Rate for Payer: United Healthcare Commercial |
$314.51
|
|
|
pralidoxime 1 g IV SDV Inj
|
Facility
OP
|
$349.46
|
|
|
Service Code
|
CPT J2730
|
| Hospital Charge Code |
43711287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$174.66 |
| Max. Negotiated Rate |
$314.51 |
| Rate for Payer: Aetna of IA Commercial |
$314.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$314.51
|
| Rate for Payer: Aetna of IA Medicare |
$199.19
|
| Rate for Payer: Amerigroup Medicaid |
$176.37
|
| Rate for Payer: Amerigroup Medicare |
$176.48
|
| Rate for Payer: Cash Price |
$279.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$262.10
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$174.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$174.66
|
| Rate for Payer: Medical Associates Commercial |
$262.10
|
| Rate for Payer: Medical Associates Managed Medicare |
$174.73
|
| Rate for Payer: Midlands Choice Commercial |
$244.62
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$177.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$262.10
|
| Rate for Payer: United Healthcare Commercial |
$314.51
|
| Rate for Payer: United Healthcare Managed Medicare |
$206.18
|
|
|
pramipexole 0.25 mg Tab
|
Facility
OP
|
$1.15
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701003
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of IA Commercial |
$1.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.04
|
| Rate for Payer: Aetna of IA Medicare |
$0.66
|
| Rate for Payer: Amerigroup Medicaid |
$0.58
|
| Rate for Payer: Amerigroup Medicare |
$0.58
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.86
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.57
|
| Rate for Payer: Medical Associates Commercial |
$0.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.58
|
| Rate for Payer: Midlands Choice Commercial |
$0.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.86
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.68
|
|
|
pramipexole 0.25 mg Tab
|
Facility
IP
|
$1.15
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701003
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of IA Commercial |
$1.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.04
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.86
|
| Rate for Payer: Medical Associates Commercial |
$0.86
|
| Rate for Payer: Midlands Choice Commercial |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
|
|
pramipexole 0.5 mg Tab
|
Facility
OP
|
$1.11
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| 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 |
$0.56
|
| Rate for Payer: Amerigroup Medicare |
$0.56
|
| Rate for Payer: Cash Price |
$0.88
|
| 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 |
$0.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.55
|
| Rate for Payer: Medical Associates Commercial |
$0.83
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.56
|
| Rate for Payer: Midlands Choice Commercial |
$0.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.83
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.65
|
|
|
pramipexole 0.5 mg Tab
|
Facility
IP
|
$1.11
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702063
|
|
Hospital Revenue Code
|
637
|
| 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 |
$0.88
|
| 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
|
|
|
pramoxine Top 1% Rectal Foam 15gm
|
Facility
IP
|
$188.40
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43789413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.88 |
| Max. Negotiated Rate |
$169.56 |
| Rate for Payer: Aetna of IA Commercial |
$169.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$169.56
|
| Rate for Payer: Cash Price |
$150.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$141.30
|
| Rate for Payer: Medical Associates Commercial |
$141.30
|
| Rate for Payer: Midlands Choice Commercial |
$131.88
|
| Rate for Payer: United Healthcare Commercial |
$169.56
|
|
|
pramoxine Top 1% Rectal Foam 15gm
|
Facility
OP
|
$188.40
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43789413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.16 |
| Max. Negotiated Rate |
$169.56 |
| Rate for Payer: Aetna of IA Commercial |
$169.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$169.56
|
| Rate for Payer: Aetna of IA Medicare |
$107.39
|
| Rate for Payer: Amerigroup Medicaid |
$95.09
|
| Rate for Payer: Amerigroup Medicare |
$95.14
|
| Rate for Payer: Cash Price |
$150.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$141.30
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$94.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$94.16
|
| Rate for Payer: Medical Associates Commercial |
$141.30
|
| Rate for Payer: Medical Associates Managed Medicare |
$94.20
|
| Rate for Payer: Midlands Choice Commercial |
$131.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$95.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$141.30
|
| Rate for Payer: United Healthcare Commercial |
$169.56
|
| Rate for Payer: United Healthcare Managed Medicare |
$111.16
|
|
|
prasugrel 10 mg Tab
|
Facility
OP
|
$1.74
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43711456
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of IA Commercial |
$1.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.57
|
| Rate for Payer: Aetna of IA Medicare |
$0.99
|
| Rate for Payer: Amerigroup Medicaid |
$0.88
|
| Rate for Payer: Amerigroup Medicare |
$0.88
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.30
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.87
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.87
|
| Rate for Payer: Medical Associates Commercial |
$1.30
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.87
|
| Rate for Payer: Midlands Choice Commercial |
$1.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.30
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.03
|
|
|
prasugrel 10 mg Tab
|
Facility
IP
|
$1.74
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43711456
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of IA Commercial |
$1.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.57
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.30
|
| Rate for Payer: Medical Associates Commercial |
$1.30
|
| Rate for Payer: Midlands Choice Commercial |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
|
|
pravastatin 20 mg Tab
|
Facility
IP
|
$1.17
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700313
|
|
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
|
|
|
pravastatin 20 mg Tab
|
Facility
OP
|
$1.17
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700313
|
|
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
|
|
|
prazosin 1 mg Cap
|
Facility
OP
|
$1.53
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702078
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna of IA Commercial |
$1.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.38
|
| Rate for Payer: Aetna of IA Medicare |
$0.87
|
| Rate for Payer: Amerigroup Medicaid |
$0.77
|
| Rate for Payer: Amerigroup Medicare |
$0.77
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.15
