|
Isolation
|
Facility
OP
|
$230.00
|
|
| Hospital Charge Code |
7861839
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$114.95 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Aetna of IA Medicare |
$131.10
|
| Rate for Payer: Amerigroup Medicaid |
$116.08
|
| Rate for Payer: Amerigroup Medicare |
$116.15
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$115.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$114.95
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$115.00
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$116.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$172.50
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
|
|
Isolation
|
Facility
IP
|
$230.00
|
|
| Hospital Charge Code |
7861839
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$2,339.10 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,258.00
|
| Rate for Payer: Amerigroup Medicare |
$2,054.34
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,034.00
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,339.10
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,306.00
|
|
|
isoniazid 100 mg Tab
|
Facility
OP
|
$1.29
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43755172
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of IA Commercial |
$1.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.16
|
| Rate for Payer: Aetna of IA Medicare |
$0.74
|
| Rate for Payer: Amerigroup Medicaid |
$0.65
|
| Rate for Payer: Amerigroup Medicare |
$0.65
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.64
|
| Rate for Payer: Medical Associates Commercial |
$0.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.65
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.97
|
| Rate for Payer: United Healthcare Commercial |
$1.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.76
|
|
|
isoniazid 100 mg Tab
|
Facility
IP
|
$1.29
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43755172
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of IA Commercial |
$1.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.16
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.97
|
| Rate for Payer: Medical Associates Commercial |
$0.97
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.16
|
|
|
isosorbide mononitrate 20 mg Tab
|
Facility
IP
|
$1.53
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701152
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna of IA Commercial |
$1.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.38
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.15
|
| Rate for Payer: Medical Associates Commercial |
$1.15
|
| Rate for Payer: Midlands Choice Commercial |
$1.07
|
| Rate for Payer: United Healthcare Commercial |
$1.38
|
|
|
isosorbide mononitrate 20 mg Tab
|
Facility
OP
|
$1.53
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701152
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna of IA Commercial |
$1.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.38
|
| Rate for Payer: Aetna of IA Medicare |
$0.87
|
| Rate for Payer: Amerigroup Medicaid |
$0.77
|
| Rate for Payer: Amerigroup Medicare |
$0.77
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.15
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.77
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.76
|
| Rate for Payer: Medical Associates Commercial |
$1.15
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.77
|
| Rate for Payer: Midlands Choice Commercial |
$1.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.15
|
| Rate for Payer: United Healthcare Commercial |
$1.38
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.90
|
|
|
isosorbide mononitrate 30 mg ER Tab
|
Facility
IP
|
$2.40
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705815
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Aetna of IA Commercial |
$2.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.16
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.80
|
| Rate for Payer: Medical Associates Commercial |
$1.80
|
| Rate for Payer: Midlands Choice Commercial |
$1.68
|
| Rate for Payer: United Healthcare Commercial |
$2.16
|
|
|
isosorbide mononitrate 30 mg ER Tab
|
Facility
OP
|
$2.40
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705815
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Aetna of IA Commercial |
$2.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.16
|
| Rate for Payer: Aetna of IA Medicare |
$1.37
|
| Rate for Payer: Amerigroup Medicaid |
$1.21
|
| Rate for Payer: Amerigroup Medicare |
$1.21
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.20
|
| Rate for Payer: Medical Associates Commercial |
$1.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.20
|
| Rate for Payer: Midlands Choice Commercial |
$1.68
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.80
|
| Rate for Payer: United Healthcare Commercial |
$2.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.42
|
|
|
ITM
|
Facility
OP
|
$531.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
7984738
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$265.39 |
| Max. Negotiated Rate |
$1,487.44 |
| Rate for Payer: Aetna of IA Commercial |
$477.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$477.90
