|
Lymphoma and Non-acute Leukemia With Other Procedures With MCC
|
Facility
IP
|
$41,008.43
|
|
|
Service Code
|
MS-DRG 823
|
| Hospital Charge Code |
565
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$41,008.43 |
| Rate for Payer: Amerigroup Medicaid |
$40,810.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40,414.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41,008.43
|
|
|
Lymphoma and Non-acute Leukemia With Other Procedures Without CC/MCC
|
Facility
IP
|
$12,244.95
|
|
|
Service Code
|
MS-DRG 825
|
| Hospital Charge Code |
567
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$12,244.95 |
| Rate for Payer: Amerigroup Medicaid |
$12,185.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12,067.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,244.95
|
|
|
Lymphoma and Non-acute Leukemia Without CC/MCC
|
Facility
IP
|
$9,279.43
|
|
|
Service Code
|
MS-DRG 842
|
| Hospital Charge Code |
584
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,279.43 |
| Rate for Payer: Amerigroup Medicaid |
$9,234.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9,144.94
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,279.43
|
|
|
LYSIS OF LABIAL ADHESIONS
|
Professional
|
$477.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
8068969
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$141.78 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Aetna of IA Medicare |
$141.78
|
| Rate for Payer: Amerigroup Medicaid |
$146.60
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$170.14
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$144.62
|
| Rate for Payer: Medical Associates Commercial |
$269.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$141.78
|
| Rate for Payer: Midlands Choice Commercial |
$333.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$212.67
|
| Rate for Payer: Wellmark IA HMO |
$296.00
|
| Rate for Payer: Wellmark IA PPO |
$348.00
|
|
|
MAC ENDO CHARGE
|
Facility
IP
|
$134.00
|
|
| Hospital Charge Code |
8059073
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna of IA Commercial |
$120.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.60
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.50
|
| Rate for Payer: Medical Associates Commercial |
$100.50
|
| Rate for Payer: Midlands Choice Commercial |
$93.80
|
| Rate for Payer: United Healthcare Commercial |
$120.60
|
|
|
MAC ENDO CHARGE
|
Facility
OP
|
$134.00
|
|
| Hospital Charge Code |
8059073
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna of IA Commercial |
$120.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.60
|
| Rate for Payer: Aetna of IA Medicare |
$76.38
|
| Rate for Payer: Amerigroup Medicaid |
$67.63
|
| Rate for Payer: Amerigroup Medicare |
$67.67
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$66.97
|
| Rate for Payer: Medical Associates Commercial |
$100.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.00
|
| Rate for Payer: Midlands Choice Commercial |
$93.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$100.50
|
| Rate for Payer: United Healthcare Commercial |
$120.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.06
|
|
|
Magic Mouthwash
|
Facility
OP
|
$167.52
|
|
|
Service Code
|
CPT A9270GY
|
| Hospital Charge Code |
43700268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.73 |
| Max. Negotiated Rate |
$150.77 |
| Rate for Payer: Aetna of IA Commercial |
$150.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$150.77
|
| Rate for Payer: Aetna of IA Medicare |
$95.49
|
| Rate for Payer: Amerigroup Medicaid |
$84.55
|
| Rate for Payer: Amerigroup Medicare |
$84.60
|
| Rate for Payer: Cash Price |
$134.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$125.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$83.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$83.73
|
| Rate for Payer: Medical Associates Commercial |
$125.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$83.76
|
| Rate for Payer: Midlands Choice Commercial |
$117.26
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$85.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$125.64
|
| Rate for Payer: United Healthcare Commercial |
$150.77
|
| Rate for Payer: United Healthcare Managed Medicare |
$98.84
|
|
|
Magic Mouthwash
|
Facility
IP
|
$167.52
|
|
|
Service Code
|
CPT A9270GY
|
| Hospital Charge Code |
43700268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.26 |
| Max. Negotiated Rate |
$150.77 |
| Rate for Payer: Aetna of IA Commercial |
$150.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$150.77
|
| Rate for Payer: Cash Price |
$134.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$125.64
|
| Rate for Payer: Medical Associates Commercial |
$125.64
|
| Rate for Payer: Midlands Choice Commercial |
$117.26
|
| Rate for Payer: United Healthcare Commercial |
$150.77
|
|
|
MAGNESIUM
|
Facility
OP
|
$64.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
633781
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
MAGNESIUM
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
633781
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
magnesium chloride DR 64 mg Tab
|
Facility
IP
|
$1.28
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702744
