|
fentaNYL-ropivacaine 2 mcg/mL-0.2%-NaCl 0.9% Sol[VDMC]
|
Facility
|
OP
|
$294.64
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
11346054
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$149.44
|
| Rate for Payer: Oscar Health of IA Commercial |
$220.98
|
| 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 [VDMC]
|
Facility
|
OP
|
$1,887.10
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
12256361
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$957.14
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,415.32
|
| 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
|
|
|
ferric carboxymaltose (as elemental iron) 50 mg/mL 15 ml Sol SDV [VDMC]
|
Facility
|
IP
|
$1,887.10
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
12256361
|
|
Hospital Revenue Code
|
259
|
| 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 subsulfate Top Sol [VDMC]
|
Facility
|
OP
|
$58.31
|
|
|
Service Code
|
NDC 59365-6065-00
|
| Hospital Charge Code |
10388833
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$52.48 |
| Rate for Payer: Aetna of IA Commercial |
$52.48
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.48
|
| Rate for Payer: Aetna of IA Medicare |
$33.24
|
| Rate for Payer: Amerigroup Medicaid |
$29.43
|
| Rate for Payer: Amerigroup Medicare |
$29.45
|
| Rate for Payer: Cash Price |
$46.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.14
|
| Rate for Payer: Medical Associates Commercial |
$43.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.16
|
| Rate for Payer: Midlands Choice Commercial |
$40.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.59
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$29.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$43.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.73
|
| Rate for Payer: United Healthcare Commercial |
$52.48
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.40
|
|
|
ferric subsulfate Top Sol [VDMC]
|
Facility
|
IP
|
$58.31
|
|
|
Service Code
|
NDC 59365-6065-00
|
| Hospital Charge Code |
10388833
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$40.82 |
| Max. Negotiated Rate |
$52.48 |
| Rate for Payer: Aetna of IA Commercial |
$52.48
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.48
|
| Rate for Payer: Cash Price |
$46.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.73
|
| Rate for Payer: Medical Associates Commercial |
$43.73
|
| Rate for Payer: Midlands Choice Commercial |
$40.82
|
| Rate for Payer: United Healthcare Commercial |
$52.48
|
|
|
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: Molina Healthcare Managed Medicare |
$55.79
|
| Rate for Payer: Oscar Health of IA Commercial |
$82.50
|
| 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 [VDMC]
|
Facility
|
IP
|
$45.72
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11221670
|
|
Hospital Revenue Code
|
259
|
| 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 220 mg/5 mL Eli [VDMC]
|
Facility
|
OP
|
$45.72
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11221670
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$23.19
|
| Rate for Payer: Oscar Health of IA Commercial |
$34.29
|
| 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 325 mg Tab UD [VDMC]
|
Facility
|
OP
|
$1.10
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10432714
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$0.56
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.83
|
| 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 [VDMC]
|
Facility
|
IP
|
$1.10
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10432714
|
|
Hospital Revenue Code
|
259
|
| 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 [VDMC]
|
Facility
|
OP
|
$740.50
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
11219710
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$375.58
|
| Rate for Payer: Oscar Health of IA Commercial |
$555.38
|
| 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
|
|
|
ferumoxytol 30 mg/mL 17 ml Sol [VDMC]
|
Facility
|
IP
|
$740.50
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
11219710
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
|
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 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: Molina Healthcare Managed Medicare |
$222.15
|
| Rate for Payer: Oscar Health of IA Commercial |
$328.50
|
| 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 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
|
|
|
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: Molina Healthcare Managed Medicare |
$26.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$39.75
|
| 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
|
|
|
Fever and Inflammatory Conditions
|
Facility
|
IP
|
$6,202.69
|
|
|
Service Code
|
MS-DRG 864
|
| Hospital Charge Code |
600
|
| Min. Negotiated Rate |
$6,112.80 |
| Max. Negotiated Rate |
$6,202.69 |
| Rate for Payer: Amerigroup Medicaid |
$6,172.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,112.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,202.69
|
|
|
FHL IMPLANT SYSTEM, 6.25MM
|
Facility
|
IP
|
$2,691.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8784970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,883.70 |
| Max. Negotiated Rate |
$2,421.90 |
| Rate for Payer: Aetna of IA Commercial |
$2,421.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,421.90
|
| Rate for Payer: Cash Price |
$2,152.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,018.25
|
| Rate for Payer: Medical Associates Commercial |
$2,018.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,883.70
|
| Rate for Payer: United Healthcare Commercial |
$2,421.90
|
|
|
FHL IMPLANT SYSTEM, 6.25MM
|
Facility
|
OP
|
$2,691.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8784970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,344.96 |
| Max. Negotiated Rate |
$2,421.90 |
| Rate for Payer: Aetna of IA Commercial |
$2,421.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,421.90
|
| Rate for Payer: Aetna of IA Medicare |
$1,533.87
|
| Rate for Payer: Amerigroup Medicaid |
$1,358.15
|
| Rate for Payer: Amerigroup Medicare |
$1,358.96
|
| Rate for Payer: Cash Price |
$2,152.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,018.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,345.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,344.96
|
| Rate for Payer: Medical Associates Commercial |
$2,018.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,345.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,883.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,365.68
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,364.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,018.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,018.25
|
| Rate for Payer: United Healthcare Commercial |
$2,421.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,587.69
|
|
|
FIBERTAPE
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
|
|
FIBERTAPE
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.47 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Aetna of IA Medicare |
$73.53
|
| Rate for Payer: Amerigroup Medicaid |
$65.11
|
| Rate for Payer: Amerigroup Medicare |
$65.14
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.47
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$65.47
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$65.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$96.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$96.75
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.11
|
|
|
FIBERWIRE 2.0
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046960
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Aetna of IA Medicare |
$31.92
|
| Rate for Payer: Amerigroup Medicaid |
$28.26
|
| Rate for Payer: Amerigroup Medicare |
$28.28
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.99
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.42
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$28.40
|
| Rate for Payer: Oscar Health of IA Commercial |
$42.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.00
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.04
|
|
|
FIBERWIRE 2.0
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046960
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
|
|
FIBERWIRE 2.0-1
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of IA Commercial |
$31.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.50
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.25
|
| Rate for Payer: Medical Associates Commercial |
$26.25
|
| Rate for Payer: Midlands Choice Commercial |
$24.50
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
|
