|
Enterovirus Detection PCR DMCL
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
8037855
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
Enterovirus Detection PCR DMCL
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
8037855
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
ePHEDrine 50 mg/mL 1ml SDV
|
Facility
IP
|
$46.49
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43701004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.54 |
| Max. Negotiated Rate |
$41.84 |
| Rate for Payer: Aetna of IA Commercial |
$41.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.84
|
| Rate for Payer: Cash Price |
$37.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.87
|
| Rate for Payer: Medical Associates Commercial |
$34.87
|
| Rate for Payer: Midlands Choice Commercial |
$32.54
|
| Rate for Payer: United Healthcare Commercial |
$41.84
|
|
|
ePHEDrine 50 mg/mL 1ml SDV
|
Facility
OP
|
$46.49
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43701004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.24 |
| Max. Negotiated Rate |
$41.84 |
| Rate for Payer: Aetna of IA Commercial |
$41.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.84
|
| Rate for Payer: Aetna of IA Medicare |
$26.50
|
| Rate for Payer: Amerigroup Medicaid |
$23.46
|
| Rate for Payer: Amerigroup Medicare |
$23.48
|
| Rate for Payer: Cash Price |
$37.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.87
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.24
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.24
|
| Rate for Payer: Medical Associates Commercial |
$34.87
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.24
|
| Rate for Payer: Midlands Choice Commercial |
$32.54
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.87
|
| Rate for Payer: United Healthcare Commercial |
$41.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$27.43
|
|
|
EPID INJECTION OF BLOOD PATCH
|
Facility
OP
|
$442.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
8059063
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$220.91 |
| Max. Negotiated Rate |
$1,487.44 |
| Rate for Payer: Aetna of IA Commercial |
$397.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$397.80
|
| Rate for Payer: Aetna of IA Medicare |
$251.94
|
| Rate for Payer: Amerigroup Medicaid |
$223.08
|
| Rate for Payer: Amerigroup Medicare |
$223.21
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$331.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$221.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$220.91
|
| Rate for Payer: Medical Associates Commercial |
$331.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$221.00
|
| Rate for Payer: Midlands Choice Commercial |
$309.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$224.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$331.50
|
| Rate for Payer: United Healthcare Commercial |
$397.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$260.78
|
| Rate for Payer: Wellmark IA HMO |
$1,352.22
|
| Rate for Payer: Wellmark IA PPO |
$1,487.44
|
|
|
EPID INJECTION OF BLOOD PATCH
|
Facility
IP
|
$442.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
8059063
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$309.40 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna of IA Commercial |
$397.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$397.80
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$331.50
|
| Rate for Payer: Medical Associates Commercial |
$331.50
|
| Rate for Payer: Midlands Choice Commercial |
$309.40
|
| Rate for Payer: United Healthcare Commercial |
$397.80
|
|
|
EPIDURAL BLOCK-CERVICAL/THORACIC SPINE
|
Professional
|
$554.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
8101309
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$90.48 |
| Max. Negotiated Rate |
$387.80 |
| Rate for Payer: Aetna of IA Medicare |
$90.48
|
| Rate for Payer: Amerigroup Medicaid |
$93.56
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$92.29
|
| Rate for Payer: Medical Associates Commercial |
$171.91
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.48
|
| Rate for Payer: Midlands Choice Commercial |
$387.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.72
|
| Rate for Payer: Wellmark IA HMO |
$178.00
|
| Rate for Payer: Wellmark IA PPO |
$209.00
|
|
|
EPIDURAL DRUG MGMT/PAINCONTINUOUS ADMIN
|
Facility
OP
|
$1,080.00
|
|
| Hospital Charge Code |
8059057
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$539.78 |
| Max. Negotiated Rate |
$972.00 |
| Rate for Payer: Aetna of IA Commercial |
$972.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$972.00
