|
Pulmonary Rehab Non COPD Charge
|
Facility
IP
|
$156.00
|
|
|
Service Code
|
CPT G0238
|
| Hospital Charge Code |
8059082
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna of IA Commercial |
$140.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.40
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.00
|
| Rate for Payer: Medical Associates Commercial |
$117.00
|
| Rate for Payer: Midlands Choice Commercial |
$109.20
|
| Rate for Payer: United Healthcare Commercial |
$140.40
|
|
|
PULMONARY REHAB PHASE II
|
Facility
OP
|
$239.00
|
|
|
Service Code
|
CPT G0424 KX
|
| Hospital Charge Code |
7702164
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$119.45 |
| Max. Negotiated Rate |
$215.10 |
| Rate for Payer: Aetna of IA Commercial |
$215.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$215.10
|
| Rate for Payer: Aetna of IA Medicare |
$136.23
|
| Rate for Payer: Amerigroup Medicaid |
$120.62
|
| Rate for Payer: Amerigroup Medicare |
$120.70
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$119.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$119.45
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$119.50
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$121.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$179.25
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$141.01
|
|
|
PULMONARY REHAB PHASE II
|
Facility
IP
|
$239.00
|
|
|
Service Code
|
CPT G0424
|
| Hospital Charge Code |
7827005
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$215.10 |
| Rate for Payer: Aetna of IA Commercial |
$215.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$215.10
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
|
|
PULMONARY REHAB PHASE II
|
Facility
IP
|
$239.00
|
|
|
Service Code
|
CPT G0424 KX
|
| Hospital Charge Code |
7702164
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$215.10 |
| Rate for Payer: Aetna of IA Commercial |
$215.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$215.10
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
|
|
PULMONARY REHAB PHASE II
|
Facility
OP
|
$239.00
|
|
|
Service Code
|
CPT G0424
|
| Hospital Charge Code |
7827005
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$119.45 |
| Max. Negotiated Rate |
$215.10 |
| Rate for Payer: Aetna of IA Commercial |
$215.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$215.10
|
| Rate for Payer: Aetna of IA Medicare |
$136.23
|
| Rate for Payer: Amerigroup Medicaid |
$120.62
|
| Rate for Payer: Amerigroup Medicare |
$120.70
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$119.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$119.45
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$119.50
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$121.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$179.25
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$141.01
|
| Rate for Payer: Wellmark IA HMO |
$189.10
|
| Rate for Payer: Wellmark IA PPO |
$208.01
|
|
|
PULMONARY REHAB PHASE II
|
Facility
OP
|
$239.00
|
|
|
Service Code
|
CPT G0424
|
| Hospital Charge Code |
7827004
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$119.45 |
| Max. Negotiated Rate |
$215.10 |
| Rate for Payer: Aetna of IA Commercial |
$215.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$215.10
|
| Rate for Payer: Aetna of IA Medicare |
$136.23
|
| Rate for Payer: Amerigroup Medicaid |
$120.62
|
| Rate for Payer: Amerigroup Medicare |
$120.70
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$119.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$119.45
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$119.50
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$121.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$179.25
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$141.01
|
| Rate for Payer: Wellmark IA HMO |
$189.10
|
| Rate for Payer: Wellmark IA PPO |
$208.01
|
|
|
PULMONARY REHAB PHASE II
|
Facility
IP
|
$239.00
|
|
|
Service Code
|
CPT G0424
|
| Hospital Charge Code |
7827004
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$215.10 |
| Rate for Payer: Aetna of IA Commercial |
$215.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$215.10
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
|
|
Pulmonary Rehab TherEx Charge
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT G0237
|
| Hospital Charge Code |
8058999
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
|
|
Pulmonary Rehab TherEx Charge
|
Facility
OP
|
$99.00
|
|
|
Service Code
|
CPT G0237
|
| Hospital Charge Code |
8058999
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$49.48 |
| Max. Negotiated Rate |
$360.78 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Aetna of IA Medicare |
$56.43
|
| Rate for Payer: Amerigroup Medicaid |
$49.97
|
| Rate for Payer: Amerigroup Medicare |
$50.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.48
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.25
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.41
|
| Rate for Payer: Wellmark IA HMO |
$327.98
|
| Rate for Payer: Wellmark IA PPO |
$360.78
|
|
|
