|
GLENOID W/KEEL MEDIUM
|
Facility
|
IP
|
$2,835.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,984.50 |
| Max. Negotiated Rate |
$2,551.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,551.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,551.50
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,126.25
|
| Rate for Payer: Medical Associates Commercial |
$2,126.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,984.50
|
| Rate for Payer: United Healthcare Commercial |
$2,551.50
|
|
|
GLENOID W/KEEL MEDIUM
|
Facility
|
OP
|
$2,835.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,416.93 |
| Max. Negotiated Rate |
$2,551.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,551.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,551.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,615.95
|
| Rate for Payer: Amerigroup Medicaid |
$1,430.82
|
| Rate for Payer: Amerigroup Medicare |
$1,431.68
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,126.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,417.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,416.93
|
| Rate for Payer: Medical Associates Commercial |
$2,126.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,417.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,984.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,438.76
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,437.91
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,126.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,126.25
|
| Rate for Payer: United Healthcare Commercial |
$2,551.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,672.65
|
|
|
GLENOID W/KEEL SMALL
|
Facility
|
OP
|
$2,835.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,416.93 |
| Max. Negotiated Rate |
$2,551.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,551.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,551.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,615.95
|
| Rate for Payer: Amerigroup Medicaid |
$1,430.82
|
| Rate for Payer: Amerigroup Medicare |
$1,431.68
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,126.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,417.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,416.93
|
| Rate for Payer: Medical Associates Commercial |
$2,126.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,417.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,984.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,438.76
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,437.91
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,126.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,126.25
|
| Rate for Payer: United Healthcare Commercial |
$2,551.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,672.65
|
|
|
GLENOID W/KEEL SMALL
|
Facility
|
IP
|
$2,835.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,984.50 |
| Max. Negotiated Rate |
$2,551.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,551.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,551.50
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,126.25
|
| Rate for Payer: Medical Associates Commercial |
$2,126.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,984.50
|
| Rate for Payer: United Healthcare Commercial |
$2,551.50
|
|
|
glimepiride 2 mg Tab [VDMC]
|
Facility
|
IP
|
$1.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10391902
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Aetna of IA Commercial |
$1.01
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.01
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.84
|
| Rate for Payer: Medical Associates Commercial |
$0.84
|
| Rate for Payer: Midlands Choice Commercial |
$0.78
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
|
|
glimepiride 2 mg Tab [VDMC]
|
Facility
|
OP
|
$1.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10391902
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Aetna of IA Commercial |
$1.01
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.01
|
| Rate for Payer: Aetna of IA Medicare |
$0.64
|
| Rate for Payer: Amerigroup Medicaid |
$0.57
|
| Rate for Payer: Amerigroup Medicare |
$0.57
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.84
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.56
|
| Rate for Payer: Medical Associates Commercial |
$0.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.56
|
| Rate for Payer: Midlands Choice Commercial |
$0.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.57
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.66
|
|
|
glimepiride 4 mg Tab [VDMC]
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10391971
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna of IA Commercial |
$2.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.17
|
| Rate for Payer: Medical Associates Commercial |
$2.17
|
| Rate for Payer: Midlands Choice Commercial |
$2.02
|
| Rate for Payer: United Healthcare Commercial |
$2.60
|
|
|
glimepiride 4 mg Tab [VDMC]
|
Facility
|
OP
|
$2.89
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10391971
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna of IA Commercial |
$2.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.60
|
| Rate for Payer: Aetna of IA Medicare |
$1.65
|
| Rate for Payer: Amerigroup Medicaid |
$1.46
|
| Rate for Payer: Amerigroup Medicare |
$1.46
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.17
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.44
|
| Rate for Payer: Medical Associates Commercial |
$2.17
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.44
|
| Rate for Payer: Midlands Choice Commercial |
$2.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.47