|
| Rate for Payer: Aetna of IA Medicare |
$615.60
|
| Rate for Payer: Amerigroup Medicaid |
$545.08
|
| Rate for Payer: Amerigroup Medicare |
$545.40
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$810.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$540.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$539.78
|
| Rate for Payer: Medical Associates Commercial |
$810.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$540.00
|
| Rate for Payer: Midlands Choice Commercial |
$756.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$548.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$810.00
|
| Rate for Payer: United Healthcare Commercial |
$972.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$637.20
|
|
|
EPIDURAL DRUG MGMT/PAINCONTINUOUS ADMIN
|
Facility
IP
|
$1,080.00
|
|
| Hospital Charge Code |
8059057
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$756.00 |
| Max. Negotiated Rate |
$972.00 |
| Rate for Payer: Aetna of IA Commercial |
$972.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$972.00
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$810.00
|
| Rate for Payer: Medical Associates Commercial |
$810.00
|
| Rate for Payer: Midlands Choice Commercial |
$756.00
|
| Rate for Payer: United Healthcare Commercial |
$972.00
|
|
|
EPINEPHrine
|
Facility
OP
|
$544.30
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
43701668
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$272.04 |
| Max. Negotiated Rate |
$489.87 |
| Rate for Payer: Aetna of IA Commercial |
$489.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$489.87
|
| Rate for Payer: Aetna of IA Medicare |
$310.25
|
| Rate for Payer: Amerigroup Medicaid |
$274.71
|
| Rate for Payer: Amerigroup Medicare |
$274.87
|
| Rate for Payer: Cash Price |
$435.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$408.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$272.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$272.04
|
| Rate for Payer: Medical Associates Commercial |
$408.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$272.15
|
| Rate for Payer: Midlands Choice Commercial |
$381.01
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$276.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$408.22
|
| Rate for Payer: United Healthcare Commercial |
$489.87
|
| Rate for Payer: United Healthcare Managed Medicare |
$321.14
|
|
|
EPINEPHrine
|
Facility
IP
|
$544.30
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
43701668
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$381.01 |
| Max. Negotiated Rate |
$489.87 |
| Rate for Payer: Aetna of IA Commercial |
$489.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$489.87
|
| Rate for Payer: Cash Price |
$435.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$408.22
|
| Rate for Payer: Medical Associates Commercial |
$408.22
|
| Rate for Payer: Midlands Choice Commercial |
$381.01
|
| Rate for Payer: United Healthcare Commercial |
$489.87
|
|
|
EPINEPHrine 1 mg/mL 1ml vial SDV
|
Facility
IP
|
$108.27
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
43788995
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.79 |
| Max. Negotiated Rate |
$97.44 |
| Rate for Payer: Aetna of IA Commercial |
$97.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.44
|
| Rate for Payer: Cash Price |
$86.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.20
|
| Rate for Payer: Medical Associates Commercial |
$81.20
|
| Rate for Payer: Midlands Choice Commercial |
$75.79
|
| Rate for Payer: United Healthcare Commercial |
$97.44
|
|
|
EPINEPHrine 1 mg/mL 1ml vial SDV
|
Facility
OP
|
$108.27
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
43788995
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.11 |
| Max. Negotiated Rate |
$97.44 |
| Rate for Payer: Aetna of IA Commercial |
$97.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.44
|
| Rate for Payer: Aetna of IA Medicare |
$61.71
|
| Rate for Payer: Amerigroup Medicaid |
$54.64
|
| Rate for Payer: Amerigroup Medicare |
$54.68
|
| Rate for Payer: Cash Price |
$86.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.20
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$54.14
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.11
|
| Rate for Payer: Medical Associates Commercial |
$81.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$54.14
|
| Rate for Payer: Midlands Choice Commercial |
$75.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$54.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.20
|
| Rate for Payer: United Healthcare Commercial |
