|
Cholecystectomy With C.D.E. Without CC/MCC
|
Facility
IP
|
$16,296.09
|
|
|
Service Code
|
MS-DRG 413
|
| Hospital Charge Code |
245
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$16,296.09 |
| Rate for Payer: Amerigroup Medicaid |
$16,217.36
|
| 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 |
$16,059.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16,296.09
|
|
|
CHOLESTEROL-TOTAL
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
633705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna of IA Commercial |
$40.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.50
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.75
|
| Rate for Payer: Medical Associates Commercial |
$33.75
|
| Rate for Payer: Midlands Choice Commercial |
$31.50
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
|
|
CHOLESTEROL-TOTAL
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
633705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna of IA Commercial |
$40.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.50
|
| Rate for Payer: Aetna of IA Medicare |
$25.65
|
| Rate for Payer: Amerigroup Medicaid |
$22.71
|
| Rate for Payer: Amerigroup Medicare |
$22.72
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.49
|
| Rate for Payer: Medical Associates Commercial |
$33.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.50
|
| Rate for Payer: Midlands Choice Commercial |
$31.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.75
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.55
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
cholestyramine
|
Facility
OP
|
$6.31
|
|
|
Service Code
|
CPT A9270GY
|
| Hospital Charge Code |
43701792
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Aetna of IA Commercial |
$5.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.68
|
| Rate for Payer: Aetna of IA Medicare |
$3.60
|
| Rate for Payer: Amerigroup Medicaid |
$3.18
|
| Rate for Payer: Amerigroup Medicare |
$3.19
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.15
|
| Rate for Payer: Medical Associates Commercial |
$4.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.16
|
| Rate for Payer: Midlands Choice Commercial |
$4.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$4.73
|
| Rate for Payer: United Healthcare Commercial |
$5.68
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.72
|
|
|
cholestyramine
|
Facility
IP
|
$6.31
|
|
|
Service Code
|
CPT A9270GY
|
| Hospital Charge Code |
43701792
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Aetna of IA Commercial |
$5.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.68
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.73
|
| Rate for Payer: Medical Associates Commercial |
$4.73
|
| Rate for Payer: Midlands Choice Commercial |
$4.42
|
| Rate for Payer: United Healthcare Commercial |
$5.68
|
|
|
chondroitin-glucosamine 400 MG-500 MG[VDMC]
|
Facility
OP
|
$1.61
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43767915
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Aetna of IA Commercial |
$1.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.45
|
| Rate for Payer: Aetna of IA Medicare |
$0.92
|
| Rate for Payer: Amerigroup Medicaid |
$0.81
|
| Rate for Payer: Amerigroup Medicare |
$0.81
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.21
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.81
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.80
|
| Rate for Payer: Medical Associates Commercial |
$1.21
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.81
|
| Rate for Payer: Midlands Choice Commercial |
$1.13
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.21
|
| Rate for Payer: United Healthcare Commercial |
$1.45
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.95
|
|
|
chondroitin-glucosamine 400 MG-500 MG[VDMC]
|
Facility
IP
|
$1.61
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43767915
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Aetna of IA Commercial |
$1.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.45
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.21
|
| Rate for Payer: Medical Associates Commercial |
$1.21
|
| Rate for Payer: Midlands Choice Commercial |
$1.13
|
| Rate for Payer: United Healthcare Commercial |
$1.45
|
|
|
Chronic Obstructive Pulmonary Disease With CC
|
Facility
IP
|
$7,952.67
|
|
|
Service Code
|
MS-DRG 191
|
| Hospital Charge Code |
62
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,952.67 |
| Rate for Payer: Amerigroup Medicaid |
$7,914.25
|
| 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 |
$7,837.41
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,952.67
|
|
|
Chronic Obstructive Pulmonary Disease With MCC
|
Facility
IP
|
$9,618.01
|
|
|
Service Code
|
MS-DRG 190
|
| Hospital Charge Code |
61
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,618.01 |
| Rate for Payer: Amerigroup Medicaid |
