|
calcitonin 200 intl units/inh 3.7ml nasal spray bottle
|
Facility
OP
|
$186.48
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.20 |
| Max. Negotiated Rate |
$167.83 |
| Rate for Payer: Aetna of IA Commercial |
$167.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$167.83
|
| Rate for Payer: Aetna of IA Medicare |
$106.29
|
| Rate for Payer: Amerigroup Medicaid |
$94.12
|
| Rate for Payer: Amerigroup Medicare |
$94.17
|
| Rate for Payer: Cash Price |
$149.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$139.86
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$93.24
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$93.20
|
| Rate for Payer: Medical Associates Commercial |
$139.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$93.24
|
| Rate for Payer: Midlands Choice Commercial |
$130.54
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$94.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$139.86
|
| Rate for Payer: United Healthcare Commercial |
$167.83
|
| Rate for Payer: United Healthcare Managed Medicare |
$110.02
|
|
|
calcitonin 200 intl units/inh 3.7ml nasal spray bottle
|
Facility
IP
|
$186.48
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.54 |
| Max. Negotiated Rate |
$167.83 |
| Rate for Payer: Aetna of IA Commercial |
$167.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$167.83
|
| Rate for Payer: Cash Price |
$149.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$139.86
|
| Rate for Payer: Medical Associates Commercial |
$139.86
|
| Rate for Payer: Midlands Choice Commercial |
$130.54
|
| Rate for Payer: United Healthcare Commercial |
$167.83
|
|
|
calcitonin 200 intl units/mL 2ml MDV Inj Sol
|
Facility
OP
|
$4,569.76
|
|
|
Service Code
|
CPT J0630
|
| Hospital Charge Code |
43701698
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,283.97 |
| Max. Negotiated Rate |
$4,112.78 |
| Rate for Payer: Aetna of IA Commercial |
$4,112.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,112.78
|
| Rate for Payer: Aetna of IA Medicare |
$2,604.76
|
| Rate for Payer: Amerigroup Medicaid |
$2,306.36
|
| Rate for Payer: Amerigroup Medicare |
$2,307.73
|
| Rate for Payer: Cash Price |
$3,655.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,427.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,284.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,283.97
|
| Rate for Payer: Medical Associates Commercial |
$3,427.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,284.88
|
| Rate for Payer: Midlands Choice Commercial |
$3,198.83
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,319.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,427.32
|
| Rate for Payer: United Healthcare Commercial |
$4,112.78
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,696.16
|
|
|
calcitonin 200 intl units/mL 2ml MDV Inj Sol
|
Facility
IP
|
$4,569.76
|
|
|
Service Code
|
CPT J0630
|
| Hospital Charge Code |
43701698
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,198.83 |
| Max. Negotiated Rate |
$4,112.78 |
| Rate for Payer: Aetna of IA Commercial |
$4,112.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,112.78
|
| Rate for Payer: Cash Price |
$3,655.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,427.32
|
| Rate for Payer: Medical Associates Commercial |
$3,427.32
|
| Rate for Payer: Midlands Choice Commercial |
$3,198.83
|
| Rate for Payer: United Healthcare Commercial |
$4,112.78
|
|
|
calcitriol 0.25 mcg Oral Cap
|
Facility
OP
|
$2.07
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna of IA Commercial |
$1.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.86
|
| Rate for Payer: Aetna of IA Medicare |
$1.18
|
| Rate for Payer: Amerigroup Medicaid |
$1.04
|
| Rate for Payer: Amerigroup Medicare |
$1.05
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.55
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.03
|
| Rate for Payer: Medical Associates Commercial |
$1.55
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.04
|
| Rate for Payer: Midlands Choice Commercial |
$1.45
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.55
|
| Rate for Payer: United Healthcare Commercial |
$1.86
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.22
|
|
|
calcitriol 0.25 mcg Oral Cap
|
Facility
IP
|
$2.07
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna of IA Commercial |
$1.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.86
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.55
|
| Rate for Payer: Medical Associates Commercial |
$1.55
|
| Rate for Payer: Midlands Choice Commercial |
$1.45
|
| Rate for Payer: United Healthcare Commercial |
$1.86
|
|
|
CALCIUM
|
Facility
IP
|
$49.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
1628887
|
|
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
|
|
|
CALCIUM
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
1628887
|
|
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
|
|
|
calcium acetate 667 mg Cap
|
Facility
IP
|
$2.09
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43751287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna of IA Commercial |
$1.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.88
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.57
|
| Rate for Payer: Medical Associates Commercial |