$97.44
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.88
|
|
|
EPINEPHrine 1 mg/mL 30ml Inj MDV
|
Facility
IP
|
$645.48
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
43701017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$451.84 |
| Max. Negotiated Rate |
$580.93 |
| Rate for Payer: Aetna of IA Commercial |
$580.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$580.93
|
| Rate for Payer: Cash Price |
$516.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$484.11
|
| Rate for Payer: Medical Associates Commercial |
$484.11
|
| Rate for Payer: Midlands Choice Commercial |
$451.84
|
| Rate for Payer: United Healthcare Commercial |
$580.93
|
|
|
EPINEPHrine 1 mg/mL 30ml Inj MDV
|
Facility
OP
|
$645.48
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
43701017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$322.61 |
| Max. Negotiated Rate |
$580.93 |
| Rate for Payer: Aetna of IA Commercial |
$580.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$580.93
|
| Rate for Payer: Aetna of IA Medicare |
$367.92
|
| Rate for Payer: Amerigroup Medicaid |
$325.77
|
| Rate for Payer: Amerigroup Medicare |
$325.97
|
| Rate for Payer: Cash Price |
$516.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$484.11
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$322.74
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$322.61
|
| Rate for Payer: Medical Associates Commercial |
$484.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$322.74
|
| Rate for Payer: Midlands Choice Commercial |
$451.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$327.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$484.11
|
| Rate for Payer: United Healthcare Commercial |
$580.93
|
| Rate for Payer: United Healthcare Managed Medicare |
$380.83
|
|
|
EPINEPHrine Emergency syringe 0.1 mg/mL 10ml Inj SDV
|
Facility
OP
|
$54.96
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
43701622
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.47 |
| Max. Negotiated Rate |
$49.46 |
| Rate for Payer: Aetna of IA Commercial |
$49.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.46
|
| Rate for Payer: Aetna of IA Medicare |
$31.33
|
| Rate for Payer: Amerigroup Medicaid |
$27.74
|
| Rate for Payer: Amerigroup Medicare |
$27.75
|
| Rate for Payer: Cash Price |
$43.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.47
|
| Rate for Payer: Medical Associates Commercial |
$41.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.48
|
| Rate for Payer: Midlands Choice Commercial |
$38.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$41.22
|
| Rate for Payer: United Healthcare Commercial |
$49.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$32.43
|
|
|
EPINEPHrine Emergency syringe 0.1 mg/mL 10ml Inj SDV
|
Facility
IP
|
$54.96
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
43701622
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.47 |
| Max. Negotiated Rate |
$49.46 |
| Rate for Payer: Aetna of IA Commercial |
$49.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.46
|
| Rate for Payer: Cash Price |
$43.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.22
|
| Rate for Payer: Medical Associates Commercial |
$41.22
|
| Rate for Payer: Midlands Choice Commercial |
$38.47
|
| Rate for Payer: United Healthcare Commercial |
$49.46
|
|
|
EPINEPHrine ( Eye Surgery )1 mg/mL 0.3ml Inj Sol
|
Facility
IP
|
$104.97
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
43701564
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.48 |
| Max. Negotiated Rate |
$94.47 |
| Rate for Payer: Aetna of IA Commercial |
$94.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$94.47
|
| Rate for Payer: Cash Price |
$83.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.73
|
| Rate for Payer: Medical Associates Commercial |
$78.73
|
| Rate for Payer: Midlands Choice Commercial |
$73.48
|
| Rate for Payer: United Healthcare Commercial |
$94.47
|
|
|
EPINEPHrine ( Eye Surgery )1 mg/mL 0.3ml Inj Sol
|
Facility
OP
|
$104.97
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
43701564
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.46 |
| Max. Negotiated Rate |
$94.47 |
| Rate for Payer: Aetna of IA Commercial |
$94.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$94.47
|
| Rate for Payer: Aetna of IA Medicare |
$59.83
|
| Rate for Payer: Amerigroup Medicaid |
$52.98
|
| Rate for Payer: Amerigroup Medicare |
$53.01
|
| Rate for Payer: Cash Price |
$83.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$52.46
|
| Rate for Payer: Medical Associates Commercial |
