|
fentaNYL 50 mcg/mL 5ml amp
|
Facility
IP
|
$43.54
|
|
|
Service Code
|
CPT J3010
|
| Hospital Charge Code |
43700067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$39.19 |
| Rate for Payer: Aetna of IA Commercial |
$39.19
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.19
|
| Rate for Payer: Cash Price |
$34.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.66
|
| Rate for Payer: Medical Associates Commercial |
$32.66
|
| Rate for Payer: Midlands Choice Commercial |
$30.48
|
| Rate for Payer: United Healthcare Commercial |
$39.19
|
|
|
fentaNYL 50 mcg/mL 5ml amp
|
Facility
OP
|
$43.54
|
|
|
Service Code
|
CPT J3010
|
| Hospital Charge Code |
43700067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$39.19 |
| Rate for Payer: Aetna of IA Commercial |
$39.19
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.19
|
| Rate for Payer: Aetna of IA Medicare |
$24.82
|
| Rate for Payer: Amerigroup Medicaid |
$21.97
|
| Rate for Payer: Amerigroup Medicare |
$21.99
|
| Rate for Payer: Cash Price |
$34.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.66
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$21.77
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.76
|
| Rate for Payer: Medical Associates Commercial |
$32.66
|
| Rate for Payer: Medical Associates Managed Medicare |
$21.77
|
| Rate for Payer: Midlands Choice Commercial |
$30.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$32.66
|
| Rate for Payer: United Healthcare Commercial |
$39.19
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.69
|
|
|
fentaNYL 75 mcg/hr Transderm ER Film
|
Facility
OP
|
$38.60
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43760620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$34.74 |
| Rate for Payer: Aetna of IA Commercial |
$34.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.74
|
| Rate for Payer: Aetna of IA Medicare |
$22.00
|
| Rate for Payer: Amerigroup Medicaid |
$19.48
|
| Rate for Payer: Amerigroup Medicare |
$19.49
|
| Rate for Payer: Cash Price |
$30.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$19.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.29
|
| Rate for Payer: Medical Associates Commercial |
$28.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.30
|
| Rate for Payer: Midlands Choice Commercial |
$27.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.95
|
| Rate for Payer: United Healthcare Commercial |
$34.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$22.77
|
|
|
fentaNYL 75 mcg/hr Transderm ER Film
|
Facility
IP
|
$38.60
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43760620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.02 |
| Max. Negotiated Rate |
$34.74 |
| Rate for Payer: Aetna of IA Commercial |
$34.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.74
|
| Rate for Payer: Cash Price |
$30.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.95
|
| Rate for Payer: Medical Associates Commercial |
$28.95
|
| Rate for Payer: Midlands Choice Commercial |
$27.02
|
| Rate for Payer: United Healthcare Commercial |
$34.74
|
|
|
fentanyl PCA 10mcg/mL 25mL
|
Facility
IP
|
$44.00
|
|
|
Service Code
|
CPT J3010
|
| Hospital Charge Code |
43700536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna of IA Commercial |
$39.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.00
|
| Rate for Payer: Medical Associates Commercial |
$33.00
|
| Rate for Payer: Midlands Choice Commercial |
$30.80
|
| Rate for Payer: United Healthcare Commercial |
$39.60
|
|
|
fentanyl PCA 10mcg/mL 25mL
|
Facility
OP
|
$44.00
|
|
|
Service Code
|
CPT J3010
|
| Hospital Charge Code |
43700536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna of IA Commercial |
$39.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.60
|
| Rate for Payer: Aetna of IA Medicare |
$25.08
|
| Rate for Payer: Amerigroup Medicaid |
$22.21
|
| Rate for Payer: Amerigroup Medicare |
$22.22
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.99
|
| Rate for Payer: Medical Associates Commercial |
$33.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.00
|
| Rate for Payer: Midlands Choice Commercial |
$30.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$39.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.96
|
|
|
fentanyl PCA 50mcg/mL 30mL
|
Facility
OP
|
$44.00
|
|
|
Service Code
|
CPT J3010
|
| Hospital Charge Code |
43701619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna of IA Commercial |
$39.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.60
|
| Rate for Payer: Aetna of IA Medicare |
$25.08
|
| Rate for Payer: Amerigroup Medicaid |
$22.21
|
| Rate for Payer: Amerigroup Medicare |
$22.22
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.99
|
| Rate for Payer: Medical Associates Commercial |
$33.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.00
|
| Rate for Payer: Midlands Choice Commercial |
$30.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$39.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.96
|
|
|
fentanyl PCA 50mcg/mL 30mL
|
Facility
IP
|
$44.00
|
|
|
Service Code
|
CPT J3010
|
| Hospital Charge Code |
43701619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna of IA Commercial |
$39.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.00
|
| Rate for Payer: Medical Associates Commercial |
$33.00
|
| Rate for Payer: Midlands Choice Commercial |
$30.80
|
| Rate for Payer: United Healthcare Commercial |
$39.60
|
|
|
fentaNYL-ropivacaine 2 mcg/mL-0.2%-NaCl 0.9% Sol
|
Facility
IP
|
$294.64
|
|
|
Service Code
|
CPT J3010
|
| Hospital Charge Code |
43700220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$206.25 |
| Max. Negotiated Rate |
$265.18 |
| Rate for Payer: Aetna of IA Commercial |
$265.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$265.18
|
| Rate for Payer: Cash Price |
$235.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$220.98
|
