|
SNIPER STAPLE IMPLANT 25X20X20MM
|
Facility
IP
|
$1,710.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8783242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,197.00 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,539.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,539.00
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,282.50
|
| Rate for Payer: Medical Associates Commercial |
$1,282.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,197.00
|
| Rate for Payer: United Healthcare Commercial |
$1,539.00
|
|
|
SODIUM
|
Facility
OP
|
$46.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
633611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna of IA Commercial |
$41.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.40
|
| Rate for Payer: Aetna of IA Medicare |
$26.22
|
| Rate for Payer: Amerigroup Medicaid |
$23.22
|
| Rate for Payer: Amerigroup Medicare |
$23.23
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.99
|
| Rate for Payer: Medical Associates Commercial |
$34.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.00
|
| Rate for Payer: Midlands Choice Commercial |
$32.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.50
|
| Rate for Payer: United Healthcare Commercial |
$41.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$27.14
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
SODIUM
|
Facility
IP
|
$46.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
633611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna of IA Commercial |
$41.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.50
|
| Rate for Payer: Medical Associates Commercial |
$34.50
|
| Rate for Payer: Midlands Choice Commercial |
$32.20
|
| Rate for Payer: United Healthcare Commercial |
$41.40
|
|
|
sodium acetate 2meq/ml 20ml
|
Facility
IP
|
$30.98
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43700215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$27.88 |
| Rate for Payer: Aetna of IA Commercial |
$27.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.88
|
| Rate for Payer: Cash Price |
$24.78
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.24
|
| Rate for Payer: Medical Associates Commercial |
$23.24
|
| Rate for Payer: Midlands Choice Commercial |
$21.69
|
| Rate for Payer: United Healthcare Commercial |
$27.88
|
|
|
sodium acetate 2meq/ml 20ml
|
Facility
OP
|
$30.98
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43700215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.48 |
| Max. Negotiated Rate |
$27.88 |
| Rate for Payer: Aetna of IA Commercial |
$27.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.88
|
| Rate for Payer: Aetna of IA Medicare |
$17.66
|
| Rate for Payer: Amerigroup Medicaid |
$15.64
|
| Rate for Payer: Amerigroup Medicare |
$15.64
|
| Rate for Payer: Cash Price |
$24.78
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.49
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.48
|
| Rate for Payer: Medical Associates Commercial |
$23.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.49
|
| Rate for Payer: Midlands Choice Commercial |
$21.69
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.24
|
| Rate for Payer: United Healthcare Commercial |
$27.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.28
|
|
|
sodium bicarbonate 4.2% IV Sol 10 mL SDS
|
Facility
IP
|
$62.65
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43709982
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.86 |
| Max. Negotiated Rate |
$56.38 |
| Rate for Payer: Aetna of IA Commercial |
$56.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$56.38
|
| Rate for Payer: Cash Price |
$50.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.99
|
| Rate for Payer: Medical Associates Commercial |
$46.99
|
| Rate for Payer: Midlands Choice Commercial |
$43.86
|
| Rate for Payer: United Healthcare Commercial |
$56.38
|
|
|
sodium bicarbonate 4.2% IV Sol 10 mL SDS
|
Facility
OP
|
$62.65
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43709982
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$56.38 |
| Rate for Payer: Aetna of IA Commercial |
$56.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$56.38
|
| Rate for Payer: Aetna of IA Medicare |
$35.71
|
| Rate for Payer: Amerigroup Medicaid |
$31.62
|
| Rate for Payer: Amerigroup Medicare |
$31.64
|
| Rate for Payer: Cash Price |
$50.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.99
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.31
|
| Rate for Payer: Medical Associates Commercial |
$46.99
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.32
