|
DESTRUCTION OF LESION(S) VULVA SIMPLE
|
Professional
|
$630.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
8825538
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$121.99 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Aetna of IA Medicare |
$121.99
|
| Rate for Payer: Amerigroup Medicaid |
$126.14
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$146.39
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$124.43
|
| Rate for Payer: Medical Associates Commercial |
$231.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.99
|
| Rate for Payer: Midlands Choice Commercial |
$441.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$182.98
|
| Rate for Payer: Wellmark IA HMO |
$257.00
|
| Rate for Payer: Wellmark IA PPO |
$301.00
|
|
|
dexamethasone 0.5 mg Tab
|
Facility
OP
|
$1.37
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43718976
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of IA Commercial |
$1.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.23
|
| Rate for Payer: Aetna of IA Medicare |
$0.78
|
| Rate for Payer: Amerigroup Medicaid |
$0.69
|
| Rate for Payer: Amerigroup Medicare |
$0.69
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.03
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.69
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.68
|
| Rate for Payer: Medical Associates Commercial |
$1.03
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.69
|
| Rate for Payer: Midlands Choice Commercial |
$0.96
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.03
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.81
|
|
|
dexamethasone 0.5 mg Tab
|
Facility
IP
|
$1.37
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43718976
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of IA Commercial |
$1.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.23
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.03
|
| Rate for Payer: Medical Associates Commercial |
$1.03
|
| Rate for Payer: Midlands Choice Commercial |
$0.96
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
|
|
dexamethasone 10 mg/mL 1 ml SDV PRESERVATIVE-FREE inj
|
Facility
OP
|
$36.31
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
43700480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$32.68 |
| Rate for Payer: Aetna of IA Commercial |
$32.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.68
|
| Rate for Payer: Aetna of IA Medicare |
$20.70
|
| Rate for Payer: Amerigroup Medicaid |
$18.33
|
| Rate for Payer: Amerigroup Medicare |
$18.34
|
| Rate for Payer: Cash Price |
$29.05
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.23
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.15
|
| Rate for Payer: Medical Associates Commercial |
$27.23
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.16
|
| Rate for Payer: Midlands Choice Commercial |
$25.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.23
|
| Rate for Payer: United Healthcare Commercial |
$32.68
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.42
|
|
|
dexamethasone 10 mg/mL 1 ml SDV PRESERVATIVE-FREE inj
|
Facility
IP
|
$36.31
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
43700480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.42 |
| Max. Negotiated Rate |
$32.68 |
| Rate for Payer: Aetna of IA Commercial |
$32.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.68
|
| Rate for Payer: Cash Price |
$29.05
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.23
|
| Rate for Payer: Medical Associates Commercial |
$27.23
|
| Rate for Payer: Midlands Choice Commercial |
$25.42
|
| Rate for Payer: United Healthcare Commercial |
$32.68
|
|
|
dexamethasone 4 mg/mL 5 ml MDV inj
|
Facility
OP
|
$23.16
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
43753374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$20.84 |
| Rate for Payer: Aetna of IA Commercial |
$20.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.84
|
| Rate for Payer: Aetna of IA Medicare |
$13.20
|
| Rate for Payer: Amerigroup Medicaid |
$11.69
|
| Rate for Payer: Amerigroup Medicare |
$11.70
|
| Rate for Payer: Cash Price |
$18.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.37
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.58
|
| Rate for Payer: Medical Associates Commercial |
$17.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.58
|
| Rate for Payer: Midlands Choice Commercial |
$16.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$17.37
|
| Rate for Payer: United Healthcare Commercial |
$20.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.66
|
|
|
dexamethasone 4 mg/mL 5 ml MDV inj
|
Facility
IP
|
$23.16
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
43753374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.21 |
| Max. Negotiated Rate |
$20.84 |
| Rate for Payer: Aetna of IA Commercial |
$20.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.84
|
| Rate for Payer: Cash Price |
$18.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.37
|
| Rate for Payer: Medical Associates Commercial |
$17.37
|
| Rate for Payer: Midlands Choice Commercial |
$16.21
|
| Rate for Payer: United Healthcare Commercial |
$20.84
|
|
|
dexamethasone 4 mg Tab
|
Facility
OP
|
$4.84
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43761827
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna of IA Commercial |
$4.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.36
|
| Rate for Payer: Aetna of IA Medicare |
$2.76
|
| Rate for Payer: Amerigroup Medicaid |
$2.44
|
| Rate for Payer: Amerigroup Medicare |
$2.44
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.63
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.42
|
