|
enalapril maleate 5 mg Tab
|
Facility
OP
|
$1.18
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Aetna of IA Commercial |
$1.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.06
|
| Rate for Payer: Aetna of IA Medicare |
$0.67
|
| Rate for Payer: Amerigroup Medicaid |
$0.60
|
| Rate for Payer: Amerigroup Medicare |
$0.60
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.89
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.59
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.59
|
| Rate for Payer: Medical Associates Commercial |
$0.89
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.59
|
| Rate for Payer: Midlands Choice Commercial |
$0.83
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.89
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.70
|
|
|
enalapril maleate 5 mg Tab
|
Facility
IP
|
$1.18
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Aetna of IA Commercial |
$1.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.06
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.89
|
| Rate for Payer: Medical Associates Commercial |
$0.89
|
| Rate for Payer: Midlands Choice Commercial |
$0.83
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
|
|
ENDO CLIP CARTRIDGE
|
Facility
IP
|
$94.00
|
|
| Hospital Charge Code |
8026309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of IA Commercial |
$84.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$84.60
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$70.50
|
| Rate for Payer: Medical Associates Commercial |
$70.50
|
| Rate for Payer: Midlands Choice Commercial |
$65.80
|
| Rate for Payer: United Healthcare Commercial |
$84.60
|
|
|
ENDO CLIP CARTRIDGE
|
Facility
OP
|
$94.00
|
|
| Hospital Charge Code |
8026309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of IA Commercial |
$84.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$84.60
|
| Rate for Payer: Aetna of IA Medicare |
$53.58
|
| Rate for Payer: Amerigroup Medicaid |
$47.44
|
| Rate for Payer: Amerigroup Medicare |
$47.47
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$70.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$47.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$46.98
|
| Rate for Payer: Medical Associates Commercial |
$70.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.00
|
| Rate for Payer: Midlands Choice Commercial |
$65.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$47.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$70.50
|
| Rate for Payer: United Healthcare Commercial |
$84.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$55.46
|
|
|
Endocrine Disorders With CC
|
Facility
IP
|
$6,898.54
|
|
|
Service Code
|
MS-DRG 644
|
| Hospital Charge Code |
430
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,898.54 |
| Rate for Payer: Amerigroup Medicaid |
$6,865.22
|
| 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 |
$6,798.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,898.54
|
|
|
Endocrine Disorders With MCC
|
Facility
IP
|
$10,931.97
|
|
|
Service Code
|
MS-DRG 643
|
| Hospital Charge Code |
429
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$10,931.97 |
| Rate for Payer: Amerigroup Medicaid |
$10,879.16
|
| 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 |
$10,773.54
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,931.97
|
|
|
Endocrine Disorders Without CC/MCC
|
Facility
IP
|
$5,322.78
|
|
|
Service Code
|
MS-DRG 645
|
| Hospital Charge Code |
431
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,322.78 |
| Rate for Payer: Amerigroup Medicaid |
$5,297.06
|
| 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 |
$5,245.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,322.78
|
|
|
ENDO GIA 30 2.5 (SULU) LOADING UNIT
|
Facility
IP
|
$1,141.00
|
|
| Hospital Charge Code |
8047001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,026.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,026.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,026.90
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$855.75
|
| Rate for Payer: Medical Associates Commercial |
$855.75
|
| Rate for Payer: Midlands Choice Commercial |
$798.70
|
| Rate for Payer: United Healthcare Commercial |
$1,026.90
|
|
|
ENDO GIA 30 2.5 (SULU) LOADING UNIT
|
Facility
OP
|
$1,141.00
|
|
| Hospital Charge Code |
8047001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.27 |
| Max. Negotiated Rate |
$1,026.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,026.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,026.90
|
| Rate for Payer: Aetna of IA Medicare |
$650.37
|
| Rate for Payer: Amerigroup Medicaid |
$575.86
|
| Rate for Payer: Amerigroup Medicare |
$576.20
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$855.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$570.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$570.27
|
| Rate for Payer: Medical Associates Commercial |
$855.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$570.50
|
| Rate for Payer: Midlands Choice Commercial |
$798.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$579.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$855.75
|
| Rate for Payer: United Healthcare Commercial |
$1,026.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$673.19
|
|
|
ENDO GIA 30 3.5 LOAD
|
Facility
OP
|
$603.00
|
|
| Hospital Charge Code |
8025853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$301.38 |
| Max. Negotiated Rate |
$542.70 |
| Rate for Payer: Aetna of IA Commercial |
$542.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$542.70
