|
Breast Biopsy, Local Excision and Other Breast Procedures Without CC/MCC
|
Facility
IP
|
$13,948.67
|
|
|
Service Code
|
MS-DRG 585
|
| Hospital Charge Code |
389
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$13,948.67 |
| Rate for Payer: Amerigroup Medicaid |
$13,881.29
|
| 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 |
$13,746.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,948.67
|
|
|
brentuximab vedotin 50 mg Pow SDV
|
Facility
IP
|
$34,421.96
|
|
|
Service Code
|
CPT J9042
|
| Hospital Charge Code |
43701067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24,095.37 |
| Max. Negotiated Rate |
$30,979.76 |
| Rate for Payer: Aetna of IA Commercial |
$30,979.76
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30,979.76
|
| Rate for Payer: Cash Price |
$27,537.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25,816.47
|
| Rate for Payer: Medical Associates Commercial |
$25,816.47
|
| Rate for Payer: Midlands Choice Commercial |
$24,095.37
|
| Rate for Payer: United Healthcare Commercial |
$30,979.76
|
|
|
brentuximab vedotin 50 mg Pow SDV
|
Facility
OP
|
$34,421.96
|
|
|
Service Code
|
CPT J9042
|
| Hospital Charge Code |
43701067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17,204.10 |
| Max. Negotiated Rate |
$30,979.76 |
| Rate for Payer: Aetna of IA Commercial |
$30,979.76
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30,979.76
|
| Rate for Payer: Aetna of IA Medicare |
$19,620.52
|
| Rate for Payer: Amerigroup Medicaid |
$17,372.76
|
| Rate for Payer: Amerigroup Medicare |
$17,383.09
|
| Rate for Payer: Cash Price |
$27,537.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25,816.47
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17,210.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17,204.10
|
| Rate for Payer: Medical Associates Commercial |
$25,816.47
|
| Rate for Payer: Medical Associates Managed Medicare |
$17,210.98
|
| Rate for Payer: Midlands Choice Commercial |
$24,095.37
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17,469.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$25,816.47
|
| Rate for Payer: United Healthcare Commercial |
$30,979.76
|
| Rate for Payer: United Healthcare Managed Medicare |
$20,308.96
|
|
|
brimonidine Ophth 0.15% Sol 5 ml
|
Facility
IP
|
$519.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43720122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$363.66 |
| Max. Negotiated Rate |
$467.57 |
| Rate for Payer: Aetna of IA Commercial |
$467.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$467.57
|
| Rate for Payer: Cash Price |
$415.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$389.64
|
| Rate for Payer: Medical Associates Commercial |
$389.64
|
| Rate for Payer: Midlands Choice Commercial |
$363.66
|
| Rate for Payer: United Healthcare Commercial |
$467.57
|
|
|
brimonidine Ophth 0.15% Sol 5 ml
|
Facility
OP
|
$519.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43720122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.66 |
| Max. Negotiated Rate |
$467.57 |
| Rate for Payer: Aetna of IA Commercial |
$467.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$467.57
|
| Rate for Payer: Aetna of IA Medicare |
$296.13
|
| Rate for Payer: Amerigroup Medicaid |
$262.20
|
| Rate for Payer: Amerigroup Medicare |
$262.36
|
| Rate for Payer: Cash Price |
$415.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$389.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$259.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$259.66
|
| Rate for Payer: Medical Associates Commercial |
$389.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$259.76
|
| Rate for Payer: Midlands Choice Commercial |
$363.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$263.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$389.64
|
| Rate for Payer: United Healthcare Commercial |
$467.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$306.52
|
|
|
brimonidine Ophth 0.2% Sol 5 ml
|
Facility
OP
|
$27.64
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna of IA Commercial |
$24.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.88
|
| Rate for Payer: Aetna of IA Medicare |
$15.75
|
| Rate for Payer: Amerigroup Medicaid |
$13.95
|
| Rate for Payer: Amerigroup Medicare |
$13.96
|
| Rate for Payer: Cash Price |
$22.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.81
|
| Rate for Payer: Medical Associates Commercial |
$20.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.82
|
| Rate for Payer: Midlands Choice Commercial |
$19.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.73
|
| Rate for Payer: United Healthcare Commercial |
$24.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.31
|
|
|
brimonidine Ophth 0.2% Sol 5 ml
|
Facility
IP
|
$27.64
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna of IA Commercial |
$24.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.88
|
| Rate for Payer: Cash Price |
$22.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.73
|
| Rate for Payer: Medical Associates Commercial |
$20.73
|
| Rate for Payer: Midlands Choice Commercial |
$19.35
|
| Rate for Payer: United Healthcare Commercial |
$24.88
|
|
|
brinzolamide Ophth 1% Susp 10 ml
|
Facility
IP
|
$1,212.48
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$848.74 |
| Max. Negotiated Rate |
$1,091.23 |
| Rate for Payer: Aetna of IA Commercial |
$1,091.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,091.23
|
| Rate for Payer: Cash Price |
$969.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$909.36
|
| Rate for Payer: Medical Associates Commercial |
$909.36
|
| Rate for Payer: Midlands Choice Commercial |
$848.74
|
| Rate for Payer: United Healthcare Commercial |
$1,091.23
|
|
|
brinzolamide Ophth 1% Susp 10 ml
|
Facility
OP
|
$1,212.48
