|
fluconazole 100 mg Tab
|
Facility
IP
|
$6.04
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701414
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Aetna of IA Commercial |
$5.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.44
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.53
|
| Rate for Payer: Medical Associates Commercial |
$4.53
|
| Rate for Payer: Midlands Choice Commercial |
$4.23
|
| Rate for Payer: United Healthcare Commercial |
$5.44
|
|
|
fluconazole 10 mg/mL 35ml Oral Liq
|
Facility
OP
|
$27.08
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43788107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$24.37 |
| Rate for Payer: Aetna of IA Commercial |
$24.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.37
|
| Rate for Payer: Aetna of IA Medicare |
$15.44
|
| Rate for Payer: Amerigroup Medicaid |
$13.67
|
| Rate for Payer: Amerigroup Medicare |
$13.68
|
| Rate for Payer: Cash Price |
$21.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.31
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.53
|
| Rate for Payer: Medical Associates Commercial |
$20.31
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.54
|
| Rate for Payer: Midlands Choice Commercial |
$18.96
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.31
|
| Rate for Payer: United Healthcare Commercial |
$24.37
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.98
|
|
|
fluconazole 10 mg/mL 35ml Oral Liq
|
Facility
IP
|
$27.08
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43788107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$24.37 |
| Rate for Payer: Aetna of IA Commercial |
$24.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.37
|
| Rate for Payer: Cash Price |
$21.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.31
|
| Rate for Payer: Medical Associates Commercial |
$20.31
|
| Rate for Payer: Midlands Choice Commercial |
$18.96
|
| Rate for Payer: United Healthcare Commercial |
$24.37
|
|
|
fluconazole 150 mg Tab
|
Facility
OP
|
$4.00
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43761728
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna of IA Commercial |
$3.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.60
|
| Rate for Payer: Aetna of IA Medicare |
$2.28
|
| Rate for Payer: Amerigroup Medicaid |
$2.02
|
| Rate for Payer: Amerigroup Medicare |
$2.02
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.00
|
| Rate for Payer: Medical Associates Commercial |
$3.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.00
|
| Rate for Payer: Midlands Choice Commercial |
$2.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.00
|
| Rate for Payer: United Healthcare Commercial |
$3.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.36
|
|
|
fluconazole 150 mg Tab
|
Facility
IP
|
$4.00
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43761728
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna of IA Commercial |
$3.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.00
|
| Rate for Payer: Medical Associates Commercial |
$3.00
|
| Rate for Payer: Midlands Choice Commercial |
$2.80
|
| Rate for Payer: United Healthcare Commercial |
$3.60
|
|
|
fluconazole 200 MG/100 mL-NaCl 0.9%
|
Facility
OP
|
$65.92
|
|
|
Service Code
|
CPT J1450
|
| Hospital Charge Code |
43702721
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.95 |
| Max. Negotiated Rate |
$59.33 |
| Rate for Payer: Aetna of IA Commercial |
$59.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.33
|
| Rate for Payer: Aetna of IA Medicare |
$37.57
|
| Rate for Payer: Amerigroup Medicaid |
$33.27
|
| Rate for Payer: Amerigroup Medicare |
$33.29
|
| Rate for Payer: Cash Price |
$52.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.95
|
| Rate for Payer: Medical Associates Commercial |
$49.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.96
|
| Rate for Payer: Midlands Choice Commercial |
$46.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.44
|
| Rate for Payer: United Healthcare Commercial |
$59.33
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.89
|
|
|
fluconazole 200 MG/100 mL-NaCl 0.9%
|
Facility
IP
|
$65.92
|
|
|
Service Code
|
CPT J1450
|
| Hospital Charge Code |
43702721
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$59.33 |
| Rate for Payer: Aetna of IA Commercial |
$59.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.33
|
| Rate for Payer: Cash Price |
$52.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.44
|
| Rate for Payer: Medical Associates Commercial |
$49.44
|
| Rate for Payer: Midlands Choice Commercial |
$46.14
