|
Aspergillus Galactomannan Antigen DMCL
|
Facility
OP
|
$98.00
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
8037500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna of IA Commercial |
$88.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.20
|
| Rate for Payer: Aetna of IA Medicare |
$55.86
|
| Rate for Payer: Amerigroup Medicaid |
$49.46
|
| Rate for Payer: Amerigroup Medicare |
$49.49
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$48.98
|
| Rate for Payer: Medical Associates Commercial |
$73.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.00
|
| Rate for Payer: Midlands Choice Commercial |
$68.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$73.50
|
| Rate for Payer: United Healthcare Commercial |
$88.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$57.82
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
Aspergillus Galactomannan Antigen DMCL
|
Facility
IP
|
$98.00
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
8037500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna of IA Commercial |
$88.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.20
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.50
|
| Rate for Payer: Medical Associates Commercial |
$73.50
|
| Rate for Payer: Midlands Choice Commercial |
$68.60
|
| Rate for Payer: United Healthcare Commercial |
$88.20
|
|
|
ASPIRATE/INJ GANGLION CYST
|
Professional
|
$143.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
7982750
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$100.10 |
| Rate for Payer: Aetna of IA Medicare |
$37.27
|
| Rate for Payer: Amerigroup Medicaid |
$38.54
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.02
|
| Rate for Payer: Medical Associates Commercial |
$70.81
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.27
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.90
|
| Rate for Payer: Wellmark IA HMO |
$78.00
|
| Rate for Payer: Wellmark IA PPO |
$91.00
|
|
|
ASPIRATE PLEURA W/ IMAGING
|
Professional
|
$961.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
7982777
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$98.85 |
| Max. Negotiated Rate |
$672.70 |
| Rate for Payer: Aetna of IA Medicare |
$98.85
|
| Rate for Payer: Amerigroup Medicaid |
$102.21
|
| Rate for Payer: Cash Price |
$768.80
|
| Rate for Payer: Cash Price |
$768.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$118.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.83
|
| Rate for Payer: Medical Associates Commercial |
$187.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$98.85
|
| Rate for Payer: Midlands Choice Commercial |
$672.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.28
|
| Rate for Payer: Wellmark IA HMO |
$205.00
|
| Rate for Payer: Wellmark IA PPO |
$240.00
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Professional
|
$474.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
7982778
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$331.80 |
| Rate for Payer: Aetna of IA Medicare |
$80.08
|
| Rate for Payer: Amerigroup Medicaid |
$82.80
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$81.68
|
| Rate for Payer: Medical Associates Commercial |
$152.15
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.08
|
| Rate for Payer: Midlands Choice Commercial |
$331.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$120.12
|
| Rate for Payer: Wellmark IA HMO |
$166.00
|
| Rate for Payer: Wellmark IA PPO |
$194.00
|
|
|
ASPIRATION OF HYDROCELE CHARGE
|
Professional
|
$278.00
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
8068938
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$77.02 |
| Max. Negotiated Rate |
$194.60 |
| Rate for Payer: Aetna of IA Medicare |
$77.02
|
| Rate for Payer: Amerigroup Medicaid |
$79.64
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$78.56
|
| Rate for Payer: Medical Associates Commercial |
$146.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$77.02
|
| Rate for Payer: Midlands Choice Commercial |
$194.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$115.53
|
| Rate for Payer: Wellmark IA HMO |
$159.00
|
| Rate for Payer: Wellmark IA PPO |
$186.00
|
|
|
Aspirin 300 mg Supp
|
Facility
IP
|
$6.84
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700537
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$6.16 |
| Rate for Payer: Aetna of IA Commercial |
$6.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.16
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.13
|
| Rate for Payer: Medical Associates Commercial |
$5.13
|
| Rate for Payer: Midlands Choice Commercial |
$4.79
|
| Rate for Payer: United Healthcare Commercial |
$6.16
|
|
|
Aspirin 300 mg Supp
|
Facility
OP
|
$6.84
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700537
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$6.16 |
| Rate for Payer: Aetna of IA Commercial |
$6.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.16
|
| Rate for Payer: Aetna of IA Medicare |
$3.90
|
| Rate for Payer: Amerigroup Medicaid |
$3.45
|
| Rate for Payer: Amerigroup Medicare |
$3.45
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.13
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.42
|
| Rate for Payer: Medical Associates Commercial |
$5.13
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.42
|
| Rate for Payer: Midlands Choice Commercial |
$4.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$5.13
|
| Rate for Payer: United Healthcare Commercial |
