|
Dextrose 5% in Water IV Sol 100 mL
|
Facility
OP
|
$66.28
|
|
|
Service Code
|
CPT J7060
|
| Hospital Charge Code |
43706262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.13 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna of IA Commercial |
$59.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.65
|
| Rate for Payer: Aetna of IA Medicare |
$37.78
|
| Rate for Payer: Amerigroup Medicaid |
$33.45
|
| Rate for Payer: Amerigroup Medicare |
$33.47
|
| Rate for Payer: Cash Price |
$53.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.71
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.14
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.13
|
| Rate for Payer: Medical Associates Commercial |
$49.71
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.14
|
| Rate for Payer: Midlands Choice Commercial |
$46.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.71
|
| Rate for Payer: United Healthcare Commercial |
$59.65
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.11
|
|
|
Dextrose 5% in Water IV Sol 100 mL
|
Facility
IP
|
$66.28
|
|
|
Service Code
|
CPT J7060
|
| Hospital Charge Code |
43706262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna of IA Commercial |
$59.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.65
|
| Rate for Payer: Cash Price |
$53.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.71
|
| Rate for Payer: Medical Associates Commercial |
$49.71
|
| Rate for Payer: Midlands Choice Commercial |
$46.40
|
| Rate for Payer: United Healthcare Commercial |
$59.65
|
|
|
Dextrose 5% in Water IV Sol 250 mL PVC FREE
|
Facility
IP
|
$72.55
|
|
|
Service Code
|
CPT J7070
|
| Hospital Charge Code |
43700242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.78 |
| Max. Negotiated Rate |
$65.30 |
| Rate for Payer: Aetna of IA Commercial |
$65.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.30
|
| Rate for Payer: Cash Price |
$58.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.41
|
| Rate for Payer: Medical Associates Commercial |
$54.41
|
| Rate for Payer: Midlands Choice Commercial |
$50.78
|
| Rate for Payer: United Healthcare Commercial |
$65.30
|
|
|
Dextrose 5% in Water IV Sol 250 mL PVC FREE
|
Facility
OP
|
$72.55
|
|
|
Service Code
|
CPT J7070
|
| Hospital Charge Code |
43700242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$65.30 |
| Rate for Payer: Aetna of IA Commercial |
$65.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.30
|
| Rate for Payer: Aetna of IA Medicare |
$41.35
|
| Rate for Payer: Amerigroup Medicaid |
$36.62
|
| Rate for Payer: Amerigroup Medicare |
$36.64
|
| Rate for Payer: Cash Price |
$58.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.26
|
| Rate for Payer: Medical Associates Commercial |
$54.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.28
|
| Rate for Payer: Midlands Choice Commercial |
$50.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.41
|
| Rate for Payer: United Healthcare Commercial |
$65.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$42.80
|
|
|
Dextrose 5% in Water IV Sol 500 mL
|
Facility
IP
|
$63.70
|
|
|
Service Code
|
CPT J7070
|
| Hospital Charge Code |
43702024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.59 |
| Max. Negotiated Rate |
$57.33 |
| Rate for Payer: Aetna of IA Commercial |
$57.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.33
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.78
|
| Rate for Payer: Medical Associates Commercial |
$47.78
|
| Rate for Payer: Midlands Choice Commercial |
$44.59
|
| Rate for Payer: United Healthcare Commercial |
$57.33
|
|
|
Dextrose 5% in Water IV Sol 500 mL
|
Facility
OP
|
$63.70
|
|
|
Service Code
|
CPT J7070
|
| Hospital Charge Code |
43702024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$57.33 |
| Rate for Payer: Aetna of IA Commercial |
$57.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.33
|
| Rate for Payer: Aetna of IA Medicare |
$36.31
|
| Rate for Payer: Amerigroup Medicaid |
$32.15
|
| Rate for Payer: Amerigroup Medicare |
$32.17
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.84
|
| Rate for Payer: Medical Associates Commercial |
$47.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.85
|
| Rate for Payer: Midlands Choice Commercial |
$44.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$47.78
|
| Rate for Payer: United Healthcare Commercial |
$57.33
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.58
|
|
|
Dextrose 5% with 0.2% NaCl IV Sol 1000 mL
|
Facility
IP
|
$65.96
|
|
|
Service Code
|
CPT J7042
|
| Hospital Charge Code |
43750114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.17 |
| Max. Negotiated Rate |
$59.36 |
| Rate for Payer: Aetna of IA Commercial |
$59.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.36