$9,571.54
|
| 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 |
$9,478.62
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,618.01
|
|
|
Chronic Obstructive Pulmonary Disease Without CC/MCC
|
Facility
IP
|
$6,273.56
|
|
|
Service Code
|
MS-DRG 192
|
| Hospital Charge Code |
63
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,273.56 |
| Rate for Payer: Amerigroup Medicaid |
$6,243.25
|
| 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 |
$6,182.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,273.56
|
|
|
cilostazol 100 mg Tab
|
Facility
OP
|
$3.56
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna of IA Commercial |
$3.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.20
|
| Rate for Payer: Aetna of IA Medicare |
$2.03
|
| Rate for Payer: Amerigroup Medicaid |
$1.80
|
| Rate for Payer: Amerigroup Medicare |
$1.80
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.67
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.78
|
| Rate for Payer: Medical Associates Commercial |
$2.67
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.78
|
| Rate for Payer: Midlands Choice Commercial |
$2.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.67
|
| Rate for Payer: United Healthcare Commercial |
$3.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.10
|
|
|
cilostazol 100 mg Tab
|
Facility
IP
|
$3.56
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna of IA Commercial |
$3.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.20
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.67
|
| Rate for Payer: Medical Associates Commercial |
$2.67
|
| Rate for Payer: Midlands Choice Commercial |
$2.49
|
| Rate for Payer: United Healthcare Commercial |
$3.20
|
|
|
ciprofloxacin 500 mg Tab
|
Facility
IP
|
$1.64
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna of IA Commercial |
$1.48
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.48
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.23
|
| Rate for Payer: Medical Associates Commercial |
$1.23
|
| Rate for Payer: Midlands Choice Commercial |
$1.15
|
| Rate for Payer: United Healthcare Commercial |
$1.48
|
|
|
ciprofloxacin 500 mg Tab
|
Facility
OP
|
$1.64
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna of IA Commercial |
$1.48
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.48
|
| Rate for Payer: Aetna of IA Medicare |
$0.93
|
| Rate for Payer: Amerigroup Medicaid |
$0.83
|
| Rate for Payer: Amerigroup Medicare |
$0.83
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.23
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.82
|
| Rate for Payer: Medical Associates Commercial |
$1.23
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.82
|
| Rate for Payer: Midlands Choice Commercial |
$1.15
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.23
|
| Rate for Payer: United Healthcare Commercial |
$1.48
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.97
|
|
|
ciprofloxacin-d5w pgbk 400mg/200ml SDV
|
Facility
OP
|
$58.35
|
|
|
Service Code
|
CPT J0744
|
| Hospital Charge Code |
43701262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.16 |
| Max. Negotiated Rate |
$52.52 |
| Rate for Payer: Aetna of IA Commercial |
$52.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.52
|
| Rate for Payer: Aetna of IA Medicare |
$33.26
|
| Rate for Payer: Amerigroup Medicaid |
$29.45
|
| Rate for Payer: Amerigroup Medicare |
$29.47
|
| Rate for Payer: Cash Price |
$46.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.76
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.18
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.16
|
| Rate for Payer: Medical Associates Commercial |
$43.76
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.18
|
| Rate for Payer: Midlands Choice Commercial |
$40.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.76
|
| Rate for Payer: United Healthcare Commercial |
$52.52
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.43
|
|
|
ciprofloxacin-d5w pgbk 400mg/200ml SDV
|
Facility
IP
|
$58.35
|
|
|
Service Code
|
CPT J0744
|
| Hospital Charge Code |
43701262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.84 |
| Max. Negotiated Rate |
$52.52 |
| Rate for Payer: Aetna of IA Commercial |
$52.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.52
|
| Rate for Payer: Cash Price |
$46.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.76
|
| Rate for Payer: Medical Associates Commercial |
$43.76
|
| Rate for Payer: Midlands Choice Commercial |
$40.84
|
| Rate for Payer: United Healthcare Commercial |
$52.52
|
|
|
ciprofloxacin-dexamethasone otic 0.3%-0.1% Sus 7.5 ml
|
Facility
OP
|
$841.16
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$420.41 |
| Max. Negotiated Rate |
$757.04 |
| Rate for Payer: Aetna of IA Commercial |
$757.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$757.04
|
| Rate for Payer: Aetna of IA Medicare |
$479.46
|