$78.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.48
|
| Rate for Payer: Midlands Choice Commercial |
$73.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$53.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.73
|
| Rate for Payer: United Healthcare Commercial |
$94.47
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.93
|
|
|
EPINEPHrine (PEN JR) 0.15 mg Inj kit SDV
|
Facility
OP
|
$545.14
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
43700162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$272.46 |
| Max. Negotiated Rate |
$490.63 |
| Rate for Payer: Aetna of IA Commercial |
$490.63
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$490.63
|
| Rate for Payer: Aetna of IA Medicare |
$310.73
|
| Rate for Payer: Amerigroup Medicaid |
$275.13
|
| Rate for Payer: Amerigroup Medicare |
$275.30
|
| Rate for Payer: Cash Price |
$436.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$408.86
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$272.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$272.46
|
| Rate for Payer: Medical Associates Commercial |
$408.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$272.57
|
| Rate for Payer: Midlands Choice Commercial |
$381.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$276.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$408.86
|
| Rate for Payer: United Healthcare Commercial |
$490.63
|
| Rate for Payer: United Healthcare Managed Medicare |
$321.63
|
|
|
EPINEPHrine (PEN JR) 0.15 mg Inj kit SDV
|
Facility
IP
|
$545.14
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
43700162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$381.60 |
| Max. Negotiated Rate |
$490.63 |
| Rate for Payer: Aetna of IA Commercial |
$490.63
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$490.63
|
| Rate for Payer: Cash Price |
$436.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$408.86
|
| Rate for Payer: Medical Associates Commercial |
$408.86
|
| Rate for Payer: Midlands Choice Commercial |
$381.60
|
| Rate for Payer: United Healthcare Commercial |
$490.63
|
|
|
Epistaxis With MCC
|
Facility
IP
|
$13,041.20
|
|
|
Service Code
|
MS-DRG 150
|
| Hospital Charge Code |
30
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$13,041.20 |
| Rate for Payer: Amerigroup Medicaid |
$12,978.20
|
| 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 |
$12,852.19
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,041.20
|
|
|
Epistaxis Without MCC
|
Facility
IP
|
$3,987.16
|
|
|
Service Code
|
MS-DRG 151
|
| Hospital Charge Code |
31
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$3,987.16 |
| Rate for Payer: Amerigroup Medicaid |
$3,967.90
|
| 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 |
$3,929.38
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,987.16
|
|
|
epoetin alfa 10,000 units/mL 1ml SDV preservative-free Sol
|
Facility
OP
|
$672.06
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
43700321
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$335.90 |
| Max. Negotiated Rate |
$604.85 |
| Rate for Payer: Aetna of IA Commercial |
$604.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$604.85
|
| Rate for Payer: Aetna of IA Medicare |
$383.07
|
| Rate for Payer: Amerigroup Medicaid |
$339.19
|
| Rate for Payer: Amerigroup Medicare |
$339.39
|
| Rate for Payer: Cash Price |
$537.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$504.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$336.03
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$335.90
|
| Rate for Payer: Medical Associates Commercial |
$504.04
|
| Rate for Payer: Medical Associates Managed Medicare |
$336.03
|
| Rate for Payer: Midlands Choice Commercial |
$470.44
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$341.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$504.04
|
| Rate for Payer: United Healthcare Commercial |
$604.85
|
| Rate for Payer: United Healthcare Managed Medicare |
$396.52
|
|
|
epoetin alfa 10,000 units/mL 1ml SDV preservative-free Sol
|
Facility
IP
|
$672.06
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
43700321
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$470.44 |
| Max. Negotiated Rate |
$604.85 |
| Rate for Payer: Aetna of IA Commercial |
$604.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$604.85
|
| Rate for Payer: Cash Price |
$537.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$504.04
|
| Rate for Payer: Medical Associates Commercial |
$504.04
|
| Rate for Payer: Midlands Choice Commercial |
$470.44
|
| Rate for Payer: United Healthcare Commercial |
$604.85
|
|