|
| Rate for Payer: Aetna of IA Medicare |
$343.71
|
| Rate for Payer: Amerigroup Medicaid |
$304.33
|
| Rate for Payer: Amerigroup Medicare |
$304.52
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$452.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$301.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$301.38
|
| Rate for Payer: Medical Associates Commercial |
$452.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$301.50
|
| Rate for Payer: Midlands Choice Commercial |
$422.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$306.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$452.25
|
| Rate for Payer: United Healthcare Commercial |
$542.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$355.77
|
|
|
ENDO GIA 30 3.5 LOAD
|
Facility
IP
|
$603.00
|
|
| Hospital Charge Code |
8025853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$422.10 |
| Max. Negotiated Rate |
$542.70 |
| Rate for Payer: Aetna of IA Commercial |
$542.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$542.70
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$452.25
|
| Rate for Payer: Medical Associates Commercial |
$452.25
|
| Rate for Payer: Midlands Choice Commercial |
$422.10
|
| Rate for Payer: United Healthcare Commercial |
$542.70
|
|
|
Endomysial IgA Antibody DMCL
|
Facility
OP
|
$115.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
8037839
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna of IA Commercial |
$103.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$103.50
|
| Rate for Payer: Aetna of IA Medicare |
$65.55
|
| Rate for Payer: Amerigroup Medicaid |
$58.04
|
| Rate for Payer: Amerigroup Medicare |
$58.08
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$86.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.48
|
| Rate for Payer: Medical Associates Commercial |
$86.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.50
|
| Rate for Payer: Midlands Choice Commercial |
$80.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$58.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$86.25
|
| Rate for Payer: United Healthcare Commercial |
$103.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.85
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Endomysial IgA Antibody DMCL
|
Facility
IP
|
$115.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
8037839
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna of IA Commercial |
$103.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$103.50
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$86.25
|
| Rate for Payer: Medical Associates Commercial |
$86.25
|
| Rate for Payer: Midlands Choice Commercial |
$80.50
|
| Rate for Payer: United Healthcare Commercial |
$103.50
|
|
|
Endovascular Cardiac Valve Replacement and Supplement Procedures With MCC
|
Facility
IP
|
$61,018.05
|
|
|
Service Code
|
MS-DRG 266
|
| Hospital Charge Code |
128
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$61,018.05 |
| Rate for Payer: Amerigroup Medicaid |
$60,723.28
|
| 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 |
$60,133.73
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$61,018.05
|
|
|
Endovascular Cardiac Valve Replacement and Supplement Procedures Without MCC
|
Facility
IP
|
$51,305.56
|
|
|
Service Code
|
MS-DRG 267
|
| Hospital Charge Code |
129
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$51,305.56 |
| Rate for Payer: Amerigroup Medicaid |
$51,057.71
|
| 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 |
$50,562.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$51,305.56
|
|
|
enoxaparin 100 mg/mL 1ml SDV syringe
|
Facility
IP
|
$44.50
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
43755124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.15 |
| Max. Negotiated Rate |
$40.05 |
| Rate for Payer: Aetna of IA Commercial |
$40.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.05
|
| Rate for Payer: Cash Price |
$35.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.38
|
| Rate for Payer: Medical Associates Commercial |
$33.38
|
| Rate for Payer: Midlands Choice Commercial |
$31.15
|
| Rate for Payer: United Healthcare Commercial |
$40.05
|
|
|
enoxaparin 100 mg/mL 1ml SDV syringe
|
Facility
OP
|
$44.50
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
43755124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.24 |
| Max. Negotiated Rate |
$40.05 |
| Rate for Payer: Aetna of IA Commercial |
$40.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.05
|
| Rate for Payer: Aetna of IA Medicare |
$25.36
|
| Rate for Payer: Amerigroup Medicaid |
$22.46
|
| Rate for Payer: Amerigroup Medicare |
$22.47
|
| Rate for Payer: Cash Price |
$35.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.24
|
| Rate for Payer: Medical Associates Commercial |
$33.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.25
|
| Rate for Payer: Midlands Choice Commercial |
$31.15
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.38
|
| Rate for Payer: United Healthcare Commercial |
$40.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.26
|
|
|
enoxaparin 30 mg/0.3 ml SDV syringe
|
Facility
IP
|
$26.50
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
43705928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.55 |
| Max. Negotiated Rate |
$23.85 |
| Rate for Payer: Aetna of IA Commercial |
$23.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.85
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.88
|
| Rate for Payer: Medical Associates Commercial |
$19.88
|
| Rate for Payer: Midlands Choice Commercial |