| Rate for Payer: Amerigroup Medicaid |
$424.53
|
| Rate for Payer: Amerigroup Medicare |
$424.79
|
| Rate for Payer: Cash Price |
$672.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$630.87
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$420.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$420.41
|
| Rate for Payer: Medical Associates Commercial |
$630.87
|
| Rate for Payer: Medical Associates Managed Medicare |
$420.58
|
| Rate for Payer: Midlands Choice Commercial |
$588.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$426.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$630.87
|
| Rate for Payer: United Healthcare Commercial |
$757.04
|
| Rate for Payer: United Healthcare Managed Medicare |
$496.28
|
|
|
ciprofloxacin-dexamethasone otic 0.3%-0.1% Sus 7.5 ml
|
Facility
IP
|
$841.16
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$588.81 |
| Max. Negotiated Rate |
$757.04 |
| Rate for Payer: Aetna of IA Commercial |
$757.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$757.04
|
| Rate for Payer: Cash Price |
$672.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$630.87
|
| Rate for Payer: Medical Associates Commercial |
$630.87
|
| Rate for Payer: Midlands Choice Commercial |
$588.81
|
| Rate for Payer: United Healthcare Commercial |
$757.04
|
|
|
Circulatory Disorders Except AMI, With Cardiac Catheterization With MCC
|
Facility
IP
|
$18,175.99
|
|
|
Service Code
|
MS-DRG 286
|
| Hospital Charge Code |
143
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$18,175.99 |
| Rate for Payer: Amerigroup Medicaid |
$18,088.18
|
| 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 |
$17,912.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18,175.99
|
|
|
Circulatory Disorders Except AMI, With Cardiac Catheterization Without MCC
|
Facility
IP
|
$9,604.23
|
|
|
Service Code
|
MS-DRG 287
|
| Hospital Charge Code |
144
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,604.23 |
| Rate for Payer: Amerigroup Medicaid |
$9,557.83
|
| 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 |
$9,465.04
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,604.23
|
|
|
Cirrhosis and Alcoholic Hepatitis With CC
|
Facility
IP
|
$9,871.94
|
|
|
Service Code
|
MS-DRG 433
|
| Hospital Charge Code |
259
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,871.94 |
| Rate for Payer: Amerigroup Medicaid |
$9,824.25
|
| 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 |
$9,728.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,871.94
|
|
|
Cirrhosis and Alcoholic Hepatitis With MCC
|
Facility
IP
|
$15,240.98
|
|
|
Service Code
|
MS-DRG 432
|
| Hospital Charge Code |
258
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$15,240.98 |
| Rate for Payer: Amerigroup Medicaid |
$15,167.35
|
| 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 |
$15,020.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15,240.98
|
|
|
Cirrhosis and Alcoholic Hepatitis Without CC/MCC
|
Facility
IP
|
$6,280.44
|
|
|
Service Code
|
MS-DRG 434
|
| Hospital Charge Code |
260
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,280.44 |
| Rate for Payer: Amerigroup Medicaid |
$6,250.10
|
| 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 |
$6,189.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,280.44
|
|
|
CISplatin 1 mg/mL Sol 100 ml MDV
|
Facility
OP
|
$115.16
|
|
|
Service Code
|
CPT J9060
|
| Hospital Charge Code |
43707651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.56 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna of IA Commercial |
$103.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$103.64
|
| Rate for Payer: Aetna of IA Medicare |
$65.64
|
| Rate for Payer: Amerigroup Medicaid |
$58.12
|
| Rate for Payer: Amerigroup Medicare |
$58.16
|
| Rate for Payer: Cash Price |
$92.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$86.37
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.56
|
| Rate for Payer: Medical Associates Commercial |
$86.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.58
|
| Rate for Payer: Midlands Choice Commercial |
$80.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$58.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$86.37
|
| Rate for Payer: United Healthcare Commercial |
$103.64
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.94
|
|
|
CISplatin 1 mg/mL Sol 100 ml MDV
|
Facility
IP
|
$115.16
|
|
|
Service Code
|
CPT J9060
|
| Hospital Charge Code |
43707651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.61 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna of IA Commercial |
$103.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$103.64
|
| Rate for Payer: Cash Price |
$92.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$86.37
|
| Rate for Payer: Medical Associates Commercial |
$86.37
|
| Rate for Payer: Midlands Choice Commercial |
$80.61
|
| Rate for Payer: United Healthcare Commercial |
$103.64
|
|