| Rate for Payer: Medical Associates Commercial |
$220.98
|
| Rate for Payer: Midlands Choice Commercial |
$206.25
|
| Rate for Payer: United Healthcare Commercial |
$265.18
|
|
|
fentaNYL-ropivacaine 2 mcg/mL-0.2%-NaCl 0.9% Sol
|
Facility
OP
|
$294.64
|
|
|
Service Code
|
CPT J3010
|
| Hospital Charge Code |
43700220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.26 |
| Max. Negotiated Rate |
$265.18 |
| Rate for Payer: Aetna of IA Commercial |
$265.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$265.18
|
| Rate for Payer: Aetna of IA Medicare |
$167.94
|
| Rate for Payer: Amerigroup Medicaid |
$148.70
|
| Rate for Payer: Amerigroup Medicare |
$148.79
|
| Rate for Payer: Cash Price |
$235.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$220.98
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$147.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$147.26
|
| Rate for Payer: Medical Associates Commercial |
$220.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$147.32
|
| Rate for Payer: Midlands Choice Commercial |
$206.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$149.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$220.98
|
| Rate for Payer: United Healthcare Commercial |
$265.18
|
| Rate for Payer: United Healthcare Managed Medicare |
$173.84
|
|
|
ferric carboxymaltose (as elemental iron) 50 mg/mL 15 ml Sol SDV
|
Facility
IP
|
$1,887.10
|
|
|
Service Code
|
CPT J1439
|
| Hospital Charge Code |
43701075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,320.97 |
| Max. Negotiated Rate |
$1,698.39 |
| Rate for Payer: Aetna of IA Commercial |
$1,698.39
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,698.39
|
| Rate for Payer: Cash Price |
$1,509.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,415.32
|
| Rate for Payer: Medical Associates Commercial |
$1,415.32
|
| Rate for Payer: Midlands Choice Commercial |
$1,320.97
|
| Rate for Payer: United Healthcare Commercial |
$1,698.39
|
|
|
ferric carboxymaltose (as elemental iron) 50 mg/mL 15 ml Sol SDV
|
Facility
OP
|
$1,887.10
|
|
|
Service Code
|
CPT J1439
|
| Hospital Charge Code |
43701075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$943.17 |
| Max. Negotiated Rate |
$1,698.39 |
| Rate for Payer: Aetna of IA Commercial |
$1,698.39
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,698.39
|
| Rate for Payer: Aetna of IA Medicare |
$1,075.65
|
| Rate for Payer: Amerigroup Medicaid |
$952.42
|
| Rate for Payer: Amerigroup Medicare |
$952.99
|
| Rate for Payer: Cash Price |
$1,509.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,415.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$943.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$943.17
|
| Rate for Payer: Medical Associates Commercial |
$1,415.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$943.55
|
| Rate for Payer: Midlands Choice Commercial |
$1,320.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$957.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,415.32
|
| Rate for Payer: United Healthcare Commercial |
$1,698.39
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,113.39
|
|
|
FERRITIN
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
1628893
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Aetna of IA Medicare |
$62.70
|
| Rate for Payer: Amerigroup Medicaid |
$55.52
|
| Rate for Payer: Amerigroup Medicare |
$55.55
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.98
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.00
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.90
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
FERRITIN
|
Facility
IP
|
$110.00
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
1628893
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
|
|
ferrous sulfate 220 mg/5 mL Eli
|
Facility
OP
|
$45.72
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700051
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.85 |
| Max. Negotiated Rate |
$41.15 |
| Rate for Payer: Aetna of IA Commercial |
$41.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.15
|
| Rate for Payer: Aetna of IA Medicare |
$26.06
|
| Rate for Payer: Amerigroup Medicaid |
$23.07
|
| Rate for Payer: Amerigroup Medicare |
$23.09
|
| Rate for Payer: Cash Price |
$36.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.29
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.85
|
| Rate for Payer: Medical Associates Commercial |
$34.29
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.86
|
| Rate for Payer: Midlands Choice Commercial |
$32.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.29
|
| Rate for Payer: United Healthcare Commercial |
$41.15
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.97
|
|
|
ferrous sulfate 220 mg/5 mL Eli
|
Facility
IP
|
$45.72
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700051
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$41.15 |
| Rate for Payer: Aetna of IA Commercial |
$41.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.15
|
| Rate for Payer: Cash Price |
$36.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.29
|
| Rate for Payer: Medical Associates Commercial |
$34.29
|
| Rate for Payer: Midlands Choice Commercial |
$32.00
|
| Rate for Payer: United Healthcare Commercial |
$41.15
|
|
|
ferrous sulfate 325 mg Tab UD
|
Facility
OP
|
$1.10
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43791882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna of IA Commercial |
$0.99
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.99
|
| Rate for Payer: Aetna of IA Medicare |
$0.63
|
| Rate for Payer: Amerigroup Medicaid |
$0.56
|
| Rate for Payer: Amerigroup Medicare |
$0.56
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.83
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.55
|
| Rate for Payer: Medical Associates Commercial |
$0.83
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.55