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.77
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.76
|
| Rate for Payer: Medical Associates Commercial |
$1.15
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.77
|
| Rate for Payer: Midlands Choice Commercial |
$1.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.15
|
| Rate for Payer: United Healthcare Commercial |
$1.38
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.90
|
|
|
prazosin 1 mg Cap
|
Facility
IP
|
$1.53
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702078
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna of IA Commercial |
$1.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.38
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.15
|
| Rate for Payer: Medical Associates Commercial |
$1.15
|
| Rate for Payer: Midlands Choice Commercial |
$1.07
|
| Rate for Payer: United Healthcare Commercial |
$1.38
|
|
|
Prealbumin DMCL
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
8037781
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| 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 |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Prealbumin DMCL
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
8037781
|
|
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
|
|
|
prednisoLONE 45 mg/15 mL Syr
|
Facility
OP
|
$69.24
|
|
|
Service Code
|
CPT J7510
|
| Hospital Charge Code |
43702245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$62.32 |
| Rate for Payer: Aetna of IA Commercial |
$62.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$62.32
|
| Rate for Payer: Aetna of IA Medicare |
$39.47
|
| Rate for Payer: Amerigroup Medicaid |
$34.95
|
| Rate for Payer: Amerigroup Medicare |
$34.97
|
| Rate for Payer: Cash Price |
$55.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.93
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.61
|
| Rate for Payer: Medical Associates Commercial |
$51.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.62
|
| Rate for Payer: Midlands Choice Commercial |
$48.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.93
|
| Rate for Payer: United Healthcare Commercial |
$62.32
|
| Rate for Payer: United Healthcare Managed Medicare |
$40.85
|
|
|
prednisoLONE 45 mg/15 mL Syr
|
Facility
IP
|
$69.24
|
|
|
Service Code
|
CPT J7510
|
| Hospital Charge Code |
43702245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$62.32 |
| Rate for Payer: Aetna of IA Commercial |
$62.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$62.32
|
| Rate for Payer: Cash Price |
$55.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.93
|
| Rate for Payer: Medical Associates Commercial |
$51.93
|
| Rate for Payer: Midlands Choice Commercial |
$48.47
|
| Rate for Payer: United Healthcare Commercial |
$62.32
|
|
|
prednisoLONE Ophth acetate 1% Susp 5 ml
|
Facility
OP
|
$106.80
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702390
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.38 |
| Max. Negotiated Rate |
$96.12 |
| Rate for Payer: Aetna of IA Commercial |
$96.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$96.12
|
| Rate for Payer: Aetna of IA Medicare |
$60.88
|
| Rate for Payer: Amerigroup Medicaid |
$53.90
|
| Rate for Payer: Amerigroup Medicare |
$53.93
|
| Rate for Payer: Cash Price |
$85.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$80.10
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$53.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$53.38
|
| Rate for Payer: Medical Associates Commercial |
$80.10
|
| Rate for Payer: Medical Associates Managed Medicare |
$53.40
|
| Rate for Payer: Midlands Choice Commercial |
$74.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$54.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$80.10
|
| Rate for Payer: United Healthcare Commercial |
$96.12
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.01
|
|
|
prednisoLONE Ophth acetate 1% Susp 5 ml
|
Facility
IP
|
$106.80
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702390
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$96.12 |
| Rate for Payer: Aetna of IA Commercial |
$96.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$96.12
|
| Rate for Payer: Cash Price |
$85.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$80.10
|
| Rate for Payer: Medical Associates Commercial |
$80.10
|
| Rate for Payer: Midlands Choice Commercial |
$74.76
|
| Rate for Payer: United Healthcare Commercial |
$96.12
|
|
|
prednisoLONE sodium phosphate 5 mg/5 mL Oral Liq
|
Facility
IP
|
$13.27
|
|
|
Service Code
|
CPT J7510
|
| Hospital Charge Code |
43709441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna of IA Commercial |
$11.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.94
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.95
|
| Rate for Payer: Medical Associates Commercial |
$9.95
|
| Rate for Payer: Midlands Choice Commercial |
$9.29
|
| Rate for Payer: United Healthcare Commercial |
$11.94
|
|
|
prednisoLONE sodium phosphate 5 mg/5 mL Oral Liq
|
Facility
OP
|
$13.27
|
|
|
Service Code
|
CPT J7510
|
| Hospital Charge Code |
43709441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna of IA Commercial |
$11.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.94
|
| Rate for Payer: Aetna of IA Medicare |
$7.56
|
| Rate for Payer: Amerigroup Medicaid |
$6.70
|
| Rate for Payer: Amerigroup Medicare |
$6.70
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.63
|
| Rate for Payer: Medical Associates Commercial |
$9.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.64
|
| Rate for Payer: Midlands Choice Commercial |
$9.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.95
|
| Rate for Payer: United Healthcare Commercial |
$11.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.83
|
|
|
predniSONE 10 mg Tab
|
Facility
OP
|
$1.41
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701486
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Aetna of IA Commercial |
$1.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.27
|
| Rate for Payer: Aetna of IA Medicare |
$0.80
|
| Rate for Payer: Amerigroup Medicaid |
$0.71
|
| Rate for Payer: Amerigroup Medicare |
$0.71
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.06
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.70
|
| Rate for Payer: Medical Associates Commercial |
$1.06
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.71
|
| Rate for Payer: Midlands Choice Commercial |
$0.99
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.06
|
| Rate for Payer: United Healthcare Commercial |
$1.27
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.83
|
|
|
predniSONE 10 mg Tab
|
Facility
IP
|
$1.41
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701486
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Aetna of IA Commercial |
$1.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.27
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.06
|
| Rate for Payer: Medical Associates Commercial |
$1.06
|
| Rate for Payer: Midlands Choice Commercial |
$0.99
|
| Rate for Payer: United Healthcare Commercial |
$1.27
|
|