|
| Rate for Payer: Midlands Choice Commercial |
$43.86
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$31.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$46.99
|
| Rate for Payer: United Healthcare Commercial |
$56.38
|
| Rate for Payer: United Healthcare Managed Medicare |
$36.96
|
|
|
sodium bicarbonate 650 mg Tab
|
Facility
IP
|
$1.24
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43745441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna of IA Commercial |
$1.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.12
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.93
|
| Rate for Payer: Medical Associates Commercial |
$0.93
|
| Rate for Payer: Midlands Choice Commercial |
$0.87
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
|
|
sodium bicarbonate 650 mg Tab
|
Facility
OP
|
$1.24
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43745441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna of IA Commercial |
$1.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.12
|
| Rate for Payer: Aetna of IA Medicare |
$0.71
|
| Rate for Payer: Amerigroup Medicaid |
$0.63
|
| Rate for Payer: Amerigroup Medicare |
$0.63
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.93
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.62
|
| Rate for Payer: Medical Associates Commercial |
$0.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.62
|
| Rate for Payer: Midlands Choice Commercial |
$0.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.73
|
|
|
sodium bicarbonate 8.4% 50ml Syringe
|
Facility
OP
|
$60.44
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43748992
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.21 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Aetna of IA Commercial |
$54.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.40
|
| Rate for Payer: Aetna of IA Medicare |
$34.45
|
| Rate for Payer: Amerigroup Medicaid |
$30.50
|
| Rate for Payer: Amerigroup Medicare |
$30.52
|
| Rate for Payer: Cash Price |
$48.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.33
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.21
|
| Rate for Payer: Medical Associates Commercial |
$45.33
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.22
|
| Rate for Payer: Midlands Choice Commercial |
$42.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.33
|
| Rate for Payer: United Healthcare Commercial |
$54.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.66
|
|
|
sodium bicarbonate 8.4% 50ml Syringe
|
Facility
IP
|
$60.44
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43748992
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Aetna of IA Commercial |
$54.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.40
|
| Rate for Payer: Cash Price |
$48.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.33
|
| Rate for Payer: Medical Associates Commercial |
$45.33
|
| Rate for Payer: Midlands Choice Commercial |
$42.31
|
| Rate for Payer: United Healthcare Commercial |
$54.40
|
|
|
sodium bicarbonate 8.4% IV 50 mL Vial
|
Facility
OP
|
$42.08
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43701650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.03 |
| Max. Negotiated Rate |
$37.87 |
| Rate for Payer: Aetna of IA Commercial |
$37.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$37.87
|
| Rate for Payer: Aetna of IA Medicare |
$23.99
|
| Rate for Payer: Amerigroup Medicaid |
$21.24
|
| Rate for Payer: Amerigroup Medicare |
$21.25
|
| Rate for Payer: Cash Price |
$33.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.56
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$21.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.03
|
| Rate for Payer: Medical Associates Commercial |
$31.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$21.04
|
| Rate for Payer: Midlands Choice Commercial |
$29.46
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.56
|
| Rate for Payer: United Healthcare Commercial |
$37.87
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.83
|
|
|
sodium bicarbonate 8.4% IV 50 mL Vial
|
Facility
IP
|
$42.08
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43701650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.46 |
| Max. Negotiated Rate |
$37.87 |
| Rate for Payer: Aetna of IA Commercial |
$37.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$37.87
|
| Rate for Payer: Cash Price |
$33.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.56
|
| Rate for Payer: Medical Associates Commercial |
$31.56
|
| Rate for Payer: Midlands Choice Commercial |
$29.46
|