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$606.00 |
| Max. Negotiated Rate |
$1,091.23 |
| Rate for Payer: Aetna of IA Commercial |
$1,091.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,091.23
|
| Rate for Payer: Aetna of IA Medicare |
$691.11
|
| Rate for Payer: Amerigroup Medicaid |
$611.94
|
| Rate for Payer: Amerigroup Medicare |
$612.30
|
| Rate for Payer: Cash Price |
$969.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$909.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$606.24
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$606.00
|
| Rate for Payer: Medical Associates Commercial |
$909.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$606.24
|
| Rate for Payer: Midlands Choice Commercial |
$848.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$615.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$909.36
|
| Rate for Payer: United Healthcare Commercial |
$1,091.23
|
| Rate for Payer: United Healthcare Managed Medicare |
$715.36
|
|
|
BRNCDILAT RSPSE SPMTRY PREPOST BRNCDILA
|
Facility
IP
|
$333.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
5338944
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
|
|
BRNCDILAT RSPSE SPMTRY PREPOST BRNCDILA
|
Facility
OP
|
$333.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
5338944
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$166.43 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Aetna of IA Medicare |
$189.81
|
| Rate for Payer: Amerigroup Medicaid |
$168.07
|
| Rate for Payer: Amerigroup Medicare |
$168.16
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$166.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$166.43
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$166.50
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$169.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$249.75
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
| Rate for Payer: Wellmark IA HMO |
$256.68
|
| Rate for Payer: Wellmark IA PPO |
$282.35
|
|
|
Bronchitis and Asthma With CC/MCC
|
Facility
IP
|
$6,520.60
|
|
|
Service Code
|
MS-DRG 202
|
| Hospital Charge Code |
73
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,520.60 |
| Rate for Payer: Amerigroup Medicaid |
$6,489.10
|
| 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 |
$6,426.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,520.60
|
|
|
Bronchitis and Asthma Without CC/MCC
|
Facility
IP
|
$4,740.10
|
|
|
Service Code
|
MS-DRG 203
|
| Hospital Charge Code |
74
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$4,740.10 |
| Rate for Payer: Amerigroup Medicaid |
$4,717.20
|
| 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 |
$4,671.41
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,740.10
|
|
|
BRONCHOSCOPY DX
|
Facility
IP
|
$791.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
8059061
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$553.70 |
| Max. Negotiated Rate |
$711.90 |
| Rate for Payer: Aetna of IA Commercial |
$711.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$711.90
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$593.25
|
| Rate for Payer: Medical Associates Commercial |
$593.25
|
| Rate for Payer: Midlands Choice Commercial |
$553.70
|
| Rate for Payer: United Healthcare Commercial |
$711.90
|
|
|
BRONCHOSCOPY DX
|
Facility
OP
|
$791.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
8059061
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$395.34 |
| Max. Negotiated Rate |
$2,981.02 |
| Rate for Payer: Aetna of IA Commercial |
$711.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$711.90
|
| Rate for Payer: Aetna of IA Medicare |
$450.87
|
| Rate for Payer: Amerigroup Medicaid |
$399.22
|
| Rate for Payer: Amerigroup Medicare |
$399.46
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$593.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$395.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$395.34
|
| Rate for Payer: Medical Associates Commercial |
$593.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$395.50
|
| Rate for Payer: Midlands Choice Commercial |
$553.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$401.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$593.25
|
| Rate for Payer: United Healthcare Commercial |
$711.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$466.69
|
| Rate for Payer: Wellmark IA HMO |
$2,710.02
|
| Rate for Payer: Wellmark IA PPO |
$2,981.02
|
|
|
budesonide
|
Facility
OP
|
$2.94
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43783070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna of IA Commercial |
$2.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.65
|
| Rate for Payer: Aetna of IA Medicare |
$1.68
|
| Rate for Payer: Amerigroup Medicaid |
$1.48
|
| Rate for Payer: Amerigroup Medicare |
$1.48
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.20
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.47
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.47
|
| Rate for Payer: Medical Associates Commercial |
$2.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.47
|
| Rate for Payer: Midlands Choice Commercial |
$2.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.20
|
| Rate for Payer: United Healthcare Commercial |
$2.65
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.73
|
|
|
budesonide
|
Facility
IP
|
$2.94
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43783070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna of IA Commercial |
$2.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.65
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.20
|
| Rate for Payer: Medical Associates Commercial |
$2.20
|
| Rate for Payer: Midlands Choice Commercial |
$2.06
|
| Rate for Payer: United Healthcare Commercial |
$2.65
|
|
|
budesonide 0.25 mg/2 mL neb Sol SDV
|
Facility
IP
|
