|
amitriptyline 10 mg Tab
|
Facility
OP
|
$1.26
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43761257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of IA Commercial |
$1.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.13
|
| Rate for Payer: Aetna of IA Medicare |
$0.72
|
| Rate for Payer: Amerigroup Medicaid |
$0.64
|
| Rate for Payer: Amerigroup Medicare |
$0.64
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.63
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.63
|
| Rate for Payer: Medical Associates Commercial |
$0.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.63
|
| Rate for Payer: Midlands Choice Commercial |
$0.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.95
|
| Rate for Payer: United Healthcare Commercial |
$1.13
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.74
|
|
|
amitriptyline 25 mg Tab
|
Facility
OP
|
$1.31
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Aetna of IA Commercial |
$1.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.18
|
| Rate for Payer: Aetna of IA Medicare |
$0.75
|
| Rate for Payer: Amerigroup Medicaid |
$0.66
|
| Rate for Payer: Amerigroup Medicare |
$0.66
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.98
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.65
|
| Rate for Payer: Medical Associates Commercial |
$0.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.66
|
| Rate for Payer: Midlands Choice Commercial |
$0.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.98
|
| Rate for Payer: United Healthcare Commercial |
$1.18
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.77
|
|
|
amitriptyline 25 mg Tab
|
Facility
IP
|
$1.31
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Aetna of IA Commercial |
$1.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.18
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.98
|
| Rate for Payer: Medical Associates Commercial |
$0.98
|
| Rate for Payer: Midlands Choice Commercial |
$0.92
|
| Rate for Payer: United Healthcare Commercial |
$1.18
|
|
|
amLODIPine-benazepril 5 mg-20 mg Cap
|
Facility
OP
|
$1.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Aetna of IA Commercial |
$1.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.37
|
| 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 |
$1.21
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.14
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.76
|
| Rate for Payer: Medical Associates Commercial |
$1.14
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.76
|
| Rate for Payer: Midlands Choice Commercial |
$1.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.14
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.90
|
|
|
amLODIPine-benazepril 5 mg-20 mg Cap
|
Facility
IP
|
$1.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Aetna of IA Commercial |
$1.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.37
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.14
|
| Rate for Payer: Medical Associates Commercial |
$1.14
|
| Rate for Payer: Midlands Choice Commercial |
$1.06
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
|
|
amLODIPine besylate 5 mg Tab
|
Facility
OP
|
$1.24
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna of IA Commercial |
$1.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.12
|
| Rate for Payer: Aetna of IA Medicare |
$0.71
|
| Rate for Payer: Amerigroup Medicaid |
$0.63
|
| Rate for Payer: Amerigroup Medicare |
$0.63
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.93
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.62
|
| Rate for Payer: Medical Associates Commercial |
$0.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.62
|
| Rate for Payer: Midlands Choice Commercial |
$0.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.73
|
|
|
amLODIPine besylate 5 mg Tab
|
Facility
IP
|
$1.24
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna of IA Commercial |
$1.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.12
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.93
|
| Rate for Payer: Medical Associates Commercial |
$0.93
|
| Rate for Payer: Midlands Choice Commercial |
$0.87
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
|
|
AMMONIA
|
Facility
IP
|
$122.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
1628880
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Aetna of IA Commercial |
$109.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$109.80
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$91.50
|
| Rate for Payer: Medical Associates Commercial |
$91.50
|
| Rate for Payer: Midlands Choice Commercial |
$85.40
|
| Rate for Payer: United Healthcare Commercial |
$109.80
|
|
|
AMMONIA
|
Facility
OP
|
$122.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
1628880
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Aetna of IA Commercial |
$109.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$109.80
|
| Rate for Payer: Aetna of IA Medicare |
$69.54
|
| Rate for Payer: Amerigroup Medicaid |
$61.57
|
| Rate for Payer: Amerigroup Medicare |
$61.61
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$91.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$61.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$60.98
|
| Rate for Payer: Medical Associates Commercial |
$91.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$61.00
|
| Rate for Payer: Midlands Choice Commercial |
$85.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$61.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$91.50
|
| Rate for Payer: United Healthcare Commercial |
$109.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$71.98
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
ammonium lactate Top 12% Lotion
