|
propafenone 150 mg Tab
|
Facility
OP
|
$1.46
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702764
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Aetna of IA Commercial |
$1.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.31
|
| Rate for Payer: Aetna of IA Medicare |
$0.83
|
| Rate for Payer: Amerigroup Medicaid |
$0.74
|
| Rate for Payer: Amerigroup Medicare |
$0.74
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.10
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.73
|
| Rate for Payer: Medical Associates Commercial |
$1.10
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.73
|
| Rate for Payer: Midlands Choice Commercial |
$1.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.10
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.86
|
|
|
propafenone 150 mg Tab
|
Facility
IP
|
$1.46
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702764
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Aetna of IA Commercial |
$1.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.31
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.10
|
| Rate for Payer: Medical Associates Commercial |
$1.10
|
| Rate for Payer: Midlands Choice Commercial |
$1.02
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
|
|
propafenone 225 mg Tab
|
Facility
OP
|
$1.71
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of IA Commercial |
$1.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.54
|
| Rate for Payer: Aetna of IA Medicare |
$0.97
|
| Rate for Payer: Amerigroup Medicaid |
$0.86
|
| Rate for Payer: Amerigroup Medicare |
$0.86
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.85
|
| Rate for Payer: Medical Associates Commercial |
$1.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.86
|
| Rate for Payer: Midlands Choice Commercial |
$1.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.28
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.01
|
|
|
propafenone 225 mg Tab
|
Facility
IP
|
$1.71
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of IA Commercial |
$1.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.54
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.28
|
| Rate for Payer: Medical Associates Commercial |
$1.28
|
| Rate for Payer: Midlands Choice Commercial |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
|
|
proparacaine ophthalmic 0.5% Sol
|
Facility
IP
|
$144.80
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$101.36 |
| Max. Negotiated Rate |
$130.32 |
| Rate for Payer: Aetna of IA Commercial |
$130.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$130.32
|
| Rate for Payer: Cash Price |
$115.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.60
|
| Rate for Payer: Medical Associates Commercial |
$108.60
|
| Rate for Payer: Midlands Choice Commercial |
$101.36
|
| Rate for Payer: United Healthcare Commercial |
$130.32
|
|
|
proparacaine ophthalmic 0.5% Sol
|
Facility
OP
|
$144.80
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.37 |
| Max. Negotiated Rate |
$130.32 |
| Rate for Payer: Aetna of IA Commercial |
$130.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$130.32
|
| Rate for Payer: Aetna of IA Medicare |
$82.54
|
| Rate for Payer: Amerigroup Medicaid |
$73.08
|
| Rate for Payer: Amerigroup Medicare |
$73.12
|
| Rate for Payer: Cash Price |
$115.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$72.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$72.37
|
| Rate for Payer: Medical Associates Commercial |
$108.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.40
|
| Rate for Payer: Midlands Choice Commercial |
$101.36
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$73.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$108.60
|
| Rate for Payer: United Healthcare Commercial |
$130.32
|
| Rate for Payer: United Healthcare Managed Medicare |
$85.43
|
|
|
propofol 10 mg/mL 100ml SDV IV Emul
|
Facility
OP
|
$60.80
|
|
|
Service Code
|
CPT J2704
|
| Hospital Charge Code |
43700273
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.39 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna of IA Commercial |
$54.72
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.72
|
| Rate for Payer: Aetna of IA Medicare |
$34.66
|
| Rate for Payer: Amerigroup Medicaid |
$30.69
|
| Rate for Payer: Amerigroup Medicare |
$30.70
|
| Rate for Payer: Cash Price |
$48.64
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.39
|
| Rate for Payer: Medical Associates Commercial |
$45.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.40
|
| Rate for Payer: Midlands Choice Commercial |
$42.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.60
|
| Rate for Payer: United Healthcare Commercial |
$54.72
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.87
|
|
|
propofol 10 mg/mL 100ml SDV IV Emul
|
Facility
IP
|
$60.80
|
|
|
Service Code
|
CPT J2704
|
| Hospital Charge Code |
43700273
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.56 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna of IA Commercial |
$54.72