$1.57
|
| Rate for Payer: Midlands Choice Commercial |
$1.46
|
| Rate for Payer: United Healthcare Commercial |
$1.88
|
|
|
calcium acetate 667 mg Cap
|
Facility
OP
|
$2.09
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43751287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna of IA Commercial |
$1.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.88
|
| Rate for Payer: Aetna of IA Medicare |
$1.19
|
| Rate for Payer: Amerigroup Medicaid |
$1.05
|
| Rate for Payer: Amerigroup Medicare |
$1.06
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.57
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.04
|
| Rate for Payer: Medical Associates Commercial |
$1.57
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.04
|
| Rate for Payer: Midlands Choice Commercial |
$1.46
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.57
|
| Rate for Payer: United Healthcare Commercial |
$1.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.23
|
|
|
calcium carbonate 500 mg(1250mg) Tab
|
Facility
IP
|
$1.13
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706099
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of IA Commercial |
$1.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.02
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.85
|
| Rate for Payer: Medical Associates Commercial |
$0.85
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
|
|
calcium carbonate 500 mg(1250mg) Tab
|
Facility
OP
|
$1.13
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706099
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of IA Commercial |
$1.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.02
|
| 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 |
$0.85
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.56
|
| Rate for Payer: Medical Associates Commercial |
$0.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.57
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.67
|
|
|
calcium carbonate 500 mg Chew Tab
|
Facility
IP
|
$1.04
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702318
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna of IA Commercial |
$0.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.94
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.78
|
| Rate for Payer: Medical Associates Commercial |
$0.78
|
| Rate for Payer: Midlands Choice Commercial |
$0.73
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
|
|
calcium carbonate 500 mg Chew Tab
|
Facility
OP
|
$1.04
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702318
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna of IA Commercial |
$0.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.94
|
| Rate for Payer: Aetna of IA Medicare |
$0.59
|
| Rate for Payer: Amerigroup Medicaid |
$0.52
|
| Rate for Payer: Amerigroup Medicare |
$0.53
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.52
|
| Rate for Payer: Medical Associates Commercial |
$0.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.52
|
| Rate for Payer: Midlands Choice Commercial |
$0.73
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.78
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.61
|
|
|
calcium chloride 100 mg/mL 10ml SDV Inj Sol
|
Facility
OP
|
$51.29
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43731088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$46.16 |
| Rate for Payer: Aetna of IA Commercial |
$46.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.16
|
| Rate for Payer: Aetna of IA Medicare |
$29.24
|
| Rate for Payer: Amerigroup Medicaid |
$25.89
|
| Rate for Payer: Amerigroup Medicare |
$25.90
|
| Rate for Payer: Cash Price |
$41.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.47
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.63
|
| Rate for Payer: Medical Associates Commercial |
$38.47
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.64
|
| Rate for Payer: Midlands Choice Commercial |
$35.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$38.47
|
| Rate for Payer: United Healthcare Commercial |
$46.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.26
|
|
|
calcium chloride 100 mg/mL 10ml SDV Inj Sol
|
Facility
IP
|
$51.29
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43731088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$46.16 |
| Rate for Payer: Aetna of IA Commercial |
$46.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.16
|
| Rate for Payer: Cash Price |
$41.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.47
|
| Rate for Payer: Medical Associates Commercial |
$38.47
|
| Rate for Payer: Midlands Choice Commercial |
$35.90
|
| Rate for Payer: United Healthcare Commercial |
$46.16
|
|
|
calcium gluconate 100 mg/mL 10 ml Inj SDV Sol
|
Facility
IP
|
$54.81
|
|
|
Service Code
|
CPT J0612
|
| Hospital Charge Code |
43702122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$49.33 |
| Rate for Payer: Aetna of IA Commercial |
$49.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.33
|
| Rate for Payer: Cash Price |
$43.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.11
|
| Rate for Payer: Medical Associates Commercial |
$41.11
|
| Rate for Payer: Midlands Choice Commercial |
$38.37
|
| Rate for Payer: United Healthcare Commercial |
$49.33
|
|
|