|
| Rate for Payer: Cash Price |
$52.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.47
|
| Rate for Payer: Medical Associates Commercial |
$49.47
|
| Rate for Payer: Midlands Choice Commercial |
$46.17
|
| Rate for Payer: United Healthcare Commercial |
$59.36
|
|
|
Dextrose 5% with 0.2% NaCl IV Sol 1000 mL
|
Facility
OP
|
$65.96
|
|
|
Service Code
|
CPT J7042
|
| Hospital Charge Code |
43750114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.97 |
| Max. Negotiated Rate |
$59.36 |
| Rate for Payer: Aetna of IA Commercial |
$59.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.36
|
| Rate for Payer: Aetna of IA Medicare |
$37.60
|
| Rate for Payer: Amerigroup Medicaid |
$33.29
|
| Rate for Payer: Amerigroup Medicare |
$33.31
|
| Rate for Payer: Cash Price |
$52.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.47
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.97
|
| Rate for Payer: Medical Associates Commercial |
$49.47
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.98
|
| Rate for Payer: Midlands Choice Commercial |
$46.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.47
|
| Rate for Payer: United Healthcare Commercial |
$59.36
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.92
|
|
|
Dextrose 5% with 0.45% NaCl and KCl 20 mEq/L intravenous solution
|
Facility
OP
|
$57.64
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
43701682
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.81 |
| Max. Negotiated Rate |
$51.88 |
| Rate for Payer: Aetna of IA Commercial |
$51.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.88
|
| Rate for Payer: Aetna of IA Medicare |
$32.85
|
| Rate for Payer: Amerigroup Medicaid |
$29.09
|
| Rate for Payer: Amerigroup Medicare |
$29.11
|
| Rate for Payer: Cash Price |
$46.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.23
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.81
|
| Rate for Payer: Medical Associates Commercial |
$43.23
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.82
|
| Rate for Payer: Midlands Choice Commercial |
$40.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.23
|
| Rate for Payer: United Healthcare Commercial |
$51.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.01
|
|
|
Dextrose 5% with 0.45% NaCl and KCl 20 mEq/L intravenous solution
|
Facility
IP
|
$57.64
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
43701682
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.35 |
| Max. Negotiated Rate |
$51.88 |
| Rate for Payer: Aetna of IA Commercial |
$51.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.88
|
| Rate for Payer: Cash Price |
$46.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.23
|
| Rate for Payer: Medical Associates Commercial |
$43.23
|
| Rate for Payer: Midlands Choice Commercial |
$40.35
|
| Rate for Payer: United Healthcare Commercial |
$51.88
|
|
|
Dextrose 5% with 0.45% NaCl and KCl 40 mEq/L intravenous solution
|
Facility
OP
|
$59.76
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
43721077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.87 |
| Max. Negotiated Rate |
$53.78 |
| Rate for Payer: Aetna of IA Commercial |
$53.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.78
|
| Rate for Payer: Aetna of IA Medicare |
$34.06
|
| Rate for Payer: Amerigroup Medicaid |
$30.16
|
| Rate for Payer: Amerigroup Medicare |
$30.18
|
| Rate for Payer: Cash Price |
$47.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.87
|
| Rate for Payer: Medical Associates Commercial |
$44.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.88
|
| Rate for Payer: Midlands Choice Commercial |
$41.83
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.82
|
| Rate for Payer: United Healthcare Commercial |
$53.78
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.26
|
|
|
Dextrose 5% with 0.45% NaCl and KCl 40 mEq/L intravenous solution
|
Facility
IP
|
$59.76
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
43721077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.83 |
| Max. Negotiated Rate |
$53.78 |
| Rate for Payer: Aetna of IA Commercial |
$53.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.78
|
| Rate for Payer: Cash Price |
$47.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.82
|
| Rate for Payer: Medical Associates Commercial |
$44.82
|
| Rate for Payer: Midlands Choice Commercial |
$41.83
|
| Rate for Payer: United Healthcare Commercial |
$53.78
|
|
|
Dextrose 5% with 0.45% NaCl IV Sol 1000 mL
|
Facility
IP
|
$74.52
|
|
|
Service Code
|
CPT J7042
|
| Hospital Charge Code |
43702040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$67.07 |
| Rate for Payer: Aetna of IA Commercial |
$67.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$67.07