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43755111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna of IA Commercial |
$18.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.00
|
| Rate for Payer: Aetna of IA Medicare |
$11.40
|
| Rate for Payer: Amerigroup Medicaid |
$10.09
|
| Rate for Payer: Amerigroup Medicare |
$10.10
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.00
|
| Rate for Payer: Medical Associates Commercial |
$15.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.00
|
| Rate for Payer: Midlands Choice Commercial |
$14.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$15.00
|
| Rate for Payer: United Healthcare Commercial |
$18.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.80
|
|
|
ammonium lactate Top 12% Lotion
|
Facility
IP
|
$20.00
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43755111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna of IA Commercial |
$18.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.00
|
| Rate for Payer: Medical Associates Commercial |
$15.00
|
| Rate for Payer: Midlands Choice Commercial |
$14.00
|
| Rate for Payer: United Healthcare Commercial |
$18.00
|
|
|
AMNIOCENTESIS DIAGNOSTIC
|
Facility
OP
|
$949.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
7984751
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$474.31 |
| Max. Negotiated Rate |
$2,339.94 |
| Rate for Payer: Aetna of IA Commercial |
$854.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$854.10
|
| Rate for Payer: Aetna of IA Medicare |
$540.93
|
| Rate for Payer: Amerigroup Medicaid |
$478.96
|
| Rate for Payer: Amerigroup Medicare |
$479.24
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$711.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$474.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$474.31
|
| Rate for Payer: Medical Associates Commercial |
$711.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$474.50
|
| Rate for Payer: Midlands Choice Commercial |
$664.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$481.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$711.75
|
| Rate for Payer: United Healthcare Commercial |
$854.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$559.91
|
| Rate for Payer: Wellmark IA HMO |
$2,127.22
|
| Rate for Payer: Wellmark IA PPO |
$2,339.94
|
|
|
AMNIOCENTESIS DIAGNOSTIC
|
Facility
IP
|
$949.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
7984751
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$664.30 |
| Max. Negotiated Rate |
$854.10 |
| Rate for Payer: Aetna of IA Commercial |
$854.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$854.10
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$711.75
|
| Rate for Payer: Medical Associates Commercial |
$711.75
|
| Rate for Payer: Midlands Choice Commercial |
$664.30
|
| Rate for Payer: United Healthcare Commercial |
$854.10
|
|
|
AMNION THIN GRAFT 4CMX6CM
|
Facility
OP
|
$5,445.00
|
|
|
Service Code
|
CPT A4649
|
| Hospital Charge Code |
8782686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,721.41 |
| Max. Negotiated Rate |
$4,900.50 |
| Rate for Payer: Aetna of IA Commercial |
$4,900.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,900.50
|
| Rate for Payer: Aetna of IA Medicare |
$3,103.65
|
| Rate for Payer: Amerigroup Medicaid |
$2,748.09
|
| Rate for Payer: Amerigroup Medicare |
$2,749.72
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,083.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,722.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,721.41
|
| Rate for Payer: Medical Associates Commercial |
$4,083.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,722.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,811.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,763.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,083.75
|
| Rate for Payer: United Healthcare Commercial |
$4,900.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,212.55
|
|
|
AMNION THIN GRAFT 4CMX6CM
|
Facility
IP
|
$5,445.00
|
|
|
Service Code
|
CPT A4649
|
| Hospital Charge Code |
8782686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,811.50 |
| Max. Negotiated Rate |
$4,900.50 |
| Rate for Payer: Aetna of IA Commercial |
$4,900.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,900.50
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,083.75
|
| Rate for Payer: Medical Associates Commercial |
$4,083.75
|
| Rate for Payer: Midlands Choice Commercial |
$3,811.50
|
| Rate for Payer: United Healthcare Commercial |
$4,900.50
|
|
|
amoxicillin 200 mg/5 mL 50ml suspension
|
Facility
OP
|
$12.56
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700002
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$11.30 |
| Rate for Payer: Aetna of IA Commercial |
$11.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.30
|
| Rate for Payer: Aetna of IA Medicare |
$7.16
|
| Rate for Payer: Amerigroup Medicaid |
$6.34
|
| Rate for Payer: Amerigroup Medicare |
$6.34
|
| Rate for Payer: Cash Price |
$10.05
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.28
|
| Rate for Payer: Medical Associates Commercial |
$9.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.28
|
| Rate for Payer: Midlands Choice Commercial |
$8.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.42
|
| Rate for Payer: United Healthcare Commercial |
$11.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.41
|
|
|
amoxicillin 200 mg/5 mL 50ml suspension
|
Facility
IP
|
$12.56
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700002
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$11.30 |
| Rate for Payer: Aetna of IA Commercial |
$11.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.30
|
| Rate for Payer: Cash Price |
$10.05
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.42
|
| Rate for Payer: Medical Associates Commercial |