$18.55
|
| Rate for Payer: United Healthcare Commercial |
$23.85
|
|
|
enoxaparin 30 mg/0.3 ml SDV syringe
|
Facility
OP
|
$26.50
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
43705928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$23.85 |
| Rate for Payer: Aetna of IA Commercial |
$23.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.85
|
| Rate for Payer: Aetna of IA Medicare |
$15.10
|
| Rate for Payer: Amerigroup Medicaid |
$13.37
|
| Rate for Payer: Amerigroup Medicare |
$13.38
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.88
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.24
|
| Rate for Payer: Medical Associates Commercial |
$19.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.25
|
| Rate for Payer: Midlands Choice Commercial |
$18.55
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.88
|
| Rate for Payer: United Healthcare Commercial |
$23.85
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.64
|
|
|
enoxaparin 40 mg/0.4 mL SDV syringe
|
Facility
OP
|
$28.21
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
43716550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna of IA Commercial |
$25.39
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.39
|
| Rate for Payer: Aetna of IA Medicare |
$16.08
|
| Rate for Payer: Amerigroup Medicaid |
$14.24
|
| Rate for Payer: Amerigroup Medicare |
$14.25
|
| Rate for Payer: Cash Price |
$22.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.16
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.10
|
| Rate for Payer: Medical Associates Commercial |
$21.16
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.10
|
| Rate for Payer: Midlands Choice Commercial |
$19.75
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.16
|
| Rate for Payer: United Healthcare Commercial |
$25.39
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.64
|
|
|
enoxaparin 40 mg/0.4 mL SDV syringe
|
Facility
IP
|
$28.21
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
43716550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna of IA Commercial |
$25.39
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.39
|
| Rate for Payer: Cash Price |
$22.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.16
|
| Rate for Payer: Medical Associates Commercial |
$21.16
|
| Rate for Payer: Midlands Choice Commercial |
$19.75
|
| Rate for Payer: United Healthcare Commercial |
$25.39
|
|
|
enoxaparin 60 mg/0.6 mL SDV syringe
|
Facility
OP
|
$37.85
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
43720175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.92 |
| Max. Negotiated Rate |
$34.06 |
| Rate for Payer: Aetna of IA Commercial |
$34.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.06
|
| Rate for Payer: Aetna of IA Medicare |
$21.57
|
| Rate for Payer: Amerigroup Medicaid |
$19.10
|
| Rate for Payer: Amerigroup Medicare |
$19.11
|
| Rate for Payer: Cash Price |
$30.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.39
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.92
|
| Rate for Payer: Medical Associates Commercial |
$28.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.92
|
| Rate for Payer: Midlands Choice Commercial |
$26.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.39
|
| Rate for Payer: United Healthcare Commercial |
$34.06
|
| Rate for Payer: United Healthcare Managed Medicare |
$22.33
|
|
|
enoxaparin 60 mg/0.6 mL SDV syringe
|
Facility
IP
|
$37.85
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
43720175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$34.06 |
| Rate for Payer: Aetna of IA Commercial |
$34.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.06
|
| Rate for Payer: Cash Price |
$30.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.39
|
| Rate for Payer: Medical Associates Commercial |
$28.39
|
| Rate for Payer: Midlands Choice Commercial |
$26.50
|
| Rate for Payer: United Healthcare Commercial |
$34.06
|
|
|
enoxaparin 80 mg/0.8 mL SDV syringe
|
Facility
OP
|
$38.68
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
43751023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.33 |
| Max. Negotiated Rate |
$34.81 |
| Rate for Payer: Aetna of IA Commercial |
$34.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.81
|
| Rate for Payer: Aetna of IA Medicare |
$22.05
|
| Rate for Payer: Amerigroup Medicaid |
$19.52
|
| Rate for Payer: Amerigroup Medicare |
$19.53
|
| Rate for Payer: Cash Price |
$30.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$29.01
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$19.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.33
|
| Rate for Payer: Medical Associates Commercial |
$29.01
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.34
|
| Rate for Payer: Midlands Choice Commercial |
$27.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$29.01
|
| Rate for Payer: United Healthcare Commercial |
$34.81
|
| Rate for Payer: United Healthcare Managed Medicare |
$22.82
|
|
|
enoxaparin 80 mg/0.8 mL SDV syringe
|
Facility
IP
|
$38.68
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
43751023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.08 |
| Max. Negotiated Rate |
$34.81 |
| Rate for Payer: Aetna of IA Commercial |
$34.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.81
|
| Rate for Payer: Cash Price |
$30.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$29.01
|
| Rate for Payer: Medical Associates Commercial |
$29.01
|
| Rate for Payer: Midlands Choice Commercial |
$27.08
|
| Rate for Payer: United Healthcare Commercial |
$34.81
|
|