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.89
|
| Rate for Payer: Medical Associates Commercial |
$55.89
|
| Rate for Payer: Midlands Choice Commercial |
$52.16
|
| Rate for Payer: United Healthcare Commercial |
$67.07
|
|
|
Dextrose 5% with 0.45% NaCl IV Sol 1000 mL
|
Facility
OP
|
$74.52
|
|
|
Service Code
|
CPT J7042
|
| Hospital Charge Code |
43702040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.25 |
| Max. Negotiated Rate |
$67.07 |
| Rate for Payer: Aetna of IA Commercial |
$67.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$67.07
|
| Rate for Payer: Aetna of IA Medicare |
$42.48
|
| Rate for Payer: Amerigroup Medicaid |
$37.61
|
| Rate for Payer: Amerigroup Medicare |
$37.63
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.89
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$37.26
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.25
|
| Rate for Payer: Medical Associates Commercial |
$55.89
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.26
|
| Rate for Payer: Midlands Choice Commercial |
$52.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.89
|
| Rate for Payer: United Healthcare Commercial |
$67.07
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.97
|
|
|
Dextrose 5% with 0.9% NaCl and KCl 40 mEq/L intravenous solution
|
Facility
OP
|
$67.64
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
43754876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$60.88 |
| Rate for Payer: Aetna of IA Commercial |
$60.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.88
|
| Rate for Payer: Aetna of IA Medicare |
$38.55
|
| Rate for Payer: Amerigroup Medicaid |
$34.14
|
| Rate for Payer: Amerigroup Medicare |
$34.16
|
| Rate for Payer: Cash Price |
$54.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.81
|
| Rate for Payer: Medical Associates Commercial |
$50.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.82
|
| Rate for Payer: Midlands Choice Commercial |
$47.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.73
|
| Rate for Payer: United Healthcare Commercial |
$60.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.91
|
|
|
Dextrose 5% with 0.9% NaCl and KCl 40 mEq/L intravenous solution
|
Facility
IP
|
$67.64
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
43754876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.35 |
| Max. Negotiated Rate |
$60.88 |
| Rate for Payer: Aetna of IA Commercial |
$60.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.88
|
| Rate for Payer: Cash Price |
$54.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.73
|
| Rate for Payer: Medical Associates Commercial |
$50.73
|
| Rate for Payer: Midlands Choice Commercial |
$47.35
|
| Rate for Payer: United Healthcare Commercial |
$60.88
|
|
|
Dextrose 5% with 0.9% NaCl intravenous solution[VDMC]
|
Facility
IP
|
$65.50
|
|
|
Service Code
|
CPT J7042
|
| Hospital Charge Code |
43702042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$58.95 |
| Rate for Payer: Aetna of IA Commercial |
$58.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.95
|
| Rate for Payer: Cash Price |
$52.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.12
|
| Rate for Payer: Medical Associates Commercial |
$49.12
|
| Rate for Payer: Midlands Choice Commercial |
$45.85
|
| Rate for Payer: United Healthcare Commercial |
$58.95
|
|
|
Dextrose 5% with 0.9% NaCl intravenous solution[VDMC]
|
Facility
IP
|
$74.52
|
|
|
Service Code
|
CPT J7042
|
| Hospital Charge Code |
43733809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$67.07 |
| Rate for Payer: Aetna of IA Commercial |
$67.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$67.07
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.89
|
| Rate for Payer: Medical Associates Commercial |
$55.89
|
| Rate for Payer: Midlands Choice Commercial |
$52.16
|
| Rate for Payer: United Healthcare Commercial |
$67.07
|
|
|
Dextrose 5% with 0.9% NaCl intravenous solution[VDMC]
|
Facility
OP
|
$74.52
|
|
|
Service Code
|
CPT J7042
|
| Hospital Charge Code |
43733809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.25 |
| Max. Negotiated Rate |
$67.07 |
| Rate for Payer: Aetna of IA Commercial |
$67.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$67.07
|
| Rate for Payer: Aetna of IA Medicare |
$42.48
|
| Rate for Payer: Amerigroup Medicaid |
$37.61
|
| Rate for Payer: Amerigroup Medicare |
$37.63
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.89
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$37.26
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.25
|
| Rate for Payer: Medical Associates Commercial |
$55.89
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.26
|
| Rate for Payer: Midlands Choice Commercial |
$52.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.89