| Rate for Payer: United Healthcare Commercial |
$37.87
|
|
|
sodium biphosphate-sodium phosphate 48%-18%
|
Facility
OP
|
$20.12
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$18.11 |
| Rate for Payer: Aetna of IA Commercial |
$18.11
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.11
|
| Rate for Payer: Aetna of IA Medicare |
$11.47
|
| Rate for Payer: Amerigroup Medicaid |
$10.15
|
| Rate for Payer: Amerigroup Medicare |
$10.16
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.09
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.06
|
| Rate for Payer: Medical Associates Commercial |
$15.09
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.06
|
| Rate for Payer: Midlands Choice Commercial |
$14.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$15.09
|
| Rate for Payer: United Healthcare Commercial |
$18.11
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.87
|
|
|
sodium biphosphate-sodium phosphate 48%-18%
|
Facility
IP
|
$20.12
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$18.11 |
| Rate for Payer: Aetna of IA Commercial |
$18.11
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.11
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.09
|
| Rate for Payer: Medical Associates Commercial |
$15.09
|
| Rate for Payer: Midlands Choice Commercial |
$14.08
|
| Rate for Payer: United Healthcare Commercial |
$18.11
|
|
|
Sodium Chloride 0.45% with KCl 20 mEq/L intravenous solution
|
Facility
OP
|
$59.32
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
43720550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.65 |
| Max. Negotiated Rate |
$53.39 |
| Rate for Payer: Aetna of IA Commercial |
$53.39
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.39
|
| Rate for Payer: Aetna of IA Medicare |
$33.81
|
| Rate for Payer: Amerigroup Medicaid |
$29.94
|
| Rate for Payer: Amerigroup Medicare |
$29.96
|
| Rate for Payer: Cash Price |
$47.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.49
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.65
|
| Rate for Payer: Medical Associates Commercial |
$44.49
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.66
|
| Rate for Payer: Midlands Choice Commercial |
$41.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.49
|
| Rate for Payer: United Healthcare Commercial |
$53.39
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.00
|
|
|
Sodium Chloride 0.45% with KCl 20 mEq/L intravenous solution
|
Facility
IP
|
$59.32
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
43720550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.52 |
| Max. Negotiated Rate |
$53.39 |
| Rate for Payer: Aetna of IA Commercial |
$53.39
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.39
|
| Rate for Payer: Cash Price |
$47.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.49
|
| Rate for Payer: Medical Associates Commercial |
$44.49
|
| Rate for Payer: Midlands Choice Commercial |
$41.52
|
| Rate for Payer: United Healthcare Commercial |
$53.39
|
|
|
Sodium Chloride 0.9% 500 ml intravenous solution
|
Facility
OP
|
$66.70
|
|
|
Service Code
|
CPT J7040
|
| Hospital Charge Code |
43700046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.34 |
| Max. Negotiated Rate |
$60.03 |
| Rate for Payer: Aetna of IA Commercial |
$60.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.03
|
| Rate for Payer: Aetna of IA Medicare |
$38.02
|
| Rate for Payer: Amerigroup Medicaid |
$33.66
|
| Rate for Payer: Amerigroup Medicare |
$33.68
|
| Rate for Payer: Cash Price |
$53.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.02
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.34
|
| Rate for Payer: Medical Associates Commercial |
$50.02
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.35
|
| Rate for Payer: Midlands Choice Commercial |
$46.69
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.02
|
| Rate for Payer: United Healthcare Commercial |
$60.03
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.35
|
|
|
Sodium Chloride 0.9% 500 ml intravenous solution
|
Facility
IP
|
$66.70
|
|
|
Service Code
|
CPT J7040
|
| Hospital Charge Code |
43700046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.69 |
| Max. Negotiated Rate |
$60.03 |
| Rate for Payer: Aetna of IA Commercial |
$60.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.03
|
| Rate for Payer: Cash Price |
$53.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.02
|
| Rate for Payer: Medical Associates Commercial |
$50.02
|
| Rate for Payer: Midlands Choice Commercial |
$46.69
|
| Rate for Payer: United Healthcare Commercial |
$60.03
|
|
|