$9.42
|
| Rate for Payer: Midlands Choice Commercial |
$8.79
|
| Rate for Payer: United Healthcare Commercial |
$11.30
|
|
|
amoxicillin 400 mg/5 mL 50 ml Pow
|
Facility
IP
|
$17.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706709
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$15.77 |
| Rate for Payer: Aetna of IA Commercial |
$15.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$15.77
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.14
|
| Rate for Payer: Medical Associates Commercial |
$13.14
|
| Rate for Payer: Midlands Choice Commercial |
$12.26
|
| Rate for Payer: United Healthcare Commercial |
$15.77
|
|
|
amoxicillin 400 mg/5 mL 50 ml Pow
|
Facility
OP
|
$17.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706709
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$15.77 |
| Rate for Payer: Aetna of IA Commercial |
$15.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$15.77
|
| Rate for Payer: Aetna of IA Medicare |
$9.99
|
| Rate for Payer: Amerigroup Medicaid |
$8.84
|
| Rate for Payer: Amerigroup Medicare |
$8.85
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.14
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.76
|
| Rate for Payer: Medical Associates Commercial |
$13.14
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.76
|
| Rate for Payer: Midlands Choice Commercial |
$12.26
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$13.14
|
| Rate for Payer: United Healthcare Commercial |
$15.77
|
| Rate for Payer: United Healthcare Managed Medicare |
$10.34
|
|
|
amoxicillin 500 mg Cap
|
Facility
IP
|
$1.54
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Aetna of IA Commercial |
$1.39
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.39
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.16
|
| Rate for Payer: Medical Associates Commercial |
$1.16
|
| Rate for Payer: Midlands Choice Commercial |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.39
|
|
|
amoxicillin 500 mg Cap
|
Facility
OP
|
$1.54
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Aetna of IA Commercial |
$1.39
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.39
|
| Rate for Payer: Aetna of IA Medicare |
$0.88
|
| Rate for Payer: Amerigroup Medicaid |
$0.78
|
| Rate for Payer: Amerigroup Medicare |
$0.78
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.16
|
| 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 |
$0.77
|
| Rate for Payer: Medical Associates Commercial |
$1.16
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.77
|
| Rate for Payer: Midlands Choice Commercial |
$1.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.16
|
| Rate for Payer: United Healthcare Commercial |
$1.39
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.91
|
|
|
amoxicillin-clavulanate 250 mg-62.5 mg/5 mL 75 ML Pow
|
Facility
OP
|
$177.32
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706702
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.62 |
| Max. Negotiated Rate |
$159.59 |
| Rate for Payer: Aetna of IA Commercial |
$159.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$159.59
|
| Rate for Payer: Aetna of IA Medicare |
$101.07
|
| Rate for Payer: Amerigroup Medicaid |
$89.49
|
| Rate for Payer: Amerigroup Medicare |
$89.55
|
| Rate for Payer: Cash Price |
$141.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.99
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$88.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$88.62
|
| Rate for Payer: Medical Associates Commercial |
$132.99
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.66
|
| Rate for Payer: Midlands Choice Commercial |
$124.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$89.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$132.99
|
| Rate for Payer: United Healthcare Commercial |
$159.59
|
| Rate for Payer: United Healthcare Managed Medicare |
$104.62
|
|
|
amoxicillin-clavulanate 250 mg-62.5 mg/5 mL 75 ML Pow
|
Facility
IP
|
$177.32
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706702
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.12 |
| Max. Negotiated Rate |
$159.59 |
| Rate for Payer: Aetna of IA Commercial |
$159.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$159.59
|
| Rate for Payer: Cash Price |
$141.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.99
|
| Rate for Payer: Medical Associates Commercial |
$132.99
|
| Rate for Payer: Midlands Choice Commercial |
$124.12
|
| Rate for Payer: United Healthcare Commercial |
$159.59
|
|
|
amoxicillin-clavulanate 500 mg-125 mg Tab
|
Facility
OP
|
$1.92
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701286
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna of IA Commercial |
$1.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.73
|
| Rate for Payer: Aetna of IA Medicare |
$1.09
|
| Rate for Payer: Amerigroup Medicaid |
$0.97
|
| Rate for Payer: Amerigroup Medicare |
$0.97
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.96
|
| Rate for Payer: Medical Associates Commercial |
$1.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.96
|
| Rate for Payer: Midlands Choice Commercial |
$1.34
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.44
|
| Rate for Payer: United Healthcare Commercial |
$1.73
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.13
|
|
|
amoxicillin-clavulanate 500 mg-125 mg Tab
|
Facility
IP
|
$1.92
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701286
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna of IA Commercial |
$1.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.73
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.44
|
| Rate for Payer: Medical Associates Commercial |
$1.44
|
| Rate for Payer: Midlands Choice Commercial |
$1.34
|
| Rate for Payer: United Healthcare Commercial |
$1.73
|
|