PUNCH FOR 3.5MM PUNCHLOCK
|
Facility
OP
|
$358.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$178.93 |
| Max. Negotiated Rate |
$322.20 |
| Rate for Payer: Aetna of IA Commercial |
$322.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$322.20
|
| Rate for Payer: Aetna of IA Medicare |
$204.06
|
| Rate for Payer: Amerigroup Medicaid |
$180.68
|
| Rate for Payer: Amerigroup Medicare |
$180.79
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$268.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$179.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$178.93
|
| Rate for Payer: Medical Associates Commercial |
$268.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$179.00
|
| Rate for Payer: Midlands Choice Commercial |
$250.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$181.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$268.50
|
| Rate for Payer: United Healthcare Commercial |
$322.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$211.22
|
|
|
PUNCH FOR 3.5MM PUNCHLOCK
|
Facility
IP
|
$358.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.60 |
| Max. Negotiated Rate |
$322.20 |
| Rate for Payer: Aetna of IA Commercial |
$322.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$322.20
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$268.50
|
| Rate for Payer: Medical Associates Commercial |
$268.50
|
| Rate for Payer: Midlands Choice Commercial |
$250.60
|
| Rate for Payer: United Healthcare Commercial |
$322.20
|
|
|
PUNCTURE DRAINAGE OF LESION
|
Professional
|
$294.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
7982854
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$88.17 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna of IA Medicare |
$88.17
|
| Rate for Payer: Amerigroup Medicaid |
$91.17
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.93
|
| Rate for Payer: Medical Associates Commercial |
$167.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.17
|
| Rate for Payer: Midlands Choice Commercial |
$205.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$132.26
|
| Rate for Payer: Wellmark IA HMO |
$183.00
|
| Rate for Payer: Wellmark IA PPO |
$215.00
|
|
|
PUSHLOCK DISPOSABLE KIT FOR HIP
|
Facility
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
|
|
PUSHLOCK DISPOSABLE KIT FOR HIP
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Aetna of IA Medicare |
$179.55
|
| Rate for Payer: Amerigroup Medicaid |
$158.98
|
| Rate for Payer: Amerigroup Medicare |
$159.08
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$157.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$157.44
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$159.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$236.25
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
|
PUSHLOCK KIT
|
Facility
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
|
|
PUSHLOCK KIT
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Aetna of IA Medicare |
$179.55
|
| Rate for Payer: Amerigroup Medicaid |
$158.98
|
| Rate for Payer: Amerigroup Medicare |
$159.08
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$157.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$157.44
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$159.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$236.25
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
|
PUTTY BONE GRAFT MATRIXCELLECT 100 ALLOGRAFT 2.5ML
|
Facility
IP
|
$1,090.32
|
|
|
Service Code
|
CPT C9359
|
| Hospital Charge Code |
8935709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$763.22 |
| Max. Negotiated Rate |
$981.29 |
| Rate for Payer: Aetna of IA Commercial |
$981.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$981.29
|
| Rate for Payer: Cash Price |
$872.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$817.74
|
| Rate for Payer: Medical Associates Commercial |
$817.74
|
| Rate for Payer: Midlands Choice Commercial |
$763.22
|
| Rate for Payer: United Healthcare Commercial |
$981.29
|
|
|
PUTTY BONE GRAFT MATRIXCELLECT 100 ALLOGRAFT 2.5ML
|
Facility
OP
|
$1,090.32
|
|
|
Service Code
|
CPT C9359
|
| Hospital Charge Code |
8935709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.94 |
| Max. Negotiated Rate |
$981.29 |
| Rate for Payer: Aetna of IA Commercial |
$981.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$981.29
|
| Rate for Payer: Aetna of IA Medicare |
$621.48
|
| Rate for Payer: Amerigroup Medicaid |
$550.28
|
| Rate for Payer: Amerigroup Medicare |
$550.61
|
| Rate for Payer: Cash Price |
$872.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$817.74
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$545.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$544.94
|
| Rate for Payer: Medical Associates Commercial |
$817.74
|
| Rate for Payer: Medical Associates Managed Medicare |
$545.16
|
| Rate for Payer: Midlands Choice Commercial |
$763.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$553.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$817.74
|
| Rate for Payer: United Healthcare Commercial |
$981.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$643.29