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.72
|
| Rate for Payer: Cash Price |
$48.64
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.60
|
| Rate for Payer: Medical Associates Commercial |
$45.60
|
| Rate for Payer: Midlands Choice Commercial |
$42.56
|
| Rate for Payer: United Healthcare Commercial |
$54.72
|
|
|
propofol 10 mg/mL 20 ml SDV IV Emul
|
Facility
OP
|
$28.17
|
|
|
Service Code
|
CPT J2704
|
| Hospital Charge Code |
43723172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna of IA Commercial |
$25.35
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.35
|
| Rate for Payer: Aetna of IA Medicare |
$16.06
|
| Rate for Payer: Amerigroup Medicaid |
$14.22
|
| Rate for Payer: Amerigroup Medicare |
$14.23
|
| Rate for Payer: Cash Price |
$22.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.13
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.08
|
| Rate for Payer: Medical Associates Commercial |
$21.13
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.08
|
| Rate for Payer: Midlands Choice Commercial |
$19.72
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.13
|
| Rate for Payer: United Healthcare Commercial |
$25.35
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.62
|
|
|
propofol 10 mg/mL 20 ml SDV IV Emul
|
Facility
IP
|
$28.17
|
|
|
Service Code
|
CPT J2704
|
| Hospital Charge Code |
43723172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.72 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna of IA Commercial |
$25.35
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.35
|
| Rate for Payer: Cash Price |
$22.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.13
|
| Rate for Payer: Medical Associates Commercial |
$21.13
|
| Rate for Payer: Midlands Choice Commercial |
$19.72
|
| Rate for Payer: United Healthcare Commercial |
$25.35
|
|
|
propofol 10 mg/mL 50 ml SDV IV Emul
|
Facility
OP
|
$41.05
|
|
|
Service Code
|
CPT J2704
|
| Hospital Charge Code |
43758971
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$36.94 |
| Rate for Payer: Aetna of IA Commercial |
$36.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.94
|
| Rate for Payer: Aetna of IA Medicare |
$23.40
|
| Rate for Payer: Amerigroup Medicaid |
$20.72
|
| Rate for Payer: Amerigroup Medicare |
$20.73
|
| Rate for Payer: Cash Price |
$32.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.79
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.52
|
| Rate for Payer: Medical Associates Commercial |
$30.79
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.52
|
| Rate for Payer: Midlands Choice Commercial |
$28.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.79
|
| Rate for Payer: United Healthcare Commercial |
$36.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.22
|
|
|
propofol 10 mg/mL 50 ml SDV IV Emul
|
Facility
IP
|
$41.05
|
|
|
Service Code
|
CPT J2704
|
| Hospital Charge Code |
43758971
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.74 |
| Max. Negotiated Rate |
$36.94 |
| Rate for Payer: Aetna of IA Commercial |
$36.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.94
|
| Rate for Payer: Cash Price |
$32.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.79
|
| Rate for Payer: Medical Associates Commercial |
$30.79
|
| Rate for Payer: Midlands Choice Commercial |
$28.74
|
| Rate for Payer: United Healthcare Commercial |
$36.94
|
|
|
propranolol 20 mg Tab
|
Facility
IP
|
$1.58
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of IA Commercial |
$1.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.42
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.18
|
| Rate for Payer: Medical Associates Commercial |
$1.18
|
| Rate for Payer: Midlands Choice Commercial |
$1.11
|
| Rate for Payer: United Healthcare Commercial |
$1.42
|
|
|
propranolol 20 mg Tab
|
Facility
OP
|
$1.58
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of IA Commercial |
$1.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.42
|
| Rate for Payer: Aetna of IA Medicare |
$0.90
|
| Rate for Payer: Amerigroup Medicaid |
$0.80
|
| Rate for Payer: Amerigroup Medicare |
$0.80
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.18
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.79
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.79
|
| Rate for Payer: Medical Associates Commercial |
$1.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.79
|
| Rate for Payer: Midlands Choice Commercial |
$1.11
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.18
|
| Rate for Payer: United Healthcare Commercial |
$1.42
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.93
|
|
|
propranolol 60 mg ER Cap
|
Facility
OP
|
$1.79
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702523
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Aetna of IA Commercial |
$1.61
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.61
|
| Rate for Payer: Aetna of IA Medicare |
$1.02
|
| Rate for Payer: Amerigroup Medicaid |
$0.90
|
| Rate for Payer: Amerigroup Medicare |
$0.90