$19.96
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43718619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna of IA Commercial |
$17.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.96
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.97
|
| Rate for Payer: Medical Associates Commercial |
$14.97
|
| Rate for Payer: Midlands Choice Commercial |
$13.97
|
| Rate for Payer: United Healthcare Commercial |
$17.96
|
|
|
budesonide 0.25 mg/2 mL neb Sol SDV
|
Facility
OP
|
$19.96
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43718619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna of IA Commercial |
$17.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.96
|
| Rate for Payer: Aetna of IA Medicare |
$11.38
|
| Rate for Payer: Amerigroup Medicaid |
$10.07
|
| Rate for Payer: Amerigroup Medicare |
$10.08
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9.98
|
| Rate for Payer: Medical Associates Commercial |
$14.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.98
|
| Rate for Payer: Midlands Choice Commercial |
$13.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.13
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.97
|
| Rate for Payer: United Healthcare Commercial |
$17.96
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.78
|
|
|
budesonide 0.5 mg/2 mL neb Sol SDV
|
Facility
IP
|
$14.99
|
|
|
Service Code
|
CPT J7626
|
| Hospital Charge Code |
43750203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$13.49 |
| Rate for Payer: Aetna of IA Commercial |
$13.49
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.49
|
| Rate for Payer: Cash Price |
$11.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.24
|
| Rate for Payer: Medical Associates Commercial |
$11.24
|
| Rate for Payer: Midlands Choice Commercial |
$10.49
|
| Rate for Payer: United Healthcare Commercial |
$13.49
|
|
|
budesonide 0.5 mg/2 mL neb Sol SDV
|
Facility
OP
|
$14.99
|
|
|
Service Code
|
CPT J7626
|
| Hospital Charge Code |
43750203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$13.49 |
| Rate for Payer: Aetna of IA Commercial |
$13.49
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.49
|
| Rate for Payer: Aetna of IA Medicare |
$8.54
|
| Rate for Payer: Amerigroup Medicaid |
$7.57
|
| Rate for Payer: Amerigroup Medicare |
$7.57
|
| Rate for Payer: Cash Price |
$11.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.49
|
| Rate for Payer: Medical Associates Commercial |
$11.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.50
|
| Rate for Payer: Midlands Choice Commercial |
$10.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.24
|
| Rate for Payer: United Healthcare Commercial |
$13.49
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.84
|
|
|
budesonide-formoterol 160 mcg-4.5 mcg/inh 6gm HFA Inhaler
|
Facility
IP
|
$651.76
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$456.23 |
| Max. Negotiated Rate |
$586.58 |
| Rate for Payer: Aetna of IA Commercial |
$586.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$586.58
|
| Rate for Payer: Cash Price |
$521.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$488.82
|
| Rate for Payer: Medical Associates Commercial |
$488.82
|
| Rate for Payer: Midlands Choice Commercial |
$456.23
|
| Rate for Payer: United Healthcare Commercial |
$586.58
|
|
|
budesonide-formoterol 160 mcg-4.5 mcg/inh 6gm HFA Inhaler
|
Facility
OP
|
$651.76
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$325.75 |
| Max. Negotiated Rate |
$586.58 |
| Rate for Payer: Aetna of IA Commercial |
$586.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$586.58
|
| Rate for Payer: Aetna of IA Medicare |
$371.50
|
| Rate for Payer: Amerigroup Medicaid |
$328.94
|
| Rate for Payer: Amerigroup Medicare |
$329.14
|
| Rate for Payer: Cash Price |
$521.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$488.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$325.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$325.75
|
| Rate for Payer: Medical Associates Commercial |
$488.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$325.88
|
| Rate for Payer: Midlands Choice Commercial |
$456.23
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$330.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$488.82
|
| Rate for Payer: United Healthcare Commercial |
$586.58
|
| Rate for Payer: United Healthcare Managed Medicare |
$384.54
|
|
|
bumetanide 0.25 mg/mL 10ml MDV Inj Sol
|
Facility
OP
|
$32.06
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43701062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$28.85 |
| Rate for Payer: Aetna of IA Commercial |
$28.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.85
|
| Rate for Payer: Aetna of IA Medicare |
$18.27
|
| Rate for Payer: Amerigroup Medicaid |
$16.18
|
| Rate for Payer: Amerigroup Medicare |
$16.19
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.03
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.02
|
| Rate for Payer: Medical Associates Commercial |
$24.04
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.03
|
| Rate for Payer: Midlands Choice Commercial |
$22.44
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.04
|
| Rate for Payer: United Healthcare Commercial |
$28.85
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.92
|
|
|
bumetanide 0.25 mg/mL 10ml MDV Inj Sol
|
Facility
IP
|
$32.06
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43701062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$28.85 |
| Rate for Payer: Aetna of IA Commercial |
$28.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.85
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.04
|
| Rate for Payer: Medical Associates Commercial |
$24.04
|
| Rate for Payer: Midlands Choice Commercial |
$22.44
|
| Rate for Payer: United Healthcare Commercial |
$28.85
|
|
