|
THP Albuterol Inhaler
|
Facility
IP
|
$82.88
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43799942
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.02 |
| Max. Negotiated Rate |
$74.59 |
| Rate for Payer: Aetna of IA Commercial |
$74.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$74.59
|
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$62.16
|
| Rate for Payer: Medical Associates Commercial |
$62.16
|
| Rate for Payer: Midlands Choice Commercial |
$58.02
|
| Rate for Payer: United Healthcare Commercial |
$74.59
|
|
|
THP albuterol-ipratropium 0.5mg/3mg neb sol 3mL SDV
|
Facility
IP
|
$10.32
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43768428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: Aetna of IA Commercial |
$9.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$9.29
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.74
|
| Rate for Payer: Medical Associates Commercial |
$7.74
|
| Rate for Payer: Midlands Choice Commercial |
$7.22
|
| Rate for Payer: United Healthcare Commercial |
$9.29
|
|
|
THP albuterol-ipratropium 0.5mg/3mg neb sol 3mL SDV
|
Facility
OP
|
$10.32
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43768428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: Aetna of IA Commercial |
$9.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$9.29
|
| Rate for Payer: Aetna of IA Medicare |
$5.88
|
| Rate for Payer: Amerigroup Medicaid |
$5.21
|
| Rate for Payer: Amerigroup Medicare |
$5.21
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.74
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5.16
|
| Rate for Payer: Medical Associates Commercial |
$7.74
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.16
|
| Rate for Payer: Midlands Choice Commercial |
$7.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.74
|
| Rate for Payer: United Healthcare Commercial |
$9.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$6.09
|
|
|
THP amoxicillin 400 mg/5 mL Oral Liq 50ml
|
Facility
OP
|
$22.32
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna of IA Commercial |
$20.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.09
|
| Rate for Payer: Aetna of IA Medicare |
$12.72
|
| Rate for Payer: Amerigroup Medicaid |
$11.26
|
| Rate for Payer: Amerigroup Medicare |
$11.27
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.74
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.16
|
| Rate for Payer: Medical Associates Commercial |
$16.74
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.16
|
| Rate for Payer: Midlands Choice Commercial |
$15.62
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.74
|
| Rate for Payer: United Healthcare Commercial |
$20.09
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.17
|
|
|
THP amoxicillin 400 mg/5 mL Oral Liq 50ml
|
Facility
IP
|
$22.32
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna of IA Commercial |
$20.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.09
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.74
|
| Rate for Payer: Medical Associates Commercial |
$16.74
|
| Rate for Payer: Midlands Choice Commercial |
$15.62
|
| Rate for Payer: United Healthcare Commercial |
$20.09
|
|
|
THP Amoxicillin 500mg 6 capsules
|
Facility
IP
|
$12.64
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43761285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Aetna of IA Commercial |
$11.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.38
|
| Rate for Payer: Cash Price |
$10.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.48
|
| Rate for Payer: Medical Associates Commercial |
$9.48
|
| Rate for Payer: Midlands Choice Commercial |
$8.85
|
| Rate for Payer: United Healthcare Commercial |
$11.38
|
|
|
THP Amoxicillin 500mg 6 capsules
|
Facility
OP
|
$12.64
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43761285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Aetna of IA Commercial |
$11.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.38
|
| Rate for Payer: Aetna of IA Medicare |
$7.20
|
| Rate for Payer: Amerigroup Medicaid |
$6.38
|
| Rate for Payer: Amerigroup Medicare |
$6.38
|
| Rate for Payer: Cash Price |
$10.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.48
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.32
|
| Rate for Payer: Medical Associates Commercial |
$9.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.32
|
| Rate for Payer: Midlands Choice Commercial |
$8.85
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.48
|
| Rate for Payer: United Healthcare Commercial |
$11.38
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.46
|
|
|
THP amoxicillin-clavulanate 250 mg-62.5 mg/5 mL Oral Liq 75 ml
|
Facility
IP
|
$186.56
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.59 |
| Max. Negotiated Rate |
$167.90 |
| Rate for Payer: Aetna of IA Commercial |
$167.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$167.90
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$139.92
|
| Rate for Payer: Medical Associates Commercial |
$139.92
|
| Rate for Payer: Midlands Choice Commercial |
$130.59
|
| Rate for Payer: United Healthcare Commercial |
$167.90
|
|
|
THP amoxicillin-clavulanate 250 mg-62.5 mg/5 mL Oral Liq 75 ml
|
Facility
OP
|
$186.56
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.24 |
| Max. Negotiated Rate |
$167.90 |
| Rate for Payer: Aetna of IA Commercial |
$167.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$167.90
|
| Rate for Payer: Aetna of IA Medicare |
$106.34
|
| Rate for Payer: Amerigroup Medicaid |
$94.16
|
| Rate for Payer: Amerigroup Medicare |
$94.21
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$139.92
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$93.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$93.24
|
| Rate for Payer: Medical Associates Commercial |
$139.92