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Aetna of IA Commercial |
$1.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.15
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.96
|
| Rate for Payer: Medical Associates Commercial |
$0.96
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.15
|
|
|
magnesium chloride DR 64 mg Tab
|
Facility
OP
|
$1.28
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702744
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Aetna of IA Commercial |
$1.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.15
|
| Rate for Payer: Aetna of IA Medicare |
$0.73
|
| Rate for Payer: Amerigroup Medicaid |
$0.65
|
| Rate for Payer: Amerigroup Medicare |
$0.65
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.96
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.64
|
| Rate for Payer: Medical Associates Commercial |
$0.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.64
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.96
|
| Rate for Payer: United Healthcare Commercial |
$1.15
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.76
|
|
|
magnesium citrate 8.85% Oral Liq 296 mL
|
Facility
IP
|
$13.16
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna of IA Commercial |
$11.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.84
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.87
|
| Rate for Payer: Medical Associates Commercial |
$9.87
|
| Rate for Payer: Midlands Choice Commercial |
$9.21
|
| Rate for Payer: United Healthcare Commercial |
$11.84
|
|
|
magnesium citrate 8.85% Oral Liq 296 mL
|
Facility
OP
|
$13.16
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna of IA Commercial |
$11.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.84
|
| Rate for Payer: Aetna of IA Medicare |
$7.50
|
| Rate for Payer: Amerigroup Medicaid |
$6.64
|
| Rate for Payer: Amerigroup Medicare |
$6.65
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.87
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.58
|
| Rate for Payer: Medical Associates Commercial |
$9.87
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.58
|
| Rate for Payer: Midlands Choice Commercial |
$9.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.87
|
| Rate for Payer: United Healthcare Commercial |
$11.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.76
|
|
|
magnesium hydroxide 24% Oral Conc 10 mL
|
Facility
OP
|
$8.98
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Aetna of IA Commercial |
$8.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8.08
|
| Rate for Payer: Aetna of IA Medicare |
$5.12
|
| Rate for Payer: Amerigroup Medicaid |
$4.53
|
| Rate for Payer: Amerigroup Medicare |
$4.53
|
| Rate for Payer: Cash Price |
$7.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6.74
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4.49
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4.49
|
| Rate for Payer: Medical Associates Commercial |
$6.74
|
| Rate for Payer: Medical Associates Managed Medicare |
$4.49
|
| Rate for Payer: Midlands Choice Commercial |
$6.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$6.74
|
| Rate for Payer: United Healthcare Commercial |
$8.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$5.30
|
|
|
magnesium hydroxide 24% Oral Conc 10 mL
|
Facility
IP
|
$8.98
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Aetna of IA Commercial |
$8.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8.08
|
| Rate for Payer: Cash Price |
$7.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6.74
|
| Rate for Payer: Medical Associates Commercial |
$6.74
|
| Rate for Payer: Midlands Choice Commercial |
$6.29
|
| Rate for Payer: United Healthcare Commercial |
$8.08
|
|
|
magnesium oxide 400 mg Tab
|
Facility
OP
|
$1.11
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of IA Commercial |
$1.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.00
|
| 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 |
$0.89
|
| 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 |
$0.56
|
| 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 |
$0.56
|
| Rate for Payer: Midlands Choice Commercial |
$0.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.83
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.65
|
|
|
magnesium oxide 400 mg Tab
|
Facility
IP
|
$1.11
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of IA Commercial |
$1.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.00
|
| Rate for Payer: Cash Price |
$0.89
|
| 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 |
$0.78
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
|
|
magnesium sulfate 10 mg/mL-D5% 100ml
|
Facility
IP
|
$79.95
|
|
|
Service Code
|
CPT J3475
|
| Hospital Charge Code |
43735717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.96 |
| Max. Negotiated Rate |
$71.96 |
| Rate for Payer: Aetna of IA Commercial |
$71.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$71.96
|
| Rate for Payer: Cash Price |
$63.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$59.96
|
| Rate for Payer: Medical Associates Commercial |
$59.96
|
| Rate for Payer: Midlands Choice Commercial |
$55.96
|
| Rate for Payer: United Healthcare Commercial |
$71.96
|
|
|
magnesium sulfate 10 mg/mL-D5% 100ml
|
Facility
