|
FLUoxetine 10 mg Cap
|
Facility
IP
|
$1.26
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of IA Commercial |
$1.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.13
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.95
|
| Rate for Payer: Medical Associates Commercial |
$0.95
|
| Rate for Payer: Midlands Choice Commercial |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$1.13
|
|
|
FLUoxetine 10 mg Cap
|
Facility
OP
|
$1.26
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of IA Commercial |
$1.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.13
|
| Rate for Payer: Aetna of IA Medicare |
$0.72
|
| Rate for Payer: Amerigroup Medicaid |
$0.64
|
| Rate for Payer: Amerigroup Medicare |
$0.64
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.63
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.63
|
| Rate for Payer: Medical Associates Commercial |
$0.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.63
|
| Rate for Payer: Midlands Choice Commercial |
$0.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.95
|
| Rate for Payer: United Healthcare Commercial |
$1.13
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.74
|
|
|
FLUoxetine 20 mg Cap
|
Facility
OP
|
$1.10
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702320
|
|
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
|
|
|
FLUoxetine 20 mg Cap
|
Facility
IP
|
$1.10
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702320
|
|
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
|
|
|
fluPHENAZine decanoate 25 mg/mL 5 ml MDV Sol
|
Facility
IP
|
$307.00
|
|
|
Service Code
|
CPT J2680
|
| Hospital Charge Code |
43700286
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$214.90 |
| Max. Negotiated Rate |
$276.30 |
| Rate for Payer: Aetna of IA Commercial |
$276.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$276.30
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$230.25
|
| Rate for Payer: Medical Associates Commercial |
$230.25
|
| Rate for Payer: Midlands Choice Commercial |
$214.90
|
| Rate for Payer: United Healthcare Commercial |
$276.30
|
|
|
fluPHENAZine decanoate 25 mg/mL 5 ml MDV Sol
|
Facility
OP
|
$307.00
|
|
|
Service Code
|
CPT J2680
|
| Hospital Charge Code |
43700286
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.44 |
| Max. Negotiated Rate |
$276.30 |
| Rate for Payer: Aetna of IA Commercial |
$276.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$276.30
|
| Rate for Payer: Aetna of IA Medicare |
$174.99
|
| Rate for Payer: Amerigroup Medicaid |
$154.94
|
| Rate for Payer: Amerigroup Medicare |
$155.04
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$230.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$153.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$153.44
|
| Rate for Payer: Medical Associates Commercial |
$230.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$153.50
|
| Rate for Payer: Midlands Choice Commercial |
$214.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$155.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$230.25
|
| Rate for Payer: United Healthcare Commercial |
$276.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$181.13
|
|
|
fluticasone CFC free 110 mcg/inh Inh Aer w/adapter
|
Facility
IP
|
$919.44
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705837
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$643.61 |
| Max. Negotiated Rate |
$827.50 |
| Rate for Payer: Aetna of IA Commercial |
$827.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$827.50
|
| Rate for Payer: Cash Price |
$735.55
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$689.58
|
| Rate for Payer: Medical Associates Commercial |
$689.58
|
| Rate for Payer: Midlands Choice Commercial |
$643.61
|
| Rate for Payer: United Healthcare Commercial |
$827.50
|
|
|
fluticasone CFC free 110 mcg/inh Inh Aer w/adapter
|
Facility
OP
|
$919.44
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705837
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$459.54 |
| Max. Negotiated Rate |
$827.50 |
| Rate for Payer: Aetna of IA Commercial |
$827.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$827.50
|
| Rate for Payer: Aetna of IA Medicare |
$524.08
|
| Rate for Payer: Amerigroup Medicaid |
$464.04
|
| Rate for Payer: Amerigroup Medicare |
$464.32
|
| Rate for Payer: Cash Price |
$735.55
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$689.58
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$459.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$459.54
|
| Rate for Payer: Medical Associates Commercial |
$689.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$459.72
|
| Rate for Payer: Midlands Choice Commercial |
$643.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$466.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$689.58
|
| Rate for Payer: United Healthcare Commercial |
$827.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$542.47
|
|
|
fluticasone CFC free 44 mcg/inh Inh Aer w/adapter
|
Facility
OP
|
$447.40
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.61 |
| Max. Negotiated Rate |
$402.66 |
| Rate for Payer: Aetna of IA Commercial |
$402.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$402.66
|
| Rate for Payer: Aetna of IA Medicare |
$255.02
|