|
| Rate for Payer: Aetna of IA Medicare |
$302.67
|
| Rate for Payer: Amerigroup Medicaid |
$268.00
|
| Rate for Payer: Amerigroup Medicare |
$268.16
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$398.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$265.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$265.39
|
| Rate for Payer: Medical Associates Commercial |
$398.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$265.50
|
| Rate for Payer: Midlands Choice Commercial |
$371.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$269.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$398.25
|
| Rate for Payer: United Healthcare Commercial |
$477.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$313.29
|
| Rate for Payer: Wellmark IA HMO |
$1,352.22
|
| Rate for Payer: Wellmark IA PPO |
$1,487.44
|
|
|
ITM
|
Facility
IP
|
$531.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
7984738
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$371.70 |
| Max. Negotiated Rate |
$477.90 |
| Rate for Payer: Aetna of IA Commercial |
$477.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$477.90
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$398.25
|
| Rate for Payer: Medical Associates Commercial |
$398.25
|
| Rate for Payer: Midlands Choice Commercial |
$371.70
|
| Rate for Payer: United Healthcare Commercial |
$477.90
|
|
|
itraconazole 100 mg Cap
|
Facility
OP
|
$5.34
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Aetna of IA Commercial |
$4.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.81
|
| Rate for Payer: Aetna of IA Medicare |
$3.04
|
| Rate for Payer: Amerigroup Medicaid |
$2.70
|
| Rate for Payer: Amerigroup Medicare |
$2.70
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.67
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.67
|
| Rate for Payer: Medical Associates Commercial |
$4.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.67
|
| Rate for Payer: Midlands Choice Commercial |
$3.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$4.00
|
| Rate for Payer: United Healthcare Commercial |
$4.81
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.15
|
|
|
itraconazole 100 mg Cap
|
Facility
IP
|
$5.34
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Aetna of IA Commercial |
$4.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.81
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.00
|
| Rate for Payer: Medical Associates Commercial |
$4.00
|
| Rate for Payer: Midlands Choice Commercial |
$3.74
|
| Rate for Payer: United Healthcare Commercial |
$4.81
|
|
|
IUD REMOVAL CHARGE
|
Professional
|
$315.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
8068939
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$59.68 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna of IA Medicare |
$59.68
|
| Rate for Payer: Amerigroup Medicaid |
$61.71
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$60.87
|
| Rate for Payer: Medical Associates Commercial |
$113.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.68
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$89.52
|
| Rate for Payer: Wellmark IA HMO |
$126.00
|
| Rate for Payer: Wellmark IA PPO |
$147.00
|
|
|
IV CONSCIOUS SEDATION CHARGE
|
Professional
|
$258.00
|
|
| Hospital Charge Code |
8084811
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$180.60 |
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$180.60
|
|
|
IVP MED ADMIN EA ADDL SEQUENTL
|
Facility
OP
|
$64.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
7984747
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$31.99 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Aetna of IA Medicare |
$36.48
|
| Rate for Payer: Amerigroup Medicaid |
$32.30
|
| Rate for Payer: Amerigroup Medicare |
$32.32
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.99
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
|
|
IVP MED ADMIN EA ADDL SEQUENTL
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
7984747
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
|
|
IVP MEDICATION ADMIN
|
Facility
IP
|
$108.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
7984746
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of IA Commercial |
$97.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.20
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.00
|
| Rate for Payer: Medical Associates Commercial |
$81.00
|
| Rate for Payer: Midlands Choice Commercial |
$75.60
|
| Rate for Payer: United Healthcare Commercial |
$97.20
|
|
|
IVP MEDICATION ADMIN
|
Facility
OP
|
$108.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
7984746
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$53.98 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of IA Commercial |
$97.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.20
|
| Rate for Payer: Aetna of IA Medicare |
$61.56
|
| Rate for Payer: Amerigroup Medicaid |
$54.51
|
| Rate for Payer: Amerigroup Medicare |
$54.54
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$54.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$53.98
|
| Rate for Payer: Medical Associates Commercial |
$81.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$54.00
|
| Rate for Payer: Midlands Choice Commercial |
