|
REV OR REM IMPL SPINAL NS PG OR RECEIVER
|
Professional
|
$1,249.00
|
|
|
Service Code
|
CPT 63688
|
| Hospital Charge Code |
8015878
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$269.06 |
| Max. Negotiated Rate |
$874.30 |
| Rate for Payer: Aetna of IA Medicare |
$269.06
|
| Rate for Payer: Amerigroup Medicaid |
$278.21
|
| Rate for Payer: Cash Price |
$999.20
|
| Rate for Payer: Cash Price |
$999.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$322.87
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$274.44
|
| Rate for Payer: Medical Associates Commercial |
$511.21
|
| Rate for Payer: Medical Associates Managed Medicare |
$269.06
|
| Rate for Payer: Midlands Choice Commercial |
$874.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$403.59
|
| Rate for Payer: Wellmark IA HMO |
$670.00
|
| Rate for Payer: Wellmark IA PPO |
$787.00
|
|
|
Rheumatoid Factor DMCL
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
8037797
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
|
|
Rheumatoid Factor DMCL
|
Facility
OP
|
$58.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
8037797
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Aetna of IA Medicare |
$33.06
|
| Rate for Payer: Amerigroup Medicaid |
$29.27
|
| Rate for Payer: Amerigroup Medicare |
$29.29
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.99
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.00
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.22
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
RHIG
|
Facility
OP
|
$133.00
|
|
|
Service Code
|
CPT 90384
|
| Hospital Charge Code |
1378504
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.47 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna of IA Commercial |
$119.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$119.70
|
| Rate for Payer: Aetna of IA Medicare |
$75.81
|
| Rate for Payer: Amerigroup Medicaid |
$67.13
|
| Rate for Payer: Amerigroup Medicare |
$67.16
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$99.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$66.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$66.47
|
| Rate for Payer: Medical Associates Commercial |
$99.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$66.50
|
| Rate for Payer: Midlands Choice Commercial |
$93.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$67.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$99.75
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$78.47
|
|
|
RHIG
|
Facility
IP
|
$133.00
|
|
|
Service Code
|
CPT 90384
|
| Hospital Charge Code |
1378504
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna of IA Commercial |
$119.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$119.70
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$99.75
|
| Rate for Payer: Medical Associates Commercial |
$99.75
|
| Rate for Payer: Midlands Choice Commercial |
$93.10
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
|
|
RH TYPING
|
Facility
OP
|
$52.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
8015194
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Aetna of IA Medicare |
$29.64
|
| Rate for Payer: Amerigroup Medicaid |
$26.24
|
| Rate for Payer: Amerigroup Medicare |
$26.26
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.99
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.00
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.68
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
RH TYPING
|
Facility
IP
|
$52.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
8015194
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
|
|
Rhythm Strip
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
7068798
|
|
Hospital Revenue Code
|
730
|
| 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: 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
|
| Rate for Payer: Wellmark IA HMO |
$83.08
|
| Rate for Payer: Wellmark IA PPO |
$91.39
|
|
|
Rhythm Strip
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
7068798
|
|
Hospital Revenue Code
|
730
|
| 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
|
|
|
riboflavin 100 mg Tab
|
Facility
IP
|
$1.22
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43748615
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna of IA Commercial |
$1.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.10
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.92
|
| Rate for Payer: Medical Associates Commercial |
$0.92
|
| Rate for Payer: Midlands Choice Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.10
|
|
|
riboflavin 100 mg Tab
|
Facility
OP
|
$1.22
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43748615
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna of IA Commercial |
$1.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.10
|
| Rate for Payer: Aetna of IA Medicare |
$0.70
|
| Rate for Payer: Amerigroup Medicaid |
$0.62
|
| Rate for Payer: Amerigroup Medicare |
$0.62
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.92
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.61
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.61
|
| Rate for Payer: Medical Associates Commercial |
$0.92
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.61
|
| Rate for Payer: Midlands Choice Commercial |
$0.85
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.92
|
| Rate for Payer: United Healthcare Commercial |
$1.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.72
|
|
|
rifampin 300mg cap
|
Facility
OP
|
$3.39
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701538
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna of IA Commercial |
$3.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.05
|
| Rate for Payer: Aetna of IA Medicare |
$1.93
|
| Rate for Payer: Amerigroup Medicaid |
$1.71
|
| Rate for Payer: Amerigroup Medicare |
$1.71
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.54
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.69
|
| Rate for Payer: Medical Associates Commercial |
$2.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.70
|
| Rate for Payer: Midlands Choice Commercial |
$2.37
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.54
|
| Rate for Payer: United Healthcare Commercial |
$3.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.00
|
|
|
rifampin 300mg cap
|
Facility
IP
|
$3.39
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701538
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna of IA Commercial |
$3.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.05
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.54
|
| Rate for Payer: Medical Associates Commercial |
$2.54
|
| Rate for Payer: Midlands Choice Commercial |
$2.37
|
| Rate for Payer: United Healthcare Commercial |
$3.05
|
|
|
rifampin 600 mg IV Inj
|
Facility
IP
|
$236.56
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43700905
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.59 |
| Max. Negotiated Rate |
$212.90 |
| Rate for Payer: Aetna of IA Commercial |
$212.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$212.90
|
| Rate for Payer: Cash Price |
$189.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$177.42
|
