|
XR Wrist 2 Views Left
|
Facility
OP
|
$127.00
|
|
|
Service Code
|
CPT 73100 LT
|
| Hospital Charge Code |
1170606
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$114.30 |
| Rate for Payer: Aetna of IA Commercial |
$114.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$114.30
|
| Rate for Payer: Aetna of IA Medicare |
$72.39
|
| Rate for Payer: Amerigroup Medicaid |
$64.10
|
| Rate for Payer: Amerigroup Medicare |
$64.14
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$95.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$63.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$63.47
|
| Rate for Payer: Medical Associates Commercial |
$95.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$63.50
|
| Rate for Payer: Midlands Choice Commercial |
$88.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$64.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$95.25
|
| Rate for Payer: United Healthcare Commercial |
$114.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$74.93
|
|
|
XR Wrist 2 Views Right
|
Facility
IP
|
$127.00
|
|
|
Service Code
|
CPT 73100 RT
|
| Hospital Charge Code |
1170608
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$114.30 |
| Rate for Payer: Aetna of IA Commercial |
$114.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$114.30
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$95.25
|
| Rate for Payer: Medical Associates Commercial |
$95.25
|
| Rate for Payer: Midlands Choice Commercial |
$88.90
|
| Rate for Payer: United Healthcare Commercial |
$114.30
|
|
|
XR Wrist 2 Views Right
|
Facility
OP
|
$127.00
|
|
|
Service Code
|
CPT 73100 RT
|
| Hospital Charge Code |
1170608
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$114.30 |
| Rate for Payer: Aetna of IA Commercial |
$114.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$114.30
|
| Rate for Payer: Aetna of IA Medicare |
$72.39
|
| Rate for Payer: Amerigroup Medicaid |
$64.10
|
| Rate for Payer: Amerigroup Medicare |
$64.14
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$95.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$63.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$63.47
|
| Rate for Payer: Medical Associates Commercial |
$95.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$63.50
|
| Rate for Payer: Midlands Choice Commercial |
$88.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$64.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$95.25
|
| Rate for Payer: United Healthcare Commercial |
$114.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$74.93
|
|
|
XR Wrist Complete Left
|
Facility
IP
|
$146.00
|
|
|
Service Code
|
CPT 73110 LT
|
| Hospital Charge Code |
1170612
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.20 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of IA Commercial |
$131.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
| Rate for Payer: Medical Associates Commercial |
$109.50
|
| Rate for Payer: Midlands Choice Commercial |
$102.20
|
| Rate for Payer: United Healthcare Commercial |
$131.40
|
|
|
XR Wrist Complete Left
|
Facility
OP
|
$146.00
|
|
|
Service Code
|
CPT 73110 LT
|
| Hospital Charge Code |
1170612
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.97 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of IA Commercial |
$131.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
| Rate for Payer: Aetna of IA Medicare |
$83.22
|
| Rate for Payer: Amerigroup Medicaid |
$73.69
|
| Rate for Payer: Amerigroup Medicare |
$73.73
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$72.97
|
| Rate for Payer: Medical Associates Commercial |
$109.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.00
|
| Rate for Payer: Midlands Choice Commercial |
$102.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$109.50
|
| Rate for Payer: United Healthcare Commercial |
$131.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.14
|
|
|
XR Wrist Complete Right
|
Facility
IP
|
$146.00
|
|
|
Service Code
|
CPT 73110 RT
|
| Hospital Charge Code |
1170614
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.20 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of IA Commercial |
$131.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
| Rate for Payer: Medical Associates Commercial |
$109.50
|
| Rate for Payer: Midlands Choice Commercial |
$102.20
|
| Rate for Payer: United Healthcare Commercial |
$131.40
|
|
|
XR Wrist Complete Right
|
Facility
OP
|
$146.00
|
|
|
Service Code
|
CPT 73110 RT
|
| Hospital Charge Code |
1170614
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.97 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of IA Commercial |
$131.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
| Rate for Payer: Aetna of IA Medicare |
$83.22
|
| Rate for Payer: Amerigroup Medicaid |
$73.69
|
| Rate for Payer: Amerigroup Medicare |
$73.73
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$72.97
|
| Rate for Payer: Medical Associates Commercial |
$109.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.00
|
| Rate for Payer: Midlands Choice Commercial |
$102.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$109.50
|
| Rate for Payer: United Healthcare Commercial |
$131.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.14
|
|
|
Zinc Level DMCL
|
Facility
IP
|
$62.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
8519183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna of IA Commercial |
$55.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$55.80
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.50
|
| Rate for Payer: Medical Associates Commercial |
$46.50
|
| Rate for Payer: Midlands Choice Commercial |
$43.40
|
| Rate for Payer: United Healthcare Commercial |
$55.80
|
|
|
Zinc Level DMCL
|
Facility
OP
|
$62.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
8519183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.99 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna of IA Commercial |
$55.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$55.80
|
| Rate for Payer: Aetna of IA Medicare |