Sodium Chloride 0.9% intravenous solution
|
Facility
IP
|
$65.88
|
|
|
Service Code
|
CPT J7050
|
| Hospital Charge Code |
43702787
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.12 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Aetna of IA Commercial |
$59.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.29
|
| Rate for Payer: Cash Price |
$52.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.41
|
| Rate for Payer: Medical Associates Commercial |
$49.41
|
| Rate for Payer: Midlands Choice Commercial |
$46.12
|
| Rate for Payer: United Healthcare Commercial |
$59.29
|
|
|
Sodium Chloride 0.9% intravenous solution
|
Facility
OP
|
$63.66
|
|
|
Service Code
|
CPT J7030
|
| Hospital Charge Code |
43700029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$57.29 |
| Rate for Payer: Aetna of IA Commercial |
$57.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.29
|
| Rate for Payer: Aetna of IA Medicare |
$36.29
|
| Rate for Payer: Amerigroup Medicaid |
$32.13
|
| Rate for Payer: Amerigroup Medicare |
$32.15
|
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.74
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.83
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.82
|
| Rate for Payer: Medical Associates Commercial |
$47.74
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.83
|
| Rate for Payer: Midlands Choice Commercial |
$44.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$47.74
|
| Rate for Payer: United Healthcare Commercial |
$57.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.56
|
|
|
Sodium Chloride 0.9% intravenous solution
|
Facility
OP
|
$65.88
|
|
|
Service Code
|
CPT J7050
|
| Hospital Charge Code |
43702787
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.93 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Aetna of IA Commercial |
$59.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.29
|
| Rate for Payer: Aetna of IA Medicare |
$37.55
|
| Rate for Payer: Amerigroup Medicaid |
$33.25
|
| Rate for Payer: Amerigroup Medicare |
$33.27
|
| Rate for Payer: Cash Price |
$52.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.93
|
| Rate for Payer: Medical Associates Commercial |
$49.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.94
|
| Rate for Payer: Midlands Choice Commercial |
$46.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.41
|
| Rate for Payer: United Healthcare Commercial |
$59.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.87
|
|
|
Sodium Chloride 0.9% intravenous solution
|
Facility
IP
|
$63.66
|
|
|
Service Code
|
CPT J7030
|
| Hospital Charge Code |
43700029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.56 |
| Max. Negotiated Rate |
$57.29 |
| Rate for Payer: Aetna of IA Commercial |
$57.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.29
|
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.74
|
| Rate for Payer: Medical Associates Commercial |
$47.74
|
| Rate for Payer: Midlands Choice Commercial |
$44.56
|
| Rate for Payer: United Healthcare Commercial |
$57.29
|
|
|
Sodium Chloride 0.9% IV Sol 1000 mL
|
Facility
IP
|
$66.80
|
|
|
Service Code
|
CPT J7050
|
| Hospital Charge Code |
43700028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.76 |
| Max. Negotiated Rate |
$60.12 |
| Rate for Payer: Aetna of IA Commercial |
$60.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.12
|
| Rate for Payer: Cash Price |
$53.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.10
|
| Rate for Payer: Medical Associates Commercial |
$50.10
|
| Rate for Payer: Midlands Choice Commercial |
$46.76
|
| Rate for Payer: United Healthcare Commercial |
$60.12
|
|
|
Sodium Chloride 0.9% IV Sol 1000 mL
|
Facility
OP
|
$66.80
|
|
|
Service Code
|
CPT J7050
|
| Hospital Charge Code |
43700028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.39 |
| Max. Negotiated Rate |
$60.12 |
| Rate for Payer: Aetna of IA Commercial |
$60.12
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.12
|
| Rate for Payer: Aetna of IA Medicare |
$38.08
|
| Rate for Payer: Amerigroup Medicaid |
$33.71
|
| Rate for Payer: Amerigroup Medicare |
$33.73
|
| Rate for Payer: Cash Price |
$53.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.10
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.39
|
| Rate for Payer: Medical Associates Commercial |
$50.10
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.40
|
| Rate for Payer: Midlands Choice Commercial |
$46.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.10
|
| Rate for Payer: United Healthcare Commercial |
$60.12
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.41
|
|