calcium gluconate 100 mg/mL 10 ml Inj SDV Sol
|
Facility
OP
|
$54.81
|
|
|
Service Code
|
CPT J0612
|
| Hospital Charge Code |
43702122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.39 |
| Max. Negotiated Rate |
$49.33 |
| Rate for Payer: Aetna of IA Commercial |
$49.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.33
|
| Rate for Payer: Aetna of IA Medicare |
$31.24
|
| Rate for Payer: Amerigroup Medicaid |
$27.66
|
| Rate for Payer: Amerigroup Medicare |
$27.68
|
| Rate for Payer: Cash Price |
$43.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.11
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.39
|
| Rate for Payer: Medical Associates Commercial |
$41.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.40
|
| Rate for Payer: Midlands Choice Commercial |
$38.37
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$41.11
|
| Rate for Payer: United Healthcare Commercial |
$49.33
|
| Rate for Payer: United Healthcare Managed Medicare |
$32.34
|
|
|
Calcium Urine Timed DMCL
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
8037507
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
|
|
Calcium Urine Timed DMCL
|
Facility
OP
|
$58.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
8037507
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Aetna of IA Medicare |
$33.06
|
| Rate for Payer: Amerigroup Medicaid |
$29.27
|
| Rate for Payer: Amerigroup Medicare |
$29.29
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.99
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.00
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.22
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
calcium-vitamin D 500 mg-200 intl units Tab
|
Facility
IP
|
$1.16
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of IA Commercial |
$1.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.04
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.87
|
| Rate for Payer: Medical Associates Commercial |
$0.87
|
| Rate for Payer: Midlands Choice Commercial |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
|
|
calcium-vitamin D 500 mg-200 intl units Tab
|
Facility
OP
|
$1.16
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of IA Commercial |
$1.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.04
|
| Rate for Payer: Aetna of IA Medicare |
$0.66
|
| Rate for Payer: Amerigroup Medicaid |
$0.59
|
| Rate for Payer: Amerigroup Medicare |
$0.59
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.87
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.58
|
| Rate for Payer: Medical Associates Commercial |
$0.87
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.58
|
| Rate for Payer: Midlands Choice Commercial |
$0.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.87
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.68
|
|
|
canagliflozin 100 mg Tab
|
Facility
IP
|
$68.38
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700344
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.87 |
| Max. Negotiated Rate |
$61.54 |
| Rate for Payer: Aetna of IA Commercial |
$61.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$61.54
|
| Rate for Payer: Cash Price |
$54.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.28
|
| Rate for Payer: Medical Associates Commercial |
$51.28
|
| Rate for Payer: Midlands Choice Commercial |
$47.87
|
| Rate for Payer: United Healthcare Commercial |
$61.54
|
|
|
canagliflozin 100 mg Tab
|
Facility
OP
|
$68.38
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700344
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.18 |
| Max. Negotiated Rate |
$61.54 |
| Rate for Payer: Aetna of IA Commercial |
$61.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$61.54
|
| Rate for Payer: Aetna of IA Medicare |
$38.98
|
| Rate for Payer: Amerigroup Medicaid |
$34.51
|
| Rate for Payer: Amerigroup Medicare |
$34.53
|
| Rate for Payer: Cash Price |
$54.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.19
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.18
|
| Rate for Payer: Medical Associates Commercial |
$51.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.19
|
| Rate for Payer: Midlands Choice Commercial |
$47.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.28
|
| Rate for Payer: United Healthcare Commercial |
$61.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$40.34
|
|
|
CANALITH REPOSITIONING PROC
|
Facility
OP
|
$116.00
|
|
|
Service Code
|
CPT 95992 GP
|
| Hospital Charge Code |
6344980
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.98 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna of IA Commercial |
$104.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$104.40
|
| Rate for Payer: Aetna of IA Medicare |
$66.12
|
| Rate for Payer: Amerigroup Medicaid |
$58.55
|
| Rate for Payer: Amerigroup Medicare |
$58.58
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$58.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.98
|
| Rate for Payer: Medical Associates Commercial |
$87.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.00
|
| Rate for Payer: Midlands Choice Commercial |
$81.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$58.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$87.00
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$68.44
|
|