|
| Rate for Payer: Midlands Choice Commercial |
$0.77
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.83
|
| Rate for Payer: United Healthcare Commercial |
$0.99
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.65
|
|
|
ferrous sulfate 325 mg Tab UD
|
Facility
IP
|
$1.10
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43791882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna of IA Commercial |
$0.99
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.99
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.83
|
| Rate for Payer: Medical Associates Commercial |
$0.83
|
| Rate for Payer: Midlands Choice Commercial |
$0.77
|
| Rate for Payer: United Healthcare Commercial |
$0.99
|
|
|
ferumoxytol 30 mg/mL 17 ml Sol
|
Facility
IP
|
$740.50
|
|
|
Service Code
|
CPT Q0138
|
| Hospital Charge Code |
43700224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$518.35 |
| Max. Negotiated Rate |
$666.45 |
| Rate for Payer: Aetna of IA Commercial |
$666.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$666.45
|
| Rate for Payer: Cash Price |
$592.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$555.38
|
| Rate for Payer: Medical Associates Commercial |
$555.38
|
| Rate for Payer: Midlands Choice Commercial |
$518.35
|
| Rate for Payer: United Healthcare Commercial |
$666.45
|
|
|
ferumoxytol 30 mg/mL 17 ml Sol
|
Facility
OP
|
$740.50
|
|
|
Service Code
|
CPT Q0138
|
| Hospital Charge Code |
43700224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$370.10 |
| Max. Negotiated Rate |
$666.45 |
| Rate for Payer: Aetna of IA Commercial |
$666.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$666.45
|
| Rate for Payer: Aetna of IA Medicare |
$422.08
|
| Rate for Payer: Amerigroup Medicaid |
$373.73
|
| Rate for Payer: Amerigroup Medicare |
$373.95
|
| Rate for Payer: Cash Price |
$592.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$555.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$370.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$370.10
|
| Rate for Payer: Medical Associates Commercial |
$555.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$370.25
|
| Rate for Payer: Midlands Choice Commercial |
$518.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$375.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$555.38
|
| Rate for Payer: United Healthcare Commercial |
$666.45
|
| Rate for Payer: United Healthcare Managed Medicare |
$436.90
|
|
|
FETAL FIBRONECTIN
|
Facility
OP
|
$438.00
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
1147772
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$218.91 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Aetna of IA Commercial |
$394.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$394.20
|
| Rate for Payer: Aetna of IA Medicare |
$249.66
|
| Rate for Payer: Amerigroup Medicaid |
$221.06
|
| Rate for Payer: Amerigroup Medicare |
$221.19
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$328.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$219.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$218.91
|
| Rate for Payer: Medical Associates Commercial |
$328.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$219.00
|
| Rate for Payer: Midlands Choice Commercial |
$306.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$222.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$328.50
|
| Rate for Payer: United Healthcare Commercial |
$394.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$258.42
|
| Rate for Payer: Wellmark IA HMO |
$262.88
|
| Rate for Payer: Wellmark IA PPO |
$289.17
|
|
|
FETAL FIBRONECTIN
|
Facility
IP
|
$438.00
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
1147772
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$306.60 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Aetna of IA Commercial |
$394.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$394.20
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$328.50
|
| Rate for Payer: Medical Associates Commercial |
$328.50
|
| Rate for Payer: Midlands Choice Commercial |
$306.60
|
| Rate for Payer: United Healthcare Commercial |
$394.20
|
|
|
FETAL SCREEN
|
Facility
OP
|
$53.00
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
7796382
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$26.49 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna of IA Commercial |
$47.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$47.70
|
| Rate for Payer: Aetna of IA Medicare |
$30.21
|
| Rate for Payer: Amerigroup Medicaid |
$26.75
|
| Rate for Payer: Amerigroup Medicare |
$26.76
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$26.49
|
| Rate for Payer: Medical Associates Commercial |
$39.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.50
|
| Rate for Payer: Midlands Choice Commercial |
$37.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.75
|
| Rate for Payer: United Healthcare Commercial |
$47.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$31.27
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
|
FETAL SCREEN
|
Facility
IP
|
$53.00
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
7796382
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna of IA Commercial |
$47.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$47.70
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.75
|
| Rate for Payer: Medical Associates Commercial |
$39.75
|
| Rate for Payer: Midlands Choice Commercial |
$37.10
|
| Rate for Payer: United Healthcare Commercial |
$47.70
|
|
|
Fever and Inflammatory Conditions
|
Facility
IP
|
$6,202.69
|
|
|
Service Code
|
MS-DRG 864
|
| Hospital Charge Code |
600
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,202.69 |
| Rate for Payer: Amerigroup Medicaid |
$6,172.73
|
| 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 |
$6,112.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,202.69
|
|