$75.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$54.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$97.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.72
|
|
|
JAK2 V617F Mutation Detection DMCL
|
Facility
OP
|
$625.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
8505649
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$143.22 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna of IA Commercial |
$562.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$562.50
|
| Rate for Payer: Aetna of IA Medicare |
$356.25
|
| Rate for Payer: Amerigroup Medicaid |
$315.44
|
| Rate for Payer: Amerigroup Medicare |
$315.62
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$468.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$312.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$312.38
|
| Rate for Payer: Medical Associates Commercial |
$468.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$312.50
|
| Rate for Payer: Midlands Choice Commercial |
$437.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$317.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$468.75
|
| Rate for Payer: United Healthcare Commercial |
$562.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$368.75
|
| Rate for Payer: Wellmark IA HMO |
$143.22
|
| Rate for Payer: Wellmark IA PPO |
$157.54
|
|
|
JAK2 V617F Mutation Detection DMCL
|
Facility
IP
|
$625.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
8505649
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna of IA Commercial |
$562.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$562.50
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$468.75
|
| Rate for Payer: Medical Associates Commercial |
$468.75
|
| Rate for Payer: Midlands Choice Commercial |
$437.50
|
| Rate for Payer: United Healthcare Commercial |
$562.50
|
|
|
KCl 20 mEq/L with Sodium Chloride 0.9% IV Sol 1000 mL [VDMC]
|
Facility
OP
|
$58.40
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
43706176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.19 |
| Max. Negotiated Rate |
$52.56 |
| Rate for Payer: Aetna of IA Commercial |
$52.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.56
|
| Rate for Payer: Aetna of IA Medicare |
$33.29
|
| Rate for Payer: Amerigroup Medicaid |
$29.47
|
| Rate for Payer: Amerigroup Medicare |
$29.49
|
| Rate for Payer: Cash Price |
$46.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.19
|
| Rate for Payer: Medical Associates Commercial |
$43.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.20
|
| Rate for Payer: Midlands Choice Commercial |
$40.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.80
|
| Rate for Payer: United Healthcare Commercial |
$52.56
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.46
|
|
|
KCl 20 mEq/L with Sodium Chloride 0.9% IV Sol 1000 mL [VDMC]
|
Facility
IP
|
$58.40
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
43706176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.88 |
| Max. Negotiated Rate |
$52.56 |
| Rate for Payer: Aetna of IA Commercial |
$52.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.56
|
| Rate for Payer: Cash Price |
$46.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.80
|
| Rate for Payer: Medical Associates Commercial |
$43.80
|
| Rate for Payer: Midlands Choice Commercial |
$40.88
|
| Rate for Payer: United Healthcare Commercial |
$52.56
|
|
|
KCl 40 mEq/L with Sodium Chloride 0.9% IV Sol 1000 mL
|
Facility
OP
|
$62.40
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
43748915
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.19 |
| Max. Negotiated Rate |
$56.16 |
| Rate for Payer: Aetna of IA Commercial |
$56.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$56.16
|
| Rate for Payer: Aetna of IA Medicare |
$35.57
|
| Rate for Payer: Amerigroup Medicaid |
$31.49
|
| Rate for Payer: Amerigroup Medicare |
$31.51
|
| Rate for Payer: Cash Price |
$49.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.19
|
| Rate for Payer: Medical Associates Commercial |
$46.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.20
|
| Rate for Payer: Midlands Choice Commercial |
$43.68
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$31.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$46.80
|
| Rate for Payer: United Healthcare Commercial |
$56.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$36.82
|
|
|
KCl 40 mEq/L with Sodium Chloride 0.9% IV Sol 1000 mL
|
Facility
IP
|
$62.40
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
43748915
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$56.16 |
| Rate for Payer: Aetna of IA Commercial |
$56.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$56.16
|
| Rate for Payer: Cash Price |
$49.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.80
|
| Rate for Payer: Medical Associates Commercial |
$46.80
|
| Rate for Payer: Midlands Choice Commercial |
$43.68
|
| Rate for Payer: United Healthcare Commercial |
$56.16
|
|
|
KENOLOG 10MG CHARGE
|
Professional
|
$25.00
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
8068950
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$17.50
|
| Rate for Payer: Wellmark IA HMO |
$1.06
|
| Rate for Payer: Wellmark IA PPO |
$1.06
|
|