|
| Rate for Payer: Medical Associates Managed Medicare |
$93.28
|
| Rate for Payer: Midlands Choice Commercial |
$130.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$94.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$139.92
|
| Rate for Payer: United Healthcare Commercial |
$167.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$110.07
|
|
|
THP Amoxicillin Clavulanate 875mg/125mg 6 tablets
|
Facility
IP
|
$21.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$19.37 |
| Rate for Payer: Aetna of IA Commercial |
$19.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.37
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.14
|
| Rate for Payer: Medical Associates Commercial |
$16.14
|
| Rate for Payer: Midlands Choice Commercial |
$15.06
|
| Rate for Payer: United Healthcare Commercial |
$19.37
|
|
|
THP Amoxicillin Clavulanate 875mg/125mg 6 tablets
|
Facility
OP
|
$21.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$19.37 |
| Rate for Payer: Aetna of IA Commercial |
$19.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.37
|
| Rate for Payer: Aetna of IA Medicare |
$12.27
|
| Rate for Payer: Amerigroup Medicaid |
$10.86
|
| Rate for Payer: Amerigroup Medicare |
$10.87
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.14
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.76
|
| Rate for Payer: Medical Associates Commercial |
$16.14
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.76
|
| Rate for Payer: Midlands Choice Commercial |
$15.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.14
|
| Rate for Payer: United Healthcare Commercial |
$19.37
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.70
|
|
|
THP Azithromycin 200mg/5ml 15ml Susp
|
Facility
IP
|
$66.60
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43760197
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.62 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna of IA Commercial |
$59.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.94
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.95
|
| Rate for Payer: Medical Associates Commercial |
$49.95
|
| Rate for Payer: Midlands Choice Commercial |
$46.62
|
| Rate for Payer: United Healthcare Commercial |
$59.94
|
|
|
THP Azithromycin 200mg/5ml 15ml Susp
|
Facility
OP
|
$66.60
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43760197
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.29 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna of IA Commercial |
$59.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.94
|
| Rate for Payer: Aetna of IA Medicare |
$37.96
|
| Rate for Payer: Amerigroup Medicaid |
$33.61
|
| Rate for Payer: Amerigroup Medicare |
$33.63
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.29
|
| Rate for Payer: Medical Associates Commercial |
$49.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.30
|
| Rate for Payer: Midlands Choice Commercial |
$46.62
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.95
|
| Rate for Payer: United Healthcare Commercial |
$59.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.29
|
|
|
THP Azithromycin 250mg 3 tablets
|
Facility
OP
|
$21.62
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43799941
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$19.46 |
| Rate for Payer: Aetna of IA Commercial |
$19.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.46
|
| Rate for Payer: Aetna of IA Medicare |
$12.32
|
| Rate for Payer: Amerigroup Medicaid |
$10.91
|
| Rate for Payer: Amerigroup Medicare |
$10.92
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.81
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.81
|
| Rate for Payer: Medical Associates Commercial |
$16.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.81
|
| Rate for Payer: Midlands Choice Commercial |
$15.13
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.22
|
| Rate for Payer: United Healthcare Commercial |
$19.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.76
|
|
|
THP Azithromycin 250mg 3 tablets
|
Facility
IP
|
$21.62
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43799941
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$19.46 |
| Rate for Payer: Aetna of IA Commercial |
$19.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.46
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.22
|
| Rate for Payer: Medical Associates Commercial |
$16.22
|
| Rate for Payer: Midlands Choice Commercial |
$15.13
|
| Rate for Payer: United Healthcare Commercial |
$19.46
|
|
|
THP benzonatate 100mg 5 capsules
|
Facility
IP
|
$10.18
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700781
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$9.16 |
| Rate for Payer: Aetna of IA Commercial |
$9.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$9.16
|
| Rate for Payer: Cash Price |
$8.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.64
|
| Rate for Payer: Medical Associates Commercial |
$7.64
|
| Rate for Payer: Midlands Choice Commercial |
$7.13
|
| Rate for Payer: United Healthcare Commercial |
$9.16
|
|
|
THP benzonatate 100mg 5 capsules
|
Facility
OP
|
$10.18
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700781
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$9.16 |
| Rate for Payer: Aetna of IA Commercial |
$9.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$9.16
|
| Rate for Payer: Aetna of IA Medicare |
$5.80
|
| Rate for Payer: Amerigroup Medicaid |
$5.14
|
| Rate for Payer: Amerigroup Medicare |
$5.14
|
| Rate for Payer: Cash Price |
$8.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.09
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5.09
|
| Rate for Payer: Medical Associates Commercial |
$7.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.09
|
| Rate for Payer: Midlands Choice Commercial |
$7.13