| Rate for Payer: Amerigroup Medicaid |
$225.80
|
| Rate for Payer: Amerigroup Medicare |
$225.94
|
| Rate for Payer: Cash Price |
$357.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$335.55
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$223.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$223.61
|
| Rate for Payer: Medical Associates Commercial |
$335.55
|
| Rate for Payer: Medical Associates Managed Medicare |
$223.70
|
| Rate for Payer: Midlands Choice Commercial |
$313.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$227.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$335.55
|
| Rate for Payer: United Healthcare Commercial |
$402.66
|
| Rate for Payer: United Healthcare Managed Medicare |
$263.97
|
|
|
fluticasone CFC free 44 mcg/inh Inh Aer w/adapter
|
Facility
IP
|
$447.40
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.18 |
| Max. Negotiated Rate |
$402.66 |
| Rate for Payer: Aetna of IA Commercial |
$402.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$402.66
|
| Rate for Payer: Cash Price |
$357.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$335.55
|
| Rate for Payer: Medical Associates Commercial |
$335.55
|
| Rate for Payer: Midlands Choice Commercial |
$313.18
|
| Rate for Payer: United Healthcare Commercial |
$402.66
|
|
|
fluticasone Nasal 0.05 mg/inh Spry
|
Facility
IP
|
$33.32
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$29.99 |
| Rate for Payer: Aetna of IA Commercial |
$29.99
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.99
|
| Rate for Payer: Cash Price |
$26.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.99
|
| Rate for Payer: Medical Associates Commercial |
$24.99
|
| Rate for Payer: Midlands Choice Commercial |
$23.32
|
| Rate for Payer: United Healthcare Commercial |
$29.99
|
|
|
fluticasone Nasal 0.05 mg/inh Spry
|
Facility
OP
|
$33.32
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$29.99 |
| Rate for Payer: Aetna of IA Commercial |
$29.99
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.99
|
| Rate for Payer: Aetna of IA Medicare |
$18.99
|
| Rate for Payer: Amerigroup Medicaid |
$16.82
|
| Rate for Payer: Amerigroup Medicare |
$16.83
|
| Rate for Payer: Cash Price |
$26.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.99
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.65
|
| Rate for Payer: Medical Associates Commercial |
$24.99
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.66
|
| Rate for Payer: Midlands Choice Commercial |
$23.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.99
|
| Rate for Payer: United Healthcare Commercial |
$29.99
|
| Rate for Payer: United Healthcare Managed Medicare |
$19.66
|
|
|
fluticasone-salmeterol 100 mcg-50 mcg Inh Pwdr
|
Facility
IP
|
$562.68
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$393.88 |
| Max. Negotiated Rate |
$506.41 |
| Rate for Payer: Aetna of IA Commercial |
$506.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$506.41
|
| Rate for Payer: Cash Price |
$450.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$422.01
|
| Rate for Payer: Medical Associates Commercial |
$422.01
|
| Rate for Payer: Midlands Choice Commercial |
$393.88
|
| Rate for Payer: United Healthcare Commercial |
$506.41
|
|
|
fluticasone-salmeterol 100 mcg-50 mcg Inh Pwdr
|
Facility
OP
|
$562.68
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.23 |
| Max. Negotiated Rate |
$506.41 |
| Rate for Payer: Aetna of IA Commercial |
$506.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$506.41
|
| Rate for Payer: Aetna of IA Medicare |
$320.73
|
| Rate for Payer: Amerigroup Medicaid |
$283.98
|
| Rate for Payer: Amerigroup Medicare |
$284.15
|
| Rate for Payer: Cash Price |
$450.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$422.01
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$281.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$281.23
|
| Rate for Payer: Medical Associates Commercial |
$422.01
|
| Rate for Payer: Medical Associates Managed Medicare |
$281.34
|
| Rate for Payer: Midlands Choice Commercial |
$393.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$285.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$422.01
|
| Rate for Payer: United Healthcare Commercial |
$506.41
|
| Rate for Payer: United Healthcare Managed Medicare |
$331.98
|
|
|
fluticasone-salmeterol 250 mcg-50 mcg Inh Pwdr
|
Facility
OP
|
$175.80
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705990
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.86 |
| Max. Negotiated Rate |
$158.22 |
| Rate for Payer: Aetna of IA Commercial |
$158.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$158.22
|
| Rate for Payer: Aetna of IA Medicare |
$100.21
|
| Rate for Payer: Amerigroup Medicaid |
$88.73
|
| Rate for Payer: Amerigroup Medicare |
$88.78
|
| Rate for Payer: Cash Price |
$140.64
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.85
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$87.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$87.86
|
| Rate for Payer: Medical Associates Commercial |
$131.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$87.90
|
| Rate for Payer: Midlands Choice Commercial |
$123.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$89.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$131.85