|
|
|
pyridostiGMine 5 mg/mL Inj Sol
|
Facility
IP
|
$140.62
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43701422
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.43 |
| Max. Negotiated Rate |
$126.56 |
| Rate for Payer: Aetna of IA Commercial |
$126.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.56
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.46
|
| Rate for Payer: Medical Associates Commercial |
$105.46
|
| Rate for Payer: Midlands Choice Commercial |
$98.43
|
| Rate for Payer: United Healthcare Commercial |
$126.56
|
|
|
pyridostiGMine 5 mg/mL Inj Sol
|
Facility
OP
|
$140.62
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43701422
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.28 |
| Max. Negotiated Rate |
$126.56 |
| Rate for Payer: Aetna of IA Commercial |
$126.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.56
|
| Rate for Payer: Aetna of IA Medicare |
$80.15
|
| Rate for Payer: Amerigroup Medicaid |
$70.97
|
| Rate for Payer: Amerigroup Medicare |
$71.01
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.46
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.31
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$70.28
|
| Rate for Payer: Medical Associates Commercial |
$105.46
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.31
|
| Rate for Payer: Midlands Choice Commercial |
$98.43
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$105.46
|
| Rate for Payer: United Healthcare Commercial |
$126.56
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.97
|
|
|
pyridostiGMine 60 mg Tab
|
Facility
IP
|
$2.11
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43758719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of IA Commercial |
$1.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.90
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.58
|
| Rate for Payer: Medical Associates Commercial |
$1.58
|
| Rate for Payer: Midlands Choice Commercial |
$1.48
|
| Rate for Payer: United Healthcare Commercial |
$1.90
|
|
|
pyridostiGMine 60 mg Tab
|
Facility
OP
|
$2.11
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43758719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of IA Commercial |
$1.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.90
|
| Rate for Payer: Aetna of IA Medicare |
$1.20
|
| Rate for Payer: Amerigroup Medicaid |
$1.06
|
| Rate for Payer: Amerigroup Medicare |
$1.07
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.58
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.05
|
| Rate for Payer: Medical Associates Commercial |
$1.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.06
|
| Rate for Payer: Midlands Choice Commercial |
$1.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.58
|
| Rate for Payer: United Healthcare Commercial |
$1.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.24
|
|
|
pyridoxine 100 mg/mL 1ml MDV Inj
|
Facility
OP
|
$51.07
|
|
|
Service Code
|
CPT J3415
|
| Hospital Charge Code |
43700076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$45.96 |
| Rate for Payer: Aetna of IA Commercial |
$45.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.96
|
| Rate for Payer: Aetna of IA Medicare |
$29.11
|
| Rate for Payer: Amerigroup Medicaid |
$25.78
|
| Rate for Payer: Amerigroup Medicare |
$25.79
|
| Rate for Payer: Cash Price |
$40.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.30
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.52
|
| Rate for Payer: Medical Associates Commercial |
$38.30
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.54
|
| Rate for Payer: Midlands Choice Commercial |
$35.75
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$38.30
|
| Rate for Payer: United Healthcare Commercial |
$45.96
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.13
|
|
|
pyridoxine 100 mg/mL 1ml MDV Inj
|
Facility
IP
|
$51.07
|
|
|
Service Code
|
CPT J3415
|
| Hospital Charge Code |
43700076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$45.96 |
| Rate for Payer: Aetna of IA Commercial |
$45.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.96
|
| Rate for Payer: Cash Price |
$40.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.30
|
| Rate for Payer: Medical Associates Commercial |
$38.30
|
| Rate for Payer: Midlands Choice Commercial |
$35.75
|
| Rate for Payer: United Healthcare Commercial |
$45.96
|
|
|
pyridoxine 50 mg Tab
|
Facility
OP
|
$1.05
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of IA Commercial |
$0.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.95
|
| Rate for Payer: Aetna of IA Medicare |
$0.60
|
| Rate for Payer: Amerigroup Medicaid |
$0.53
|
| Rate for Payer: Amerigroup Medicare |
$0.53
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.79
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.53
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.52
|
| Rate for Payer: Medical Associates Commercial |
$0.79
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.53
|
| Rate for Payer: Midlands Choice Commercial |
$0.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.62
|
|