| Rate for Payer: Medical Associates Commercial |
$177.42
|
| Rate for Payer: Midlands Choice Commercial |
$165.59
|
| Rate for Payer: United Healthcare Commercial |
$212.90
|
|
|
rifampin 600 mg IV Inj
|
Facility
OP
|
$236.56
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43700905
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.23 |
| Max. Negotiated Rate |
$212.90 |
| Rate for Payer: Aetna of IA Commercial |
$212.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$212.90
|
| Rate for Payer: Aetna of IA Medicare |
$134.84
|
| Rate for Payer: Amerigroup Medicaid |
$119.39
|
| Rate for Payer: Amerigroup Medicare |
$119.46
|
| Rate for Payer: Cash Price |
$189.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$177.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$118.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$118.23
|
| Rate for Payer: Medical Associates Commercial |
$177.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$118.28
|
| Rate for Payer: Midlands Choice Commercial |
$165.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$120.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$177.42
|
| Rate for Payer: United Healthcare Commercial |
$212.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$139.57
|
|
|
RING CAPSULAR TENSION 12MM
|
Facility
IP
|
$128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna of IA Commercial |
$115.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$115.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.00
|
| Rate for Payer: Medical Associates Commercial |
$96.00
|
| Rate for Payer: Midlands Choice Commercial |
$89.60
|
| Rate for Payer: United Healthcare Commercial |
$115.20
|
|
|
RING CAPSULAR TENSION 12MM
|
Facility
OP
|
$128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.97 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna of IA Commercial |
$115.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$115.20
|
| Rate for Payer: Aetna of IA Medicare |
$72.96
|
| Rate for Payer: Amerigroup Medicaid |
$64.60
|
| Rate for Payer: Amerigroup Medicare |
$64.64
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$63.97
|
| Rate for Payer: Medical Associates Commercial |
$96.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.00
|
| Rate for Payer: Midlands Choice Commercial |
$89.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$64.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$96.00
|
| Rate for Payer: United Healthcare Commercial |
$115.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$75.52
|
|
|
risperiDONE 0.25 mg Tab
|
Facility
IP
|
$1.43
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43761248
|
|
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
|
|
|
risperiDONE 0.25 mg Tab
|
Facility
OP
|
$1.43
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43761248
|
|
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
|
|
|
risperiDONE 1 mg Tab
|
Facility
OP
|
$2.16
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna of IA Commercial |
$1.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.94
|
| Rate for Payer: Aetna of IA Medicare |
$1.23
|
| Rate for Payer: Amerigroup Medicaid |
$1.09
|
| Rate for Payer: Amerigroup Medicare |
$1.09
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.62
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.08
|
| Rate for Payer: Medical Associates Commercial |
$1.62
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.08
|
| Rate for Payer: Midlands Choice Commercial |
$1.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.62
|
| Rate for Payer: United Healthcare Commercial |
$1.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.27
|
|
|
risperiDONE 1 mg Tab
|
Facility
IP
|
$2.16
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna of IA Commercial |
$1.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.94
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.62
|
| Rate for Payer: Medical Associates Commercial |
$1.62
|
| Rate for Payer: Midlands Choice Commercial |
$1.51
|
| Rate for Payer: United Healthcare Commercial |
$1.94
|
|
|
riTUXimab-abbs 10mg/mL 50mL SDV
|
Facility
OP
|
$4,914.14
|
|
|
Service Code
|
CPT Q5115
|
| Hospital Charge Code |
43700073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,456.09 |
| Max. Negotiated Rate |
$4,422.73 |
| Rate for Payer: Aetna of IA Commercial |
$4,422.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,422.73
|
| Rate for Payer: Aetna of IA Medicare |
$2,801.06
|
| Rate for Payer: Amerigroup Medicaid |
$2,480.17
|
| Rate for Payer: Amerigroup Medicare |
$2,481.64
|
| Rate for Payer: Cash Price |
$3,931.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,685.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,457.07
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,456.09
|
| Rate for Payer: Medical Associates Commercial |
$3,685.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,457.07
|
| Rate for Payer: Midlands Choice Commercial |
$3,439.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,493.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,685.60
|
| Rate for Payer: United Healthcare Commercial |
$4,422.73
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,899.34
|
|
|
riTUXimab-abbs 10mg/mL 50mL SDV
|
Facility
IP
|
$4,914.14
|
|
|
Service Code
|
CPT Q5115
|
| Hospital Charge Code |
43700073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,439.90 |
| Max. Negotiated Rate |
$4,422.73 |
| Rate for Payer: Aetna of IA Commercial |
$4,422.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,422.73
|
| Rate for Payer: Cash Price |
$3,931.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,685.60
|
| Rate for Payer: Medical Associates Commercial |
$3,685.60
|
| Rate for Payer: Midlands Choice Commercial |
$3,439.90
|
| Rate for Payer: United Healthcare Commercial |
$4,422.73
|
|
|
rivaroxaban 10 mg Tab UD
|
Facility
OP
|
$50.91
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$45.82 |
| Rate for Payer: Aetna of IA Commercial |
$45.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.82
|
| Rate for Payer: Aetna of IA Medicare |
$29.02
|
| Rate for Payer: Amerigroup Medicaid |
$25.69
|
| Rate for Payer: Amerigroup Medicare |
$25.71
|
| Rate for Payer: Cash Price |
$40.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.18
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.44
|
| Rate for Payer: Medical Associates Commercial |
$38.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.46
|
| Rate for Payer: Midlands Choice Commercial |
$35.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$38.18
|
| Rate for Payer: United Healthcare Commercial |
$45.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.04
|
|
|
rivaroxaban 10 mg Tab UD
|
Facility
IP
|
$50.91
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.64 |
| Max. Negotiated Rate |
$45.82 |
| Rate for Payer: Aetna of IA Commercial |
$45.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.82
|
| Rate for Payer: Cash Price |
$40.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.18
|
| Rate for Payer: Medical Associates Commercial |
$38.18
|
| Rate for Payer: Midlands Choice Commercial |
$35.64
|
| Rate for Payer: United Healthcare Commercial |
$45.82
|
|