$35.34
|
| Rate for Payer: Amerigroup Medicaid |
$31.29
|
| Rate for Payer: Amerigroup Medicare |
$31.31
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.99
|
| Rate for Payer: Medical Associates Commercial |
$46.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.00
|
| Rate for Payer: Midlands Choice Commercial |
$43.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$31.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$46.50
|
| Rate for Payer: United Healthcare Commercial |
$55.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$36.58
|
| Rate for Payer: Wellmark IA HMO |
$37.20
|
| Rate for Payer: Wellmark IA PPO |
$40.92
|
|
|
zinc oxide Top 40% Paste
|
Facility
IP
|
$35.40
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43718546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.78 |
| Max. Negotiated Rate |
$31.86 |
| Rate for Payer: Aetna of IA Commercial |
$31.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.86
|
| Rate for Payer: Cash Price |
$28.32
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.55
|
| Rate for Payer: Medical Associates Commercial |
$26.55
|
| Rate for Payer: Midlands Choice Commercial |
$24.78
|
| Rate for Payer: United Healthcare Commercial |
$31.86
|
|
|
zinc oxide Top 40% Paste
|
Facility
OP
|
$35.40
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43718546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$31.86 |
| Rate for Payer: Aetna of IA Commercial |
$31.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.86
|
| Rate for Payer: Aetna of IA Medicare |
$20.18
|
| Rate for Payer: Amerigroup Medicaid |
$17.87
|
| Rate for Payer: Amerigroup Medicare |
$17.88
|
| Rate for Payer: Cash Price |
$28.32
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.55
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.69
|
| Rate for Payer: Medical Associates Commercial |
$26.55
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.70
|
| Rate for Payer: Midlands Choice Commercial |
$24.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.55
|
| Rate for Payer: United Healthcare Commercial |
$31.86
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.89
|
|
|
zinc sulfate 50 mg Cap
|
Facility
IP
|
$1.31
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700493
|
|
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
|
|
|
zinc sulfate 50 mg Cap
|
Facility
OP
|
$1.31
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700493
|
|
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
|
|
|
ZioPatch EXT ECG>48HR<7D RECORDING
|
Facility
IP
|
$305.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
8831646
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$213.50 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna of IA Commercial |
$274.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$274.50
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$228.75
|
| Rate for Payer: Medical Associates Commercial |
$228.75
|
| Rate for Payer: Midlands Choice Commercial |
$213.50
|
| Rate for Payer: United Healthcare Commercial |
$274.50
|
|
|
ZioPatch EXT ECG>48HR<7D RECORDING
|
Facility
OP
|
$305.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
8831646
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$152.44 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna of IA Commercial |
$274.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$274.50
|
| Rate for Payer: Aetna of IA Medicare |
$173.85
|
| Rate for Payer: Amerigroup Medicaid |
$153.93
|
| Rate for Payer: Amerigroup Medicare |
$154.02
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$228.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$152.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$152.44
|
| Rate for Payer: Medical Associates Commercial |
$228.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$152.50
|
| Rate for Payer: Midlands Choice Commercial |
$213.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$154.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$228.75
|
| Rate for Payer: United Healthcare Commercial |
$274.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$179.95
|
|
|
ZioPatch EXT ECG>7D<15D RECORDING
|
Facility
IP
|
$305.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
8829640
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$213.50 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna of IA Commercial |
$274.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$274.50
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$228.75
|
| Rate for Payer: Medical Associates Commercial |
$228.75
|
| Rate for Payer: Midlands Choice Commercial |
$213.50
|
| Rate for Payer: United Healthcare Commercial |
$274.50
|
|
|
ZioPatch EXT ECG>7D<15D RECORDING
|
Facility
OP
|
$305.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
8829640
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$152.44 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna of IA Commercial |
$274.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$274.50
|
| Rate for Payer: Aetna of IA Medicare |
$173.85
|
| Rate for Payer: Amerigroup Medicaid |
$153.93
|
| Rate for Payer: Amerigroup Medicare |
$154.02
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$228.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$152.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$152.44
|
| Rate for Payer: Medical Associates Commercial |
$228.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$152.50
|
| Rate for Payer: Midlands Choice Commercial |
$213.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$154.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$228.75
|
| Rate for Payer: United Healthcare Commercial |
$274.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$179.95
|
|
|
ziprasidone 20 mg Cap
|
Facility
OP
|
$2.46
|
|
|
Service Code
|
CPT J3486
|
| Hospital Charge Code |
43700098
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Aetna of IA Commercial |
$2.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.21
|
| Rate for Payer: Aetna of IA Medicare |
$1.40
|