|
| Rate for Payer: United Healthcare Commercial |
$158.22
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.72
|
|
|
fluticasone-salmeterol 250 mcg-50 mcg Inh Pwdr
|
Facility
IP
|
$175.80
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705990
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.06 |
| Max. Negotiated Rate |
$158.22 |
| Rate for Payer: Aetna of IA Commercial |
$158.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$158.22
|
| Rate for Payer: Cash Price |
$140.64
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.85
|
| Rate for Payer: Medical Associates Commercial |
$131.85
|
| Rate for Payer: Midlands Choice Commercial |
$123.06
|
| Rate for Payer: United Healthcare Commercial |
$158.22
|
|
|
fluticasone-salmeterol 500 mcg-50 mcg Inh Pwdr
|
Facility
IP
|
$910.96
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$637.67 |
| Max. Negotiated Rate |
$819.86 |
| Rate for Payer: Aetna of IA Commercial |
$819.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$819.86
|
| Rate for Payer: Cash Price |
$728.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$683.22
|
| Rate for Payer: Medical Associates Commercial |
$683.22
|
| Rate for Payer: Midlands Choice Commercial |
$637.67
|
| Rate for Payer: United Healthcare Commercial |
$819.86
|
|
|
fluticasone-salmeterol 500 mcg-50 mcg Inh Pwdr
|
Facility
OP
|
$910.96
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$455.30 |
| Max. Negotiated Rate |
$819.86 |
| Rate for Payer: Aetna of IA Commercial |
$819.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$819.86
|
| Rate for Payer: Aetna of IA Medicare |
$519.25
|
| Rate for Payer: Amerigroup Medicaid |
$459.76
|
| Rate for Payer: Amerigroup Medicare |
$460.03
|
| Rate for Payer: Cash Price |
$728.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$683.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$455.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$455.30
|
| Rate for Payer: Medical Associates Commercial |
$683.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$455.48
|
| Rate for Payer: Midlands Choice Commercial |
$637.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$462.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$683.22
|
| Rate for Payer: United Healthcare Commercial |
$819.86
|
| Rate for Payer: United Healthcare Managed Medicare |
$537.47
|
|
|
fluvoxaMINE 100 mg Tab
|
Facility
OP
|
$1.83
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700195
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$1.65 |
| Rate for Payer: Aetna of IA Commercial |
$1.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.65
|
| Rate for Payer: Aetna of IA Medicare |
$1.04
|
| Rate for Payer: Amerigroup Medicaid |
$0.92
|
| Rate for Payer: Amerigroup Medicare |
$0.92
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.37
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.91
|
| Rate for Payer: Medical Associates Commercial |
$1.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.92
|
| Rate for Payer: Midlands Choice Commercial |
$1.28
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.37
|
| Rate for Payer: United Healthcare Commercial |
$1.65
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.08
|
|
|
fluvoxaMINE 100 mg Tab
|
Facility
IP
|
$1.83
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700195
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$1.65 |
| Rate for Payer: Aetna of IA Commercial |
$1.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.65
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.37
|
| Rate for Payer: Medical Associates Commercial |
$1.37
|
| Rate for Payer: Midlands Choice Commercial |
$1.28
|
| Rate for Payer: United Healthcare Commercial |
$1.65
|
|
|
FOLATE (FOLIC ACID)
|
Facility
IP
|
$100.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
8093933
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
|
|
FOLATE (FOLIC ACID)
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
8093933
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Aetna of IA Medicare |
$57.00
|
| Rate for Payer: Amerigroup Medicaid |
$50.47
|
| Rate for Payer: Amerigroup Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$50.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.98
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Folate Level
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
1628894
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Aetna of IA Medicare |
$57.00
|
| Rate for Payer: Amerigroup Medicaid |
$50.47
|
| Rate for Payer: Amerigroup Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$50.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.98
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Folate Level
|
Facility
IP
|
$100.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
1628894
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
|
|
Folate Level
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
8220859
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Aetna of IA Medicare |
$57.00
|
| Rate for Payer: Amerigroup Medicaid |
$50.47
|
| Rate for Payer: Amerigroup Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$50.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.98
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