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.47
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.17
|
| Rate for Payer: United Healthcare Commercial |
$2.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.71
|
|
|
glipiZIDE 2.5 mg ER Tab [VDMC]
|
Facility
|
IP
|
$1.49
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
22424481
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna of IA Commercial |
$1.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.34
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.12
|
| Rate for Payer: Medical Associates Commercial |
$1.12
|
| Rate for Payer: Midlands Choice Commercial |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.34
|
|
|
glipiZIDE 2.5 mg ER Tab [VDMC]
|
Facility
|
OP
|
$1.49
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
22424481
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna of IA Commercial |
$1.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.34
|
| Rate for Payer: Aetna of IA Medicare |
$0.85
|
| Rate for Payer: Amerigroup Medicaid |
$0.75
|
| Rate for Payer: Amerigroup Medicare |
$0.75
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.74
|
| Rate for Payer: Medical Associates Commercial |
$1.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.75
|
| Rate for Payer: Midlands Choice Commercial |
$1.04
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.76
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.76
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.12
|
| Rate for Payer: United Healthcare Commercial |
$1.34
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.88
|
|
|
glipiZIDE 5 mg ER Tab [VDMC]
|
Facility
|
OP
|
$1.43
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10392109
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna of IA Commercial |
$1.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.29
|
| Rate for Payer: Aetna of IA Medicare |
$0.82
|
| Rate for Payer: Amerigroup Medicaid |
$0.72
|
| Rate for Payer: Amerigroup Medicare |
$0.72
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.07
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.71
|
| Rate for Payer: Medical Associates Commercial |
$1.07
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.72
|
| Rate for Payer: Midlands Choice Commercial |
$1.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.73
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.73
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.07
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.84
|
|
|
glipiZIDE 5 mg ER Tab [VDMC]
|
Facility
|
IP
|
$1.43
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10392109
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna of IA Commercial |
$1.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.29
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.07
|
| Rate for Payer: Medical Associates Commercial |
$1.07
|
| Rate for Payer: Midlands Choice Commercial |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
|
|
glipiZIDE 5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.14
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10392180
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Aetna of IA Commercial |
$1.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.03
|
| Rate for Payer: Aetna of IA Medicare |
$0.65
|
| Rate for Payer: Amerigroup Medicaid |
$0.58
|
| Rate for Payer: Amerigroup Medicare |
$0.58
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.86
|
| 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 |
$0.57
|
| Rate for Payer: Medical Associates Commercial |
$0.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.57
|
| Rate for Payer: Midlands Choice Commercial |
$0.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.58
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.58
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.86
|
| Rate for Payer: United Healthcare Commercial |
$1.03
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.67
|
|
|
glipiZIDE 5 mg Tab [VDMC]
|
Facility
|
IP
|
$1.14
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10392180
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Aetna of IA Commercial |
$1.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.03
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.86
|
| Rate for Payer: Medical Associates Commercial |
$0.86
|
| Rate for Payer: Midlands Choice Commercial |
$0.80
|
| Rate for Payer: United Healthcare Commercial |
$1.03
|
|
|
GL LOCKING SCREW 3.0MMX20MM
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8757688
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.94 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna of IA Commercial |
$259.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$259.20
|
| Rate for Payer: Aetna of IA Medicare |
$164.16
|
| Rate for Payer: Amerigroup Medicaid |
$145.35
|
| Rate for Payer: Amerigroup Medicare |
$145.44
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$216.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$144.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$143.94
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$144.00
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$146.16
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$146.07
|
| Rate for Payer: Oscar Health of IA Commercial |
$216.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$216.00
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$169.92
|
|
|
GL LOCKING SCREW 3.0MMX20MM
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8757688
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna of IA Commercial |
$259.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$259.20