| Rate for Payer: Amerigroup Medicaid |
$1.24
|
| Rate for Payer: Amerigroup Medicare |
$1.24
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.84
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.23
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.23
|
| Rate for Payer: Medical Associates Commercial |
$1.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.23
|
| Rate for Payer: Midlands Choice Commercial |
$1.72
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.84
|
| Rate for Payer: United Healthcare Commercial |
$2.21
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.45
|
|
|
ziprasidone 20 mg Cap
|
Facility
IP
|
$2.46
|
|
|
Service Code
|
CPT J3486
|
| Hospital Charge Code |
43700098
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Aetna of IA Commercial |
$2.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.21
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.84
|
| Rate for Payer: Medical Associates Commercial |
$1.84
|
| Rate for Payer: Midlands Choice Commercial |
$1.72
|
| Rate for Payer: United Healthcare Commercial |
$2.21
|
|
|
ziprasidone 20 mg/ml IM SDV Inj
|
Facility
OP
|
$147.62
|
|
|
Service Code
|
CPT J3489
|
| Hospital Charge Code |
43700095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.78 |
| Max. Negotiated Rate |
$132.86 |
| Rate for Payer: Aetna of IA Commercial |
$132.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$132.86
|
| Rate for Payer: Aetna of IA Medicare |
$84.14
|
| Rate for Payer: Amerigroup Medicaid |
$74.50
|
| Rate for Payer: Amerigroup Medicare |
$74.55
|
| Rate for Payer: Cash Price |
$118.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$110.72
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.81
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.78
|
| Rate for Payer: Medical Associates Commercial |
$110.72
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.81
|
| Rate for Payer: Midlands Choice Commercial |
$103.33
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$110.72
|
| Rate for Payer: United Healthcare Commercial |
$132.86
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.10
|
|
|
ziprasidone 20 mg/ml IM SDV Inj
|
Facility
IP
|
$147.62
|
|
|
Service Code
|
CPT J3489
|
| Hospital Charge Code |
43700095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.33 |
| Max. Negotiated Rate |
$132.86 |
| Rate for Payer: Aetna of IA Commercial |
$132.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$132.86
|
| Rate for Payer: Cash Price |
$118.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$110.72
|
| Rate for Payer: Medical Associates Commercial |
$110.72
|
| Rate for Payer: Midlands Choice Commercial |
$103.33
|
| Rate for Payer: United Healthcare Commercial |
$132.86
|
|
|
zoledronic acid 4mg/5ml SDV 5 ml
|
Facility
IP
|
$184.32
|
|
|
Service Code
|
CPT J3489
|
| Hospital Charge Code |
43734881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.02 |
| Max. Negotiated Rate |
$165.89 |
| Rate for Payer: Aetna of IA Commercial |
$165.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$165.89
|
| Rate for Payer: Cash Price |
$147.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$138.24
|
| Rate for Payer: Medical Associates Commercial |
$138.24
|
| Rate for Payer: Midlands Choice Commercial |
$129.02
|
| Rate for Payer: United Healthcare Commercial |
$165.89
|
|
|
zoledronic acid 4mg/5ml SDV 5 ml
|
Facility
OP
|
$184.32
|
|
|
Service Code
|
CPT J3489
|
| Hospital Charge Code |
43734881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.12 |
| Max. Negotiated Rate |
$165.89 |
| Rate for Payer: Aetna of IA Commercial |
$165.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$165.89
|
| Rate for Payer: Aetna of IA Medicare |
$105.06
|
| Rate for Payer: Amerigroup Medicaid |
$93.03
|
| Rate for Payer: Amerigroup Medicare |
$93.08
|
| Rate for Payer: Cash Price |
$147.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$138.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$92.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$92.12
|
| Rate for Payer: Medical Associates Commercial |
$138.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$92.16
|
| Rate for Payer: Midlands Choice Commercial |
$129.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$93.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$138.24
|
| Rate for Payer: United Healthcare Commercial |
$165.89
|
| Rate for Payer: United Healthcare Managed Medicare |
$108.75
|
|
|
zoledronic acid 5 mg/100 mL SD PREMIX
|
Facility
IP
|
$290.92
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.64 |
| Max. Negotiated Rate |
$261.83 |
| Rate for Payer: Aetna of IA Commercial |
$261.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$261.83
|
| Rate for Payer: Cash Price |
$232.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$218.19
|
| Rate for Payer: Medical Associates Commercial |
$218.19
|
| Rate for Payer: Midlands Choice Commercial |
$203.64
|
| Rate for Payer: United Healthcare Commercial |
$261.83
|
|
|
zoledronic acid 5 mg/100 mL SD PREMIX
|
Facility
OP
|
$290.92
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.40 |
| Max. Negotiated Rate |
$261.83 |
| Rate for Payer: Aetna of IA Commercial |
$261.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$261.83
|
| Rate for Payer: Aetna of IA Medicare |
$165.82
|
| Rate for Payer: Amerigroup Medicaid |
$146.83
|
| Rate for Payer: Amerigroup Medicare |
$146.91
|
| Rate for Payer: Cash Price |
$232.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$218.19
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$145.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$145.40
|
| Rate for Payer: Medical Associates Commercial |
$218.19
|
| Rate for Payer: Medical Associates Managed Medicare |
$145.46
|
| Rate for Payer: Midlands Choice Commercial |
$203.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$147.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$218.19
|
| Rate for Payer: United Healthcare Commercial |
$261.83
|
| Rate for Payer: United Healthcare Managed Medicare |
$171.64
|
|