| Rate for Payer: Medical Associates Commercial |
$3.63
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.42
|
| Rate for Payer: Midlands Choice Commercial |
$3.39
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.63
|
| Rate for Payer: United Healthcare Commercial |
$4.36
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.86
|
|
|
dexamethasone 4 mg Tab
|
Facility
IP
|
$4.84
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43761827
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna of IA Commercial |
$4.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.36
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.63
|
| Rate for Payer: Medical Associates Commercial |
$3.63
|
| Rate for Payer: Midlands Choice Commercial |
$3.39
|
| Rate for Payer: United Healthcare Commercial |
$4.36
|
|
|
dexmedetomidine 100 mcg/mL 2 ml SDV inj
|
Facility
OP
|
$26.71
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43700288
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$24.04 |
| Rate for Payer: Aetna of IA Commercial |
$24.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.04
|
| Rate for Payer: Aetna of IA Medicare |
$15.22
|
| Rate for Payer: Amerigroup Medicaid |
$13.48
|
| Rate for Payer: Amerigroup Medicare |
$13.49
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.03
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.35
|
| Rate for Payer: Medical Associates Commercial |
$20.03
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.36
|
| Rate for Payer: Midlands Choice Commercial |
$18.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.03
|
| Rate for Payer: United Healthcare Commercial |
$24.04
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.76
|
|
|
dexmedetomidine 100 mcg/mL 2 ml SDV inj
|
Facility
IP
|
$26.71
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43700288
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$24.04 |
| Rate for Payer: Aetna of IA Commercial |
$24.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.04
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.03
|
| Rate for Payer: Medical Associates Commercial |
$20.03
|
| Rate for Payer: Midlands Choice Commercial |
$18.70
|
| Rate for Payer: United Healthcare Commercial |
$24.04
|
|
|
dextromethorphan-guaiFENesin 10 MG-100 MG/5 mL
|
Facility
OP
|
$3.56
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706271
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna of IA Commercial |
$3.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.20
|
| Rate for Payer: Aetna of IA Medicare |
$2.03
|
| Rate for Payer: Amerigroup Medicaid |
$1.80
|
| Rate for Payer: Amerigroup Medicare |
$1.80
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.67
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.78
|
| Rate for Payer: Medical Associates Commercial |
$2.67
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.78
|
| Rate for Payer: Midlands Choice Commercial |
$2.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.67
|
| Rate for Payer: United Healthcare Commercial |
$3.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.10
|
|
|
dextromethorphan-guaiFENesin 10 MG-100 MG/5 mL
|
Facility
IP
|
$3.56
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43706271
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna of IA Commercial |
$3.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.20
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.67
|
| Rate for Payer: Medical Associates Commercial |
$2.67
|
| Rate for Payer: Midlands Choice Commercial |
$2.49
|
| Rate for Payer: United Healthcare Commercial |
$3.20
|
|
|
dextromethorphan-promethazine 15 MG-6.25 MG/5 mL
|
Facility
OP
|
$5.25
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700033
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Aetna of IA Commercial |
$4.72
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.72
|
| Rate for Payer: Aetna of IA Medicare |
$2.99
|
| Rate for Payer: Amerigroup Medicaid |
$2.65
|
| Rate for Payer: Amerigroup Medicare |
$2.65
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.94
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.62
|
| Rate for Payer: Medical Associates Commercial |
$3.94
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.62
|
| Rate for Payer: Midlands Choice Commercial |
$3.68
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.94
|
| Rate for Payer: United Healthcare Commercial |
$4.72
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.10
|
|
|
dextromethorphan-promethazine 15 MG-6.25 MG/5 mL
|
Facility
IP
|
$5.25
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700033
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Aetna of IA Commercial |
$4.72
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.72
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.94
|
| Rate for Payer: Medical Associates Commercial |
$3.94
|
| Rate for Payer: Midlands Choice Commercial |
$3.68
|
| Rate for Payer: United Healthcare Commercial |
$4.72
|
|
|
Dextrose 10% in Water intravenous solution 500 mL
|
Facility
IP
|
$69.40
|
|
|
Service Code
|
CPT J7799
|
| Hospital Charge Code |
43700086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.58 |
| Max. Negotiated Rate |
$62.46 |
| Rate for Payer: Aetna of IA Commercial |
$62.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$62.46
|
| Rate for Payer: Cash Price |
$55.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.05
|
| Rate for Payer: Medical Associates Commercial |
$52.05
|
| Rate for Payer: Midlands Choice Commercial |
$48.58
|
| Rate for Payer: United Healthcare Commercial |
$62.46
|
|
|
Dextrose 10% in Water intravenous solution 500 mL
|
Facility
OP
|
$69.40
|
|
|
Service Code
|
CPT J7799
