|
Fentanyl PCA 250mcg/25mL [VDMC]
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
22396464
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$221.80 |
| 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 |
$25.38
|
| Rate for Payer: Amerigroup Medicare |
$20.00
|
| Rate for Payer: Cash Price |
$35.20
|
| 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 |
$19.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.13
|
| Rate for Payer: Medical Associates Commercial |
$33.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.80
|
| Rate for Payer: Midlands Choice Commercial |
$30.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.77
|
| Rate for Payer: United Healthcare Commercial |
$39.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.96
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
Fentanyl PCA 250mcg/25mL [VDMC]
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
22396464
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
|
ferric carboxymaltose (as elemental iron) 50 mg/mL 15 ml Sol SDV [VDMC]
|
Facility
|
OP
|
$2,104.58
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
12256361
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$947.06 |
| Max. Negotiated Rate |
$1,894.12 |
| Rate for Payer: Aetna of IA Commercial |
$1,894.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,894.12
|
| Rate for Payer: Aetna of IA Medicare |
$1,199.61
|
| Rate for Payer: Amerigroup Medicaid |
$1,213.92
|
| Rate for Payer: Amerigroup Medicare |
$956.53
|
| Rate for Payer: Cash Price |
$1,683.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,578.43
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$947.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,202.14
|
| Rate for Payer: Medical Associates Commercial |
$1,578.43
|
| Rate for Payer: Medical Associates Managed Medicare |
$947.06
|
| Rate for Payer: Midlands Choice Commercial |
$1,473.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,219.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,089.12
|
| Rate for Payer: United Healthcare Commercial |
$1,894.12
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,241.70
|
|
|
ferric carboxymaltose (as elemental iron) 50 mg/mL 15 ml Sol SDV [VDMC]
|
Facility
|
IP
|
$2,104.58
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
12256361
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,473.21 |
| Max. Negotiated Rate |
$1,894.12 |
| Rate for Payer: Aetna of IA Commercial |
$1,894.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,894.12
|
| Rate for Payer: Cash Price |
$1,683.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,578.43
|
| Rate for Payer: Medical Associates Commercial |
$1,578.43
|
| Rate for Payer: Midlands Choice Commercial |
$1,473.21
|
| Rate for Payer: United Healthcare Commercial |
$1,894.12
|
|
|
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
|
|
|
FERRITIN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
1628893
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.50 |
| 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 |
$63.45
|
| Rate for Payer: Amerigroup Medicare |
$50.00
|
| 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 |
$49.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$62.83
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$63.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.92
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$61.68
|
| Rate for Payer: Wellmark IA PPO |
$67.95
|
|
|
ferrous sulfate 220 mg/5 mL Eli [VDMC]
|
Facility
|
OP
|
$36.67
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11221670
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of IA Commercial |
$33.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.00
|
| Rate for Payer: Aetna of IA Medicare |
$20.90
|
| Rate for Payer: Amerigroup Medicaid |
$21.15
|
| Rate for Payer: Amerigroup Medicare |
$16.67
|
| Rate for Payer: Cash Price |
$29.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.95
|
| Rate for Payer: Medical Associates Commercial |
$27.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.50
|
| Rate for Payer: Midlands Choice Commercial |
$25.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.98
|
| Rate for Payer: United Healthcare Commercial |
$33.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.64
|
|
|
ferrous sulfate 220 mg/5 mL Eli [VDMC]
|
Facility
|
IP
|
$36.67
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11221670
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.67 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of IA Commercial |
$33.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.00
|
| Rate for Payer: Cash Price |
$29.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.50
|
| Rate for Payer: Medical Associates Commercial |
$27.50
|
| Rate for Payer: Midlands Choice Commercial |
$25.67
|
| Rate for Payer: United Healthcare Commercial |
$33.00
|
|
|
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 |
$0.82
|
| Rate for Payer: Medical Associates Commercial |
$0.82
|
| Rate for Payer: Midlands Choice Commercial |
$0.77
|
| Rate for Payer: United Healthcare Commercial |
$0.99
|
|
|
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 |
$0.49 |
| 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 |
$0.62
|
| Rate for Payer: Amerigroup Medicaid |
$0.63
|
| Rate for Payer: Amerigroup Medicare |
$0.50
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.49
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.63
|
| Rate for Payer: Medical Associates Commercial |
$0.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.49
|
| Rate for Payer: Midlands Choice Commercial |
$0.77
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.57
|
| Rate for Payer: United Healthcare Commercial |
$0.99
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.65
|
|
|
ferumoxytol 30 mg/mL 17 ml Sol [VDMC]
|
Facility
|
IP
|
$350.56
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
11219710
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$245.39 |
| Max. Negotiated Rate |
$315.50 |
| Rate for Payer: Aetna of IA Commercial |
$315.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.50
|
