|
Lyme IgM Antibody DMCL
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
8505652
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.55 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$80.18
|
| Rate for Payer: Amerigroup Medicare |
$63.18
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$62.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.40
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.55
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.93
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
|
|
Lyme IgM Antibody DMCL
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
8505652
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
Lyme Western Blot DMCL
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
8632480
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
Lyme Western Blot DMCL
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
8632480
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.55 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$80.18
|
| Rate for Payer: Amerigroup Medicare |
$63.18
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$62.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.40
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.55
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.93
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
|
|
LYSE CHEST FIBRIN INIT DAY
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
7982931
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$378.70 |
| Max. Negotiated Rate |
$486.90 |
| Rate for Payer: Aetna of IA Commercial |
$486.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$486.90
|
| Rate for Payer: Cash Price |
$432.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$405.75
|
| Rate for Payer: Medical Associates Commercial |
$405.75
|
| Rate for Payer: Midlands Choice Commercial |
$378.70
|
| Rate for Payer: United Healthcare Commercial |
$486.90
|
|
|
LYSE CHEST FIBRIN INIT DAY
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
7982931
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$243.45 |
| Max. Negotiated Rate |
$486.90 |
| Rate for Payer: Aetna of IA Commercial |
$486.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$486.90
|
| Rate for Payer: Aetna of IA Medicare |
$308.37
|
| Rate for Payer: Amerigroup Medicaid |
$312.05
|
| Rate for Payer: Amerigroup Medicare |
$245.88
|
| Rate for Payer: Cash Price |
$432.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$405.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$243.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$309.02
|
| Rate for Payer: Medical Associates Commercial |
$405.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$243.45
|
| Rate for Payer: Midlands Choice Commercial |
$378.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$313.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$279.97
|
| Rate for Payer: United Healthcare Commercial |
$486.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$319.19
|
|
|
LYSIS OF LABIAL ADHESIONS
|
Professional
|
Both
|
$477.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
8068969
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$250.24 |
| Max. Negotiated Rate |
$357.75 |
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Medical Associates Commercial |
$357.75
|
| Rate for Payer: Midlands Choice Commercial |
$333.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$357.75
|
| Rate for Payer: United Healthcare Commercial |
$250.24
|
|
|
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 |
$60.30 |
| 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 |
$77.29
|
| Rate for Payer: Amerigroup Medicare |
$60.90
|
| 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 |
$60.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$76.54
|
| Rate for Payer: Medical Associates Commercial |
$100.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$60.30
|
| Rate for Payer: Midlands Choice Commercial |
$93.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$77.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$69.34
|
| Rate for Payer: United Healthcare Commercial |
$120.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.06
|
|
|
Magic Mouthwash [VDMC]
|
Facility
|
OP
|
$167.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
20213408
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$75.38 |
| 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 |
$96.63
|
| Rate for Payer: Amerigroup Medicare |
$76.14
|
| 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 |
$75.38
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$95.69
|
| Rate for Payer: Medical Associates Commercial |
$125.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.38
|
| Rate for Payer: Midlands Choice Commercial |
$117.26
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$97.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$86.69
|
| Rate for Payer: United Healthcare Commercial |
$150.77
|
| Rate for Payer: United Healthcare Managed Medicare |
$98.84
|
|
|
Magic Mouthwash [VDMC]
|
Facility
|
IP
|
$167.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
20213408
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
|
Magic Mouthwash [VDMC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
28639935
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna of IA Commercial |
$2.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.70
|
| Rate for Payer: Aetna of IA Medicare |
$1.71
|
| Rate for Payer: Amerigroup Medicaid |
$1.73
|
| Rate for Payer: Amerigroup Medicare |
$1.36
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.71
|
| Rate for Payer: Medical Associates Commercial |
$2.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.35
|
| Rate for Payer: Midlands Choice Commercial |
$2.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.55
|
| Rate for Payer: United Healthcare Commercial |
$2.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.77
|
|
|
Magic Mouthwash [VDMC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
28639935
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna of IA Commercial |
$2.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.70