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.34
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.89
|
| Rate for Payer: Medical Associates Commercial |
$1.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.90
|
| Rate for Payer: Midlands Choice Commercial |
$1.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.34
|
| Rate for Payer: United Healthcare Commercial |
$1.61
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.06
|
|
|
propranolol 60 mg ER Cap
|
Facility
IP
|
$1.79
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702523
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Aetna of IA Commercial |
$1.61
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.61
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.34
|
| Rate for Payer: Medical Associates Commercial |
$1.34
|
| Rate for Payer: Midlands Choice Commercial |
$1.25
|
| Rate for Payer: United Healthcare Commercial |
$1.61
|
|
|
propranolol 80 mg ERCap
|
Facility
OP
|
$1.88
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701388
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Aetna of IA Commercial |
$1.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.69
|
| Rate for Payer: Aetna of IA Medicare |
$1.07
|
| Rate for Payer: Amerigroup Medicaid |
$0.95
|
| Rate for Payer: Amerigroup Medicare |
$0.95
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.94
|
| Rate for Payer: Medical Associates Commercial |
$1.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.94
|
| Rate for Payer: Midlands Choice Commercial |
$1.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.41
|
| Rate for Payer: United Healthcare Commercial |
$1.69
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.11
|
|
|
propranolol 80 mg ERCap
|
Facility
IP
|
$1.88
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701388
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Aetna of IA Commercial |
$1.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.69
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.41
|
| Rate for Payer: Medical Associates Commercial |
$1.41
|
| Rate for Payer: Midlands Choice Commercial |
$1.32
|
| Rate for Payer: United Healthcare Commercial |
$1.69
|
|
|
propylthiouracil 50 mg Tab
|
Facility
OP
|
$2.99
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna of IA Commercial |
$2.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.69
|
| Rate for Payer: Aetna of IA Medicare |
$1.70
|
| Rate for Payer: Amerigroup Medicaid |
$1.51
|
| Rate for Payer: Amerigroup Medicare |
$1.51
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.49
|
| Rate for Payer: Medical Associates Commercial |
$2.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.50
|
| Rate for Payer: Midlands Choice Commercial |
$2.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.24
|
| Rate for Payer: United Healthcare Commercial |
$2.69
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.76
|
|
|
propylthiouracil 50 mg Tab
|
Facility
IP
|
$2.99
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna of IA Commercial |
$2.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.69
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.24
|
| Rate for Payer: Medical Associates Commercial |
$2.24
|
| Rate for Payer: Midlands Choice Commercial |
$2.09
|
| Rate for Payer: United Healthcare Commercial |
$2.69
|
|
|
Prostatectomy With CC
|
Facility
IP
|
$12,453.61
|
|
|
Service Code
|
MS-DRG 666
|
| Hospital Charge Code |
448
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$12,453.61 |
| Rate for Payer: Amerigroup Medicaid |
$12,393.44
|
| 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 |
$12,273.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,453.61
|
|
|
Prostatectomy With MCC
|
Facility
IP
|
$29,896.34
|
|
|
Service Code
|
MS-DRG 665
|
| Hospital Charge Code |
447
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$29,896.34 |
| Rate for Payer: Amerigroup Medicaid |
$29,751.91
|
| 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 |
$29,463.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29,896.34
|
|
|
Prostatectomy Without CC/MCC
|
Facility
IP
|
$7,755.82
|
|
|
Service Code
|
MS-DRG 667
|
| Hospital Charge Code |
449
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,755.82 |
| Rate for Payer: Amerigroup Medicaid |
$7,718.36
|
| 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 |
$7,643.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,755.82
|
|
|
PROSTH TRAIN 15 MIN EACH
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT 97761 GP
|
| Hospital Charge Code |
1042081
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
|
|
PROSTH TRAIN 15 MIN EACH
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT 97761 GP
|
| Hospital Charge Code |
1042081
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Aetna of IA Medicare |
$59.28
|
| Rate for Payer: Amerigroup Medicaid |
$52.49
|
| Rate for Payer: Amerigroup Medicare |
$52.52
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.00
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.36
|
|