OP
|
$79.95
|
|
|
Service Code
|
CPT J3475
|
| Hospital Charge Code |
43735717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$71.96 |
| Rate for Payer: Aetna of IA Commercial |
$71.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$71.96
|
| Rate for Payer: Aetna of IA Medicare |
$45.57
|
| Rate for Payer: Amerigroup Medicaid |
$40.35
|
| Rate for Payer: Amerigroup Medicare |
$40.37
|
| Rate for Payer: Cash Price |
$63.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$59.96
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$39.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$39.96
|
| Rate for Payer: Medical Associates Commercial |
$59.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$39.98
|
| Rate for Payer: Midlands Choice Commercial |
$55.96
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$40.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$59.96
|
| Rate for Payer: United Healthcare Commercial |
$71.96
|
| Rate for Payer: United Healthcare Managed Medicare |
$47.17
|
|
|
magnesium sulfate 2 g/50 mL-sterile water 50ml
|
Facility
IP
|
$111.63
|
|
|
Service Code
|
CPT J3475
|
| Hospital Charge Code |
43799947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.14 |
| Max. Negotiated Rate |
$100.47 |
| Rate for Payer: Aetna of IA Commercial |
$100.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$100.47
|
| Rate for Payer: Cash Price |
$89.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$83.72
|
| Rate for Payer: Medical Associates Commercial |
$83.72
|
| Rate for Payer: Midlands Choice Commercial |
$78.14
|
| Rate for Payer: United Healthcare Commercial |
$100.47
|
|
|
magnesium sulfate 2 g/50 mL-sterile water 50ml
|
Facility
OP
|
$111.63
|
|
|
Service Code
|
CPT J3475
|
| Hospital Charge Code |
43799947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.79 |
| Max. Negotiated Rate |
$100.47 |
| Rate for Payer: Aetna of IA Commercial |
$100.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$100.47
|
| Rate for Payer: Aetna of IA Medicare |
$63.63
|
| Rate for Payer: Amerigroup Medicaid |
$56.34
|
| Rate for Payer: Amerigroup Medicare |
$56.37
|
| Rate for Payer: Cash Price |
$89.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$83.72
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$55.79
|
| Rate for Payer: Medical Associates Commercial |
$83.72
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.82
|
| Rate for Payer: Midlands Choice Commercial |
$78.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$56.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$83.72
|
| Rate for Payer: United Healthcare Commercial |
$100.47
|
| Rate for Payer: United Healthcare Managed Medicare |
$65.86
|
|
|
magnesium sulfate 40 mg/mL 1000ml bag
|
Facility
OP
|
$83.80
|
|
|
Service Code
|
CPT J3475
|
| Hospital Charge Code |
43701598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.88 |
| Max. Negotiated Rate |
$75.42 |
| Rate for Payer: Aetna of IA Commercial |
$75.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$75.42
|
| Rate for Payer: Aetna of IA Medicare |
$47.77
|
| Rate for Payer: Amerigroup Medicaid |
$42.29
|
| Rate for Payer: Amerigroup Medicare |
$42.32
|
| Rate for Payer: Cash Price |
$67.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$62.85
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$41.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.88
|
| Rate for Payer: Medical Associates Commercial |
$62.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$41.90
|
| Rate for Payer: Midlands Choice Commercial |
$58.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$62.85
|
| Rate for Payer: United Healthcare Commercial |
$75.42
|
| Rate for Payer: United Healthcare Managed Medicare |
$49.44
|
|
|
magnesium sulfate 40 mg/mL 1000ml bag
|
Facility
IP
|
$83.80
|
|
|
Service Code
|
CPT J3475
|
| Hospital Charge Code |
43701598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.66 |
| Max. Negotiated Rate |
$75.42 |
| Rate for Payer: Aetna of IA Commercial |
$75.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$75.42
|
| Rate for Payer: Cash Price |
$67.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$62.85
|
| Rate for Payer: Medical Associates Commercial |
$62.85
|
| Rate for Payer: Midlands Choice Commercial |
$58.66
|
| Rate for Payer: United Healthcare Commercial |
$75.42
|
|
|
magnesium sulfate 50% 5gm/10ml SDV
|
Facility
OP
|
$24.21
|
|
|
Service Code
|
CPT J3475
|
| Hospital Charge Code |
43700538
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$21.79 |
| Rate for Payer: Aetna of IA Commercial |
$21.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.79
|
| Rate for Payer: Aetna of IA Medicare |
$13.80
|
| Rate for Payer: Amerigroup Medicaid |
$12.22
|
| Rate for Payer: Amerigroup Medicare |
$12.23
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.16
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.10
|
| Rate for Payer: Medical Associates Commercial |
$18.16
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.10
|
| Rate for Payer: Midlands Choice Commercial |
$16.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.16
|
| Rate for Payer: United Healthcare Commercial |
$21.79
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.28
|
|