|
| Rate for Payer: United Healthcare Commercial |
$59.33
|
|
|
fluconazole 400 mg (200 mL) NaCl 0.9% Bag
|
Facility
IP
|
$67.46
|
|
|
Service Code
|
CPT J1450
|
| Hospital Charge Code |
43700542
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.22 |
| Max. Negotiated Rate |
$60.71 |
| Rate for Payer: Aetna of IA Commercial |
$60.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.71
|
| Rate for Payer: Cash Price |
$53.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.60
|
| Rate for Payer: Medical Associates Commercial |
$50.60
|
| Rate for Payer: Midlands Choice Commercial |
$47.22
|
| Rate for Payer: United Healthcare Commercial |
$60.71
|
|
|
fluconazole 400 mg (200 mL) NaCl 0.9% Bag
|
Facility
OP
|
$67.46
|
|
|
Service Code
|
CPT J1450
|
| Hospital Charge Code |
43700542
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.72 |
| Max. Negotiated Rate |
$60.71 |
| Rate for Payer: Aetna of IA Commercial |
$60.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.71
|
| Rate for Payer: Aetna of IA Medicare |
$38.45
|
| Rate for Payer: Amerigroup Medicaid |
$34.05
|
| Rate for Payer: Amerigroup Medicare |
$34.07
|
| Rate for Payer: Cash Price |
$53.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.72
|
| Rate for Payer: Medical Associates Commercial |
$50.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.73
|
| Rate for Payer: Midlands Choice Commercial |
$47.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.60
|
| Rate for Payer: United Healthcare Commercial |
$60.71
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.80
|
|
|
fludrocortisone 0.1 mg Tab
|
Facility
OP
|
$2.69
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna of IA Commercial |
$2.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.42
|
| Rate for Payer: Aetna of IA Medicare |
$1.53
|
| Rate for Payer: Amerigroup Medicaid |
$1.36
|
| Rate for Payer: Amerigroup Medicare |
$1.36
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.02
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.34
|
| Rate for Payer: Medical Associates Commercial |
$2.02
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.34
|
| Rate for Payer: Midlands Choice Commercial |
$1.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.02
|
| Rate for Payer: United Healthcare Commercial |
$2.42
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.59
|
|
|
fludrocortisone 0.1 mg Tab
|
Facility
IP
|
$2.69
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna of IA Commercial |
$2.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.42
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.02
|
| Rate for Payer: Medical Associates Commercial |
$2.02
|
| Rate for Payer: Midlands Choice Commercial |
$1.88
|
| Rate for Payer: United Healthcare Commercial |
$2.42
|
|
|
flumazenil 0.1 mg/mL 10ml MDV
|
Facility
OP
|
$54.76
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43700544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$49.28 |
| Rate for Payer: Aetna of IA Commercial |
$49.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.28
|
| Rate for Payer: Aetna of IA Medicare |
$31.21
|
| Rate for Payer: Amerigroup Medicaid |
$27.64
|
| Rate for Payer: Amerigroup Medicare |
$27.65
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.07
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.38
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.37
|
| Rate for Payer: Medical Associates Commercial |
$41.07
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.38
|
| Rate for Payer: Midlands Choice Commercial |
$38.33
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$41.07
|
| Rate for Payer: United Healthcare Commercial |
$49.28
|
| Rate for Payer: United Healthcare Managed Medicare |
$32.31
|
|
|
flumazenil 0.1 mg/mL 10ml MDV
|
Facility
IP
|
$54.76
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43700544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.33 |
| Max. Negotiated Rate |
$49.28 |
| Rate for Payer: Aetna of IA Commercial |
$49.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.28
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.07
|
| Rate for Payer: Medical Associates Commercial |
$41.07
|
| Rate for Payer: Midlands Choice Commercial |
$38.33
|
| Rate for Payer: United Healthcare Commercial |
$49.28
|
|
|
flumazenil 0.1 mg/mL 5ml MDV
|
Facility
IP
|
$30.31
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43701068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$27.28 |
| Rate for Payer: Aetna of IA Commercial |
$27.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.28
|