|
| Rate for Payer: United Healthcare Commercial |
$67.07
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.97
|
|
|
Dextrose 5% with 0.9% NaCl intravenous solution[VDMC]
|
Facility
OP
|
$65.50
|
|
|
Service Code
|
CPT J7042
|
| Hospital Charge Code |
43702042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.74 |
| Max. Negotiated Rate |
$58.95 |
| Rate for Payer: Aetna of IA Commercial |
$58.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.95
|
| Rate for Payer: Aetna of IA Medicare |
$37.34
|
| Rate for Payer: Amerigroup Medicaid |
$33.06
|
| Rate for Payer: Amerigroup Medicare |
$33.08
|
| Rate for Payer: Cash Price |
$52.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.74
|
| Rate for Payer: Medical Associates Commercial |
$49.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.75
|
| Rate for Payer: Midlands Choice Commercial |
$45.85
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.12
|
| Rate for Payer: United Healthcare Commercial |
$58.95
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.64
|
|
|
dextrose emergency syringe 50% IV Sol 50 mL
|
Facility
OP
|
$73.90
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43798514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.94 |
| Max. Negotiated Rate |
$66.51 |
| Rate for Payer: Aetna of IA Commercial |
$66.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.51
|
| Rate for Payer: Aetna of IA Medicare |
$42.12
|
| Rate for Payer: Amerigroup Medicaid |
$37.30
|
| Rate for Payer: Amerigroup Medicare |
$37.32
|
| Rate for Payer: Cash Price |
$59.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.94
|
| Rate for Payer: Medical Associates Commercial |
$55.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.95
|
| Rate for Payer: Midlands Choice Commercial |
$51.73
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.42
|
| Rate for Payer: United Healthcare Commercial |
$66.51
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.60
|
|
|
dextrose emergency syringe 50% IV Sol 50 mL
|
Facility
IP
|
$73.90
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43798514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.73 |
| Max. Negotiated Rate |
$66.51 |
| Rate for Payer: Aetna of IA Commercial |
$66.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.51
|
| Rate for Payer: Cash Price |
$59.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.42
|
| Rate for Payer: Medical Associates Commercial |
$55.42
|
| Rate for Payer: Midlands Choice Commercial |
$51.73
|
| Rate for Payer: United Healthcare Commercial |
$66.51
|
|
|
DIAB ED GROUP T19
|
Facility
OP
|
$1,022.00
|
|
|
Service Code
|
CPT S9455
|
| Hospital Charge Code |
8059033
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$510.80 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of IA Commercial |
$919.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$919.80
|
| Rate for Payer: Aetna of IA Medicare |
$582.54
|
| Rate for Payer: Amerigroup Medicaid |
$515.80
|
| Rate for Payer: Amerigroup Medicare |
$516.11
|
| Rate for Payer: Cash Price |
$817.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$766.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$511.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$510.80
|
| Rate for Payer: Medical Associates Commercial |
$766.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$511.00
|
| Rate for Payer: Midlands Choice Commercial |
$715.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$518.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$766.50
|
| Rate for Payer: United Healthcare Commercial |
$919.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$602.98
|
|
|
DIAB ED GROUP T19
|
Facility
IP
|
$1,022.00
|
|
|
Service Code
|
CPT S9455
|
| Hospital Charge Code |
8059033
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$715.40 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of IA Commercial |
$919.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$919.80
|
| Rate for Payer: Cash Price |
$817.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$766.50
|
| Rate for Payer: Medical Associates Commercial |
$766.50
|
| Rate for Payer: Midlands Choice Commercial |
$715.40
|
| Rate for Payer: United Healthcare Commercial |
$919.80
|
|
|
DIABETES ED-GROUP EA 30 MINUTE
|
Facility
IP
|
$91.00
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
5616793
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of IA Commercial |
$81.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.90
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$68.25
|
| Rate for Payer: Medical Associates Commercial |
$68.25
|
| Rate for Payer: Midlands Choice Commercial |
$63.70
|
| Rate for Payer: United Healthcare Commercial |
$81.90
|
|