| Rate for Payer: Cash Price |
$280.45
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$262.92
|
| Rate for Payer: Medical Associates Commercial |
$262.92
|
| Rate for Payer: Midlands Choice Commercial |
$245.39
|
| Rate for Payer: United Healthcare Commercial |
$315.50
|
|
|
ferumoxytol 30 mg/mL 17 ml Sol [VDMC]
|
Facility
|
OP
|
$350.56
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
11219710
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$157.75 |
| Max. Negotiated Rate |
$315.50 |
| Rate for Payer: Aetna of IA Commercial |
$315.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.50
|
| Rate for Payer: Aetna of IA Medicare |
$199.82
|
| Rate for Payer: Amerigroup Medicaid |
$202.20
|
| Rate for Payer: Amerigroup Medicare |
$159.33
|
| Rate for Payer: Cash Price |
$280.45
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$262.92
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$157.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$200.24
|
| Rate for Payer: Medical Associates Commercial |
$262.92
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.75
|
| Rate for Payer: Midlands Choice Commercial |
$245.39
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$203.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$181.41
|
| Rate for Payer: United Healthcare Commercial |
$315.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$206.83
|
|
|
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 |
$197.10 |
| 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 |
$252.64
|
| Rate for Payer: Amerigroup Medicare |
$199.07
|
| 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 |
$197.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$250.19
|
| Rate for Payer: Medical Associates Commercial |
$328.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$197.10
|
| Rate for Payer: Midlands Choice Commercial |
$306.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$253.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$226.66
|
| Rate for Payer: United Healthcare Commercial |
$394.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$258.42
|
| Rate for Payer: Wellmark IA HMO WHPI |
$276.51
|
| Rate for Payer: Wellmark IA PPO |
$304.59
|
|
|
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 |
$23.85 |
| 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 |
$30.57
|
| Rate for Payer: Amerigroup Medicare |
$24.09
|
| 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 |
$23.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.27
|
| Rate for Payer: Medical Associates Commercial |
$39.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.85
|
| Rate for Payer: Midlands Choice Commercial |
$37.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.43
|
| Rate for Payer: United Healthcare Commercial |
$47.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$31.27
|
| Rate for Payer: Wellmark IA HMO WHPI |
$29.07
|
| Rate for Payer: Wellmark IA PPO |
$32.02
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$7,095.91
|
|
|
Service Code
|
MSDRG 864
|
| Min. Negotiated Rate |
$6,993.06 |
| Max. Negotiated Rate |
$7,095.91 |
| Rate for Payer: Amerigroup Medicaid |
$7,061.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,993.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,095.91
|
|
|
FHL IMPLANT SYSTEM, 6.25MM
|
Facility
|
IP
|
$2,691.00
|
|
|
Service Code
|
HCPCS 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
|
HCPCS C1713
|
| Hospital Charge Code |
8784970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.95 |
| 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 |
$1,552.17
|
| Rate for Payer: Amerigroup Medicare |
$1,223.06
|
| 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 |
$1,210.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,537.10
|
| Rate for Payer: Medical Associates Commercial |
$2,018.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,210.95
|
| Rate for Payer: Midlands Choice Commercial |
$1,883.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,559.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,392.59
|
| 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
|
HCPCS 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
|
HCPCS C1713
|
| Hospital Charge Code |
8047071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.05 |
| 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 |
$74.41
|
| Rate for Payer: Amerigroup Medicare |
$58.63
|
| 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 |
$58.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.68
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.05
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$66.76
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.11
|
|
|
FIBERWIRE 2.0
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 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
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046960
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.20 |
| 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: Aetna of IA Medicare |
$31.92
|
| Rate for Payer: Amerigroup Medicaid |
$32.30
|
| Rate for Payer: Amerigroup Medicare |
$25.45
|
| 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 |
$25.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.99
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.20
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.98
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.04
|
|
|
FIBERWIRE 2.0-1
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.75 |
| 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: Aetna of IA Medicare |
$19.95
|
| Rate for Payer: Amerigroup Medicaid |
$20.19
|
| Rate for Payer: Amerigroup Medicare |
$15.91
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.99
|
| Rate for Payer: Medical Associates Commercial |
$26.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.75
|
| Rate for Payer: Midlands Choice Commercial |
$24.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.11
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.65
|
|
|
FIBERWIRE 2.0-1
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 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
|
|