| Rate for Payer: Cash Price |
$24.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.73
|
| Rate for Payer: Medical Associates Commercial |
$22.73
|
| Rate for Payer: Midlands Choice Commercial |
$21.22
|
| Rate for Payer: United Healthcare Commercial |
$27.28
|
|
|
flumazenil 0.1 mg/mL 5ml MDV
|
Facility
OP
|
$30.31
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43701068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$27.28 |
| Rate for Payer: Aetna of IA Commercial |
$27.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.28
|
| Rate for Payer: Aetna of IA Medicare |
$17.28
|
| Rate for Payer: Amerigroup Medicaid |
$15.30
|
| Rate for Payer: Amerigroup Medicare |
$15.31
|
| Rate for Payer: Cash Price |
$24.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.15
|
| Rate for Payer: Medical Associates Commercial |
$22.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.16
|
| Rate for Payer: Midlands Choice Commercial |
$21.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.73
|
| Rate for Payer: United Healthcare Commercial |
$27.28
|
| Rate for Payer: United Healthcare Managed Medicare |
$17.88
|
|
|
fluocinonide Top 0.05% Crm 30grams
|
Facility
IP
|
$111.76
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43789523
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.23 |
| Max. Negotiated Rate |
$100.58 |
| Rate for Payer: Aetna of IA Commercial |
$100.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$100.58
|
| Rate for Payer: Cash Price |
$89.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$83.82
|
| Rate for Payer: Medical Associates Commercial |
$83.82
|
| Rate for Payer: Midlands Choice Commercial |
$78.23
|
| Rate for Payer: United Healthcare Commercial |
$100.58
|
|
|
fluocinonide Top 0.05% Crm 30grams
|
Facility
OP
|
$111.76
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43789523
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$100.58 |
| Rate for Payer: Aetna of IA Commercial |
$100.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$100.58
|
| Rate for Payer: Aetna of IA Medicare |
$63.70
|
| Rate for Payer: Amerigroup Medicaid |
$56.41
|
| Rate for Payer: Amerigroup Medicare |
$56.44
|
| Rate for Payer: Cash Price |
$89.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$83.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$55.86
|
| Rate for Payer: Medical Associates Commercial |
$83.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.88
|
| Rate for Payer: Midlands Choice Commercial |
$78.23
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$56.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$83.82
|
| Rate for Payer: United Healthcare Commercial |
$100.58
|
| Rate for Payer: United Healthcare Managed Medicare |
$65.94
|
|
|
fluocinonide Top 0.05% Oint 30gm
|
Facility
IP
|
$107.36
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.15 |
| Max. Negotiated Rate |
$96.62 |
| Rate for Payer: Aetna of IA Commercial |
$96.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$96.62
|
| Rate for Payer: Cash Price |
$85.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$80.52
|
| Rate for Payer: Medical Associates Commercial |
$80.52
|
| Rate for Payer: Midlands Choice Commercial |
$75.15
|
| Rate for Payer: United Healthcare Commercial |
$96.62
|
|
|
fluocinonide Top 0.05% Oint 30gm
|
Facility
OP
|
$107.36
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.66 |
| Max. Negotiated Rate |
$96.62 |
| Rate for Payer: Aetna of IA Commercial |
$96.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$96.62
|
| Rate for Payer: Aetna of IA Medicare |
$61.20
|
| Rate for Payer: Amerigroup Medicaid |
$54.18
|
| Rate for Payer: Amerigroup Medicare |
$54.22
|
| Rate for Payer: Cash Price |
$85.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$80.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$53.68
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$53.66
|
| Rate for Payer: Medical Associates Commercial |
$80.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$53.68
|
| Rate for Payer: Midlands Choice Commercial |
$75.15
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$54.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$80.52
|
| Rate for Payer: United Healthcare Commercial |
$96.62
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.34
|
|
|
fluorouracil 50 mg/mL 100ml
|
Facility
OP
|
$253.92
|
|
|
Service Code
|
CPT J9190
|
| Hospital Charge Code |
43700050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.91 |
| Max. Negotiated Rate |
$228.53 |
| Rate for Payer: Aetna of IA Commercial |
$228.53