$6.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$4.04
|
|
|
aspirin-dipyridamole 25 mg-200 mg ER Cap
|
Facility
IP
|
$3.68
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Aetna of IA Commercial |
$3.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.31
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.76
|
| Rate for Payer: Medical Associates Commercial |
$2.76
|
| Rate for Payer: Midlands Choice Commercial |
$2.58
|
| Rate for Payer: United Healthcare Commercial |
$3.31
|
|
|
aspirin-dipyridamole 25 mg-200 mg ER Cap
|
Facility
OP
|
$3.68
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Aetna of IA Commercial |
$3.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.31
|
| Rate for Payer: Aetna of IA Medicare |
$2.10
|
| Rate for Payer: Amerigroup Medicaid |
$1.86
|
| Rate for Payer: Amerigroup Medicare |
$1.86
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.76
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.84
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.84
|
| Rate for Payer: Medical Associates Commercial |
$2.76
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.84
|
| Rate for Payer: Midlands Choice Commercial |
$2.58
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.76
|
| Rate for Payer: United Healthcare Commercial |
$3.31
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.17
|
|
|
ASSESSMENT OF APHASIA HR
|
Facility
IP
|
$357.00
|
|
|
Service Code
|
CPT 96105 GN
|
| Hospital Charge Code |
1373853
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: Aetna of IA Commercial |
$321.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$321.30
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$267.75
|
| Rate for Payer: Medical Associates Commercial |
$267.75
|
| Rate for Payer: Midlands Choice Commercial |
$249.90
|
| Rate for Payer: United Healthcare Commercial |
$321.30
|
|
|
ASSESSMENT OF APHASIA HR
|
Facility
OP
|
$357.00
|
|
|
Service Code
|
CPT 96105 GN
|
| Hospital Charge Code |
1373853
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$178.43 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: Aetna of IA Commercial |
$321.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$321.30
|
| Rate for Payer: Aetna of IA Medicare |
$203.49
|
| Rate for Payer: Amerigroup Medicaid |
$180.18
|
| Rate for Payer: Amerigroup Medicare |
$180.28
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$267.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$178.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$178.43
|
| Rate for Payer: Medical Associates Commercial |
$267.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$178.50
|
| Rate for Payer: Midlands Choice Commercial |
$249.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$181.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$267.75
|
| Rate for Payer: United Healthcare Commercial |
$321.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$210.63
|
|
|
AST (SGOT)
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
633633
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of IA Commercial |
$44.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$44.10
|
| Rate for Payer: Aetna of IA Medicare |
$27.93
|
| Rate for Payer: Amerigroup Medicaid |
$24.73
|
| Rate for Payer: Amerigroup Medicare |
$24.74
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$24.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$24.49
|
| Rate for Payer: Medical Associates Commercial |
$36.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$24.50
|
| Rate for Payer: Midlands Choice Commercial |
$34.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$36.75
|
| Rate for Payer: United Healthcare Commercial |
$44.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$28.91
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
AST (SGOT)
|
Facility
IP
|
$49.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
633633
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of IA Commercial |
$44.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$44.10
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.75
|
| Rate for Payer: Medical Associates Commercial |
$36.75
|
| Rate for Payer: Midlands Choice Commercial |
$34.30
|
| Rate for Payer: United Healthcare Commercial |
$44.10
|
|
|
atenolol 50 mg Tab
|
Facility
IP
|
$1.29
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702342
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of IA Commercial |
$1.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.16
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.97
|
| Rate for Payer: Medical Associates Commercial |
$0.97
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.16
|
|
|
atenolol 50 mg Tab
|
Facility
OP
|
$1.29
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702342
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of IA Commercial |
$1.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.16
|
| Rate for Payer: Aetna of IA Medicare |
$0.74
|
| Rate for Payer: Amerigroup Medicaid |
$0.65
|
| Rate for Payer: Amerigroup Medicare |
$0.65
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.64
|
| Rate for Payer: Medical Associates Commercial |
$0.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.65
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.97
|
| Rate for Payer: United Healthcare Commercial |
$1.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.76
|
|
|
atezolizumab 1200 mg/20 mL SDV inj
|
Facility
OP
|
$19,039.70
|
|
|
Service Code
|
CPT J9022
|