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.64
|
| Rate for Payer: United Healthcare Commercial |
$9.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$6.01
|
|
|
THP cefdinir 250 mg/5 mL Oral Susp 60ML
|
Facility
OP
|
$50.12
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$45.11 |
| Rate for Payer: Aetna of IA Commercial |
$45.11
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.11
|
| Rate for Payer: Aetna of IA Medicare |
$28.57
|
| Rate for Payer: Amerigroup Medicaid |
$25.30
|
| Rate for Payer: Amerigroup Medicare |
$25.31
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.59
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.05
|
| Rate for Payer: Medical Associates Commercial |
$37.59
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.06
|
| Rate for Payer: Midlands Choice Commercial |
$35.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$37.59
|
| Rate for Payer: United Healthcare Commercial |
$45.11
|
| Rate for Payer: United Healthcare Managed Medicare |
$29.57
|
|
|
THP cefdinir 250 mg/5 mL Oral Susp 60ML
|
Facility
IP
|
$50.12
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.08 |
| Max. Negotiated Rate |
$45.11 |
| Rate for Payer: Aetna of IA Commercial |
$45.11
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.11
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.59
|
| Rate for Payer: Medical Associates Commercial |
$37.59
|
| Rate for Payer: Midlands Choice Commercial |
$35.08
|
| Rate for Payer: United Healthcare Commercial |
$45.11
|
|
|
THP cefprozil 250 mg/5 mL 50ml Oral Liq
|
Facility
OP
|
$99.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43726396
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.74 |
| Max. Negotiated Rate |
$89.57 |
| Rate for Payer: Aetna of IA Commercial |
$89.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.57
|
| Rate for Payer: Aetna of IA Medicare |
$56.73
|
| Rate for Payer: Amerigroup Medicaid |
$50.23
|
| Rate for Payer: Amerigroup Medicare |
$50.26
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.74
|
| Rate for Payer: Medical Associates Commercial |
$74.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.76
|
| Rate for Payer: Midlands Choice Commercial |
$69.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.64
|
| Rate for Payer: United Healthcare Commercial |
$89.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.72
|
|
|
THP cefprozil 250 mg/5 mL 50ml Oral Liq
|
Facility
IP
|
$99.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43726396
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.66 |
| Max. Negotiated Rate |
$89.57 |
| Rate for Payer: Aetna of IA Commercial |
$89.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.57
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.64
|
| Rate for Payer: Medical Associates Commercial |
$74.64
|
| Rate for Payer: Midlands Choice Commercial |
$69.66
|
| Rate for Payer: United Healthcare Commercial |
$89.57
|
|
|
THP Cefuroxime 250mg 3 tabs
|
Facility
IP
|
$21.92
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$19.73 |
| Rate for Payer: Aetna of IA Commercial |
$19.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.73
|
| Rate for Payer: Cash Price |
$17.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.44
|
| Rate for Payer: Medical Associates Commercial |
$16.44
|
| Rate for Payer: Midlands Choice Commercial |
$15.34
|
| Rate for Payer: United Healthcare Commercial |
$19.73
|
|
|
THP Cefuroxime 250mg 3 tabs
|
Facility
OP
|
$21.92
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.96 |
| Max. Negotiated Rate |
$19.73 |
| Rate for Payer: Aetna of IA Commercial |
$19.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.73
|
| Rate for Payer: Aetna of IA Medicare |
$12.49
|
| Rate for Payer: Amerigroup Medicaid |
$11.06
|
| Rate for Payer: Amerigroup Medicare |
$11.07
|
| Rate for Payer: Cash Price |
$17.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.96
|
| Rate for Payer: Medical Associates Commercial |
$16.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.96
|
| Rate for Payer: Midlands Choice Commercial |
$15.34
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.44
|
| Rate for Payer: United Healthcare Commercial |
$19.73
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.93
|
|
|
THP Cephalexin 250mg/5ml 100ml Oral Susp Bottle
|
Facility
OP
|
$60.96
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43732188
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.47 |
| Max. Negotiated Rate |
$54.86 |
| Rate for Payer: Aetna of IA Commercial |
$54.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.86
|
| Rate for Payer: Aetna of IA Medicare |
$34.75
|
| Rate for Payer: Amerigroup Medicaid |
$30.77
|
| Rate for Payer: Amerigroup Medicare |
$30.78
|
| Rate for Payer: Cash Price |
$48.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.72
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.47
|
| Rate for Payer: Medical Associates Commercial |
$45.72
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.48
|
| Rate for Payer: Midlands Choice Commercial |
$42.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.72
|
| Rate for Payer: United Healthcare Commercial |
$54.86
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.97
|
|
|
THP Cephalexin 250mg/5ml 100ml Oral Susp Bottle
|
Facility
IP
|
$60.96
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43732188
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.67 |
| Max. Negotiated Rate |
$54.86 |
| Rate for Payer: Aetna of IA Commercial |
$54.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.86
|
| Rate for Payer: Cash Price |
$48.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.72
|
| Rate for Payer: Medical Associates Commercial |
$45.72
|
| Rate for Payer: Midlands Choice Commercial |
$42.67
|
| Rate for Payer: United Healthcare Commercial |
$54.86
|
|