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$228.53
|
| Rate for Payer: Aetna of IA Medicare |
$144.73
|
| Rate for Payer: Amerigroup Medicaid |
$128.15
|
| Rate for Payer: Amerigroup Medicare |
$128.23
|
| Rate for Payer: Cash Price |
$203.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$190.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$126.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.91
|
| Rate for Payer: Medical Associates Commercial |
$190.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$126.96
|
| Rate for Payer: Midlands Choice Commercial |
$177.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$190.44
|
| Rate for Payer: United Healthcare Commercial |
$228.53
|
| Rate for Payer: United Healthcare Managed Medicare |
$149.81
|
|
|
fluorouracil 50 mg/mL 100ml
|
Facility
IP
|
$253.92
|
|
|
Service Code
|
CPT J9190
|
| Hospital Charge Code |
43700050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.74 |
| Max. Negotiated Rate |
$228.53 |
| Rate for Payer: Aetna of IA Commercial |
$228.53
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$228.53
|
| Rate for Payer: Cash Price |
$203.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$190.44
|
| Rate for Payer: Medical Associates Commercial |
$190.44
|
| Rate for Payer: Midlands Choice Commercial |
$177.74
|
| Rate for Payer: United Healthcare Commercial |
$228.53
|
|
|
fluorouracil 50 mg/mL 20ml vial
|
Facility
OP
|
$63.56
|
|
|
Service Code
|
CPT J9190
|
| Hospital Charge Code |
43700161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.77 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Aetna of IA Commercial |
$57.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.20
|
| Rate for Payer: Aetna of IA Medicare |
$36.23
|
| Rate for Payer: Amerigroup Medicaid |
$32.08
|
| Rate for Payer: Amerigroup Medicare |
$32.10
|
| Rate for Payer: Cash Price |
$50.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.67
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.77
|
| Rate for Payer: Medical Associates Commercial |
$47.67
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.78
|
| Rate for Payer: Midlands Choice Commercial |
$44.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$47.67
|
| Rate for Payer: United Healthcare Commercial |
$57.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.50
|
|
|
fluorouracil 50 mg/mL 20ml vial
|
Facility
IP
|
$63.56
|
|
|
Service Code
|
CPT J9190
|
| Hospital Charge Code |
43700161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.49 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Aetna of IA Commercial |
$57.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.20
|
| Rate for Payer: Cash Price |
$50.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.67
|
| Rate for Payer: Medical Associates Commercial |
$47.67
|
| Rate for Payer: Midlands Choice Commercial |
$44.49
|
| Rate for Payer: United Healthcare Commercial |
$57.20
|
|
|
fluorouracil 50 mg/mL MDV 50ml
|
Facility
OP
|
$146.36
|
|
|
Service Code
|
CPT J9190
|
| Hospital Charge Code |
43700057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.15 |
| Max. Negotiated Rate |
$131.72 |
| Rate for Payer: Aetna of IA Commercial |
$131.72
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.72
|
| Rate for Payer: Aetna of IA Medicare |
$83.43
|
| Rate for Payer: Amerigroup Medicaid |
$73.87
|
| Rate for Payer: Amerigroup Medicare |
$73.91
|
| Rate for Payer: Cash Price |
$117.09
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.77
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.18
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.15
|
| Rate for Payer: Medical Associates Commercial |
$109.77
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.18
|
| Rate for Payer: Midlands Choice Commercial |
$102.45
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$109.77
|
| Rate for Payer: United Healthcare Commercial |
$131.72
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.35
|
|
|
fluorouracil 50 mg/mL MDV 50ml
|
Facility
IP
|
$146.36
|
|
|
Service Code
|
CPT J9190
|
| Hospital Charge Code |
43700057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.45 |
| Max. Negotiated Rate |
$131.72 |
| Rate for Payer: Aetna of IA Commercial |
$131.72
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.72
|
| Rate for Payer: Cash Price |
$117.09
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.77
|
| Rate for Payer: Medical Associates Commercial |
$109.77
|
| Rate for Payer: Midlands Choice Commercial |
$102.45
|
| Rate for Payer: United Healthcare Commercial |
$131.72
|
|