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.25
|
| Rate for Payer: Medical Associates Commercial |
$2.25
|
| Rate for Payer: Midlands Choice Commercial |
$2.10
|
| Rate for Payer: United Healthcare Commercial |
$2.70
|
|
|
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
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
633781
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.80 |
| 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: Aetna of IA Medicare |
$36.48
|
| Rate for Payer: Amerigroup Medicaid |
$36.92
|
| Rate for Payer: Amerigroup Medicare |
$29.09
|
| 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 |
$28.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.56
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.80
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.12
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
|
|
magnesium chloride DR 64 mg Tab [VDMC]
|
Facility
|
IP
|
$1.27
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373307
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna of IA Commercial |
$1.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.14
|
| 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 |
$0.89
|
| Rate for Payer: United Healthcare Commercial |
$1.14
|
|
|
magnesium chloride DR 64 mg Tab [VDMC]
|
Facility
|
OP
|
$1.27
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373307
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna of IA Commercial |
$1.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.14
|
| Rate for Payer: Aetna of IA Medicare |
$0.72
|
| Rate for Payer: Amerigroup Medicaid |
$0.73
|
| Rate for Payer: Amerigroup Medicare |
$0.58
|
| 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 |
$0.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.72
|
| Rate for Payer: Medical Associates Commercial |
$0.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.57
|
| Rate for Payer: Midlands Choice Commercial |
$0.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.66
|
| Rate for Payer: United Healthcare Commercial |
$1.14
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.75
|
|
|
magnesium citrate 8.85% Oral Liq 296 mL [VDMC]
|
Facility
|
OP
|
$13.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10435641
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.92 |
| 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 |
$7.59
|
| Rate for Payer: Amerigroup Medicare |
$5.98
|
| 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 |
$5.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.52
|
| Rate for Payer: Medical Associates Commercial |
$9.87
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.92
|
| Rate for Payer: Midlands Choice Commercial |
$9.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$6.81
|
| Rate for Payer: United Healthcare Commercial |
$11.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.76
|
|
|
magnesium citrate 8.85% Oral Liq 296 mL [VDMC]
|
Facility
|
IP
|
$13.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10435641
|
|
Hospital Revenue Code
|
259
|
| 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 hydroxide 24% Oral Conc 10 mL [VDMC]
|
Facility
|
IP
|
$8.98
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10435706
|
|
Hospital Revenue Code
|
259
|
| 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 hydroxide 24% Oral Conc 10 mL [VDMC]
|
Facility
|
OP
|
$8.98
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10435706
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.04 |
| 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 |
$5.18
|
| Rate for Payer: Amerigroup Medicare |
$4.08
|
| 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 |
$4.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5.13
|
| Rate for Payer: Medical Associates Commercial |
$6.74
|
| Rate for Payer: Medical Associates Managed Medicare |
$4.04
|
| Rate for Payer: Midlands Choice Commercial |
$6.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$4.65
|
| Rate for Payer: United Healthcare Commercial |
$8.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$5.30
|
|
|
magnesium oxide 400 mg Tab [VDMC]
|
Facility
|
IP
|
$1.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402061
|
|
Hospital Revenue Code
|
259
|
| 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 oxide 400 mg Tab [VDMC]
|
Facility
|
OP
|
$1.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402061
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| 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 |
$0.64
|
| Rate for Payer: Amerigroup Medicare |
$0.50
|
| 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 |
$0.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.63
|
| Rate for Payer: Medical Associates Commercial |
$0.83
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.50
|
| Rate for Payer: Midlands Choice Commercial |
$0.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.57
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.66
|
|
|
magnesium sulfate 10 mg/mL-D5% 100ml]VDMC]
|
Facility
|
OP
|
$79.95
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
14145942
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.98 |
| 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 |
$46.12
|
| Rate for Payer: Amerigroup Medicare |
$36.34
|
| 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 |
$35.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$45.67
|
| Rate for Payer: Medical Associates Commercial |
$59.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.98
|
| Rate for Payer: Midlands Choice Commercial |
$55.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$46.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$41.38
|
| Rate for Payer: United Healthcare Commercial |
$71.96
|
| Rate for Payer: United Healthcare Managed Medicare |
$47.17
|
|
|
magnesium sulfate 10 mg/mL-D5% 100ml]VDMC]
|
Facility
|
IP
|
$79.95
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
14145942
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$55.97 |
| 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 |
$55.97
|
| Rate for Payer: United Healthcare Commercial |
$71.96
|
|