|
| Hospital Charge Code |
43700086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.69 |
| Max. Negotiated Rate |
$62.46 |
| Rate for Payer: Aetna of IA Commercial |
$62.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$62.46
|
| Rate for Payer: Aetna of IA Medicare |
$39.56
|
| Rate for Payer: Amerigroup Medicaid |
$35.03
|
| Rate for Payer: Amerigroup Medicare |
$35.05
|
| Rate for Payer: Cash Price |
$55.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.05
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.69
|
| Rate for Payer: Medical Associates Commercial |
$52.05
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.70
|
| Rate for Payer: Midlands Choice Commercial |
$48.58
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$52.05
|
| Rate for Payer: United Healthcare Commercial |
$62.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$40.95
|
|
|
dextrose 40% Oral gel
|
Facility
OP
|
$15.64
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Aetna of IA Commercial |
$14.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.08
|
| Rate for Payer: Aetna of IA Medicare |
$8.91
|
| Rate for Payer: Amerigroup Medicaid |
$7.89
|
| Rate for Payer: Amerigroup Medicare |
$7.90
|
| Rate for Payer: Cash Price |
$12.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.82
|
| Rate for Payer: Medical Associates Commercial |
$11.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.82
|
| Rate for Payer: Midlands Choice Commercial |
$10.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.73
|
| Rate for Payer: United Healthcare Commercial |
$14.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$9.23
|
|
|
dextrose 40% Oral gel
|
Facility
IP
|
$15.64
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Aetna of IA Commercial |
$14.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.08
|
| Rate for Payer: Cash Price |
$12.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.73
|
| Rate for Payer: Medical Associates Commercial |
$11.73
|
| Rate for Payer: Midlands Choice Commercial |
$10.95
|
| Rate for Payer: United Healthcare Commercial |
$14.08
|
|
|
Dextrose 5% in Lactated Ringers 1000ml IV
|
Facility
OP
|
$65.88
|
|
|
Service Code
|
CPT J7121
|
| Hospital Charge Code |
43706020
|
|
Hospital Revenue Code
|
636
|
| 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
|
|
|
Dextrose 5% in Lactated Ringers 1000ml IV
|
Facility
IP
|
$65.88
|
|
|
Service Code
|
CPT J7121
|
| Hospital Charge Code |
43706020
|
|
Hospital Revenue Code
|
636
|
| 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
|
|
|
Dextrose 5% in Water intravenous solution
|
Facility
OP
|
$74.40
|
|
|
Service Code
|
CPT J7060
|
| Hospital Charge Code |
43702026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.19 |
| Max. Negotiated Rate |
$66.96 |
| Rate for Payer: Aetna of IA Commercial |
$66.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.96
|
| Rate for Payer: Aetna of IA Medicare |
$42.41
|
| Rate for Payer: Amerigroup Medicaid |
$37.55
|
| Rate for Payer: Amerigroup Medicare |
$37.57
|
| Rate for Payer: Cash Price |
$59.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$37.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.19
|
| Rate for Payer: Medical Associates Commercial |
$55.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.20
|
| Rate for Payer: Midlands Choice Commercial |
$52.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.80
|
| Rate for Payer: United Healthcare Commercial |
$66.96
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.90
|
|
|
Dextrose 5% in Water intravenous solution
|
Facility
IP
|
$74.40
|
|
|
Service Code
|
CPT J7060
|
| Hospital Charge Code |
43702026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.08 |
| Max. Negotiated Rate |
$66.96 |
| Rate for Payer: Aetna of IA Commercial |
$66.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.96
|
| Rate for Payer: Cash Price |
$59.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.80
|
| Rate for Payer: Medical Associates Commercial |
$55.80
|
| Rate for Payer: Midlands Choice Commercial |
$52.08
|
| Rate for Payer: United Healthcare Commercial |
$66.96
|
|
|
Dextrose 5% in Water IV 500ml Sol PVC FREE
|
Facility
IP
|
$71.36
|
|
|
Service Code
|
CPT J7060
|
| Hospital Charge Code |
43707650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.95 |
| Max. Negotiated Rate |
$64.22 |
| Rate for Payer: Aetna of IA Commercial |
$64.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.22
|
| Rate for Payer: Cash Price |
$57.09
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.52
|
| Rate for Payer: Medical Associates Commercial |
$53.52
|
| Rate for Payer: Midlands Choice Commercial |
$49.95
|
| Rate for Payer: United Healthcare Commercial |
$64.22
|
|
|
Dextrose 5% in Water IV 500ml Sol PVC FREE
|
Facility
OP
|
$71.36
|
|
|
Service Code
|
CPT J7060
|
| Hospital Charge Code |
43707650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$64.22 |
| Rate for Payer: Aetna of IA Commercial |
$64.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.22
|
| Rate for Payer: Aetna of IA Medicare |
$40.68
|
| Rate for Payer: Amerigroup Medicaid |
$36.02
|
| Rate for Payer: Amerigroup Medicare |
$36.04
|
| Rate for Payer: Cash Price |
$57.09
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.68
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.67
|
| Rate for Payer: Medical Associates Commercial |
$53.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.68
|
| Rate for Payer: Midlands Choice Commercial |
$49.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.52
|
| Rate for Payer: United Healthcare Commercial |
$64.22
|
| Rate for Payer: United Healthcare Managed Medicare |
$42.10
|
|