| Hospital Charge Code |
43700509
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,516.04 |
| Max. Negotiated Rate |
$17,135.73 |
| Rate for Payer: Aetna of IA Commercial |
$17,135.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17,135.73
|
| Rate for Payer: Aetna of IA Medicare |
$10,852.63
|
| Rate for Payer: Amerigroup Medicaid |
$9,609.34
|
| Rate for Payer: Amerigroup Medicare |
$9,615.05
|
| Rate for Payer: Cash Price |
$15,231.76
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14,279.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9,519.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9,516.04
|
| Rate for Payer: Medical Associates Commercial |
$14,279.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$9,519.85
|
| Rate for Payer: Midlands Choice Commercial |
$13,327.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,662.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$14,279.78
|
| Rate for Payer: United Healthcare Commercial |
$17,135.73
|
| Rate for Payer: United Healthcare Managed Medicare |
$11,233.42
|
|
|
atezolizumab 1200 mg/20 mL SDV inj
|
Facility
IP
|
$19,039.70
|
|
|
Service Code
|
CPT J9022
|
| Hospital Charge Code |
43700509
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,327.79 |
| Max. Negotiated Rate |
$17,135.73 |
| Rate for Payer: Aetna of IA Commercial |
$17,135.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17,135.73
|
| Rate for Payer: Cash Price |
$15,231.76
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14,279.78
|
| Rate for Payer: Medical Associates Commercial |
$14,279.78
|
| Rate for Payer: Midlands Choice Commercial |
$13,327.79
|
| Rate for Payer: United Healthcare Commercial |
$17,135.73
|
|
|
Atherosclerosis With MCC
|
Facility
IP
|
$7,001.90
|
|
|
Service Code
|
MS-DRG 302
|
| Hospital Charge Code |
159
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,001.90 |
| Rate for Payer: Amerigroup Medicaid |
$6,968.07
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,900.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,001.90
|
|
|
Atherosclerosis Without MCC
|
Facility
IP
|
$6,058.01
|
|
|
Service Code
|
MS-DRG 303
|
| Hospital Charge Code |
160
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,058.01 |
| Rate for Payer: Amerigroup Medicaid |
$6,028.74
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5,970.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,058.01
|
|
|
atorvastatin 10 mg Tab
|
Facility
OP
|
$1.12
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702525
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Aetna of IA Commercial |
$1.01
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.01
|
| Rate for Payer: Aetna of IA Medicare |
$0.64
|
| Rate for Payer: Amerigroup Medicaid |
$0.57
|
| Rate for Payer: Amerigroup Medicare |
$0.57
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.84
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.56
|
| Rate for Payer: Medical Associates Commercial |
$0.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.56
|
| Rate for Payer: Midlands Choice Commercial |
$0.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.66
|
|
|
atorvastatin 10 mg Tab
|
Facility
IP
|
$1.12
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702525
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Aetna of IA Commercial |
$1.01
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.01
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.84
|
| Rate for Payer: Medical Associates Commercial |
$0.84
|
| Rate for Payer: Midlands Choice Commercial |
$0.78
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
|
|
atorvastatin 20 mg Tab
|
Facility
OP
|
$1.09
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705869
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna of IA Commercial |
$0.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.98
|
| Rate for Payer: Aetna of IA Medicare |
$0.62
|
| Rate for Payer: Amerigroup Medicaid |
$0.55
|
| Rate for Payer: Amerigroup Medicare |
$0.55
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.54
|
| Rate for Payer: Medical Associates Commercial |
$0.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.55
|
| Rate for Payer: Midlands Choice Commercial |
$0.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.64
|
|
|
atorvastatin 20 mg Tab
|
Facility
IP
|
$1.09
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705869
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna of IA Commercial |
$0.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.98
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.82
|
| Rate for Payer: Medical Associates Commercial |
$0.82
|
| Rate for Payer: Midlands Choice Commercial |
$0.76
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
|
|
atorvastatin 40 mg Tab
|
Facility
OP
|
$1.71
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43792171
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of IA Commercial |
$1.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.54
|
| Rate for Payer: Aetna of IA Medicare |
$0.97
|
| Rate for Payer: Amerigroup Medicaid |
$0.86
|
| Rate for Payer: Amerigroup Medicare |
$0.86
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.85
|
| Rate for Payer: Medical Associates Commercial |
$1.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.86
|
| Rate for Payer: Midlands Choice Commercial |
$1.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.28
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.01
|
|