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$216.00
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
|
|
GL SCREW 3.0MMX20MM
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8757686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna of IA Commercial |
$129.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$129.60
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.00
|
| Rate for Payer: Medical Associates Commercial |
$108.00
|
| Rate for Payer: Midlands Choice Commercial |
$100.80
|
| Rate for Payer: United Healthcare Commercial |
$129.60
|
|
|
GL SCREW 3.0MMX20MM
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8757686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.97 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna of IA Commercial |
$129.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$129.60
|
| Rate for Payer: Aetna of IA Medicare |
$82.08
|
| Rate for Payer: Amerigroup Medicaid |
$72.68
|
| Rate for Payer: Amerigroup Medicare |
$72.72
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$72.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.97
|
| Rate for Payer: Medical Associates Commercial |
$108.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.00
|
| Rate for Payer: Midlands Choice Commercial |
$100.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$73.08
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$73.04
|
| Rate for Payer: Oscar Health of IA Commercial |
$108.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$108.00
|
| Rate for Payer: United Healthcare Commercial |
$129.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.96
|
|
|
glucagon recombinant 1 mg Syringe kit [VDMC]
|
Facility
|
IP
|
$803.12
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
10392249
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$562.18 |
| Max. Negotiated Rate |
$722.81 |
| Rate for Payer: Aetna of IA Commercial |
$722.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$722.81
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$602.34
|
| Rate for Payer: Medical Associates Commercial |
$602.34
|
| Rate for Payer: Midlands Choice Commercial |
$562.18
|
| Rate for Payer: United Healthcare Commercial |
$722.81
|
|
|
glucagon recombinant 1 mg Syringe kit [VDMC]
|
Facility
|
OP
|
$803.12
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
10392249
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$401.40 |
| Max. Negotiated Rate |
$722.81 |
| Rate for Payer: Aetna of IA Commercial |
$722.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$722.81
|
| Rate for Payer: Aetna of IA Medicare |
$457.78
|
| Rate for Payer: Amerigroup Medicaid |
$405.33
|
| Rate for Payer: Amerigroup Medicare |
$405.58
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$602.34
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$401.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$401.40
|
| Rate for Payer: Medical Associates Commercial |
$602.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$401.56
|
| Rate for Payer: Midlands Choice Commercial |
$562.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$407.58
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$407.34
|
| Rate for Payer: Oscar Health of IA Commercial |
$602.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$602.34
|
| Rate for Payer: United Healthcare Commercial |
$722.81
|
| Rate for Payer: United Healthcare Managed Medicare |
$473.84
|
|
|
glucagon recombinant 1 mg Vial[VDMC]
|
Facility
|
IP
|
$835.52
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
11406978
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$584.86 |
| Max. Negotiated Rate |
$751.97 |
| Rate for Payer: Aetna of IA Commercial |
$751.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$751.97
|
| Rate for Payer: Cash Price |
$668.42
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$626.64
|
| Rate for Payer: Medical Associates Commercial |
$626.64
|
| Rate for Payer: Midlands Choice Commercial |
$584.86
|
| Rate for Payer: United Healthcare Commercial |
$751.97
|
|
|
glucagon recombinant 1 mg Vial[VDMC]
|
Facility
|
OP
|
$835.52
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
11406978
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$417.59 |
| Max. Negotiated Rate |
$751.97 |
| Rate for Payer: Aetna of IA Commercial |
$751.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$751.97
|
| Rate for Payer: Aetna of IA Medicare |
$476.25
|
| Rate for Payer: Amerigroup Medicaid |
$421.69
|
| Rate for Payer: Amerigroup Medicare |
$421.94
|
| Rate for Payer: Cash Price |
$668.42
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$626.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$417.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$417.59
|
| Rate for Payer: Medical Associates Commercial |
$626.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$417.76
|
| Rate for Payer: Midlands Choice Commercial |
$584.86
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$424.03
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$423.78
|
| Rate for Payer: Oscar Health of IA Commercial |
$626.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$626.64
|
| Rate for Payer: United Healthcare Commercial |
$751.97
|
| Rate for Payer: United Healthcare Managed Medicare |
$492.96
|
|
|
glucosamine-chondroitin 500 mg-400 mg oral capsule [VDMC]
|
Facility
|
IP
|
$1.61
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10377778
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Aetna of IA Commercial |
$1.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.45
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.21
|
| Rate for Payer: Medical Associates Commercial |
$1.21
|
| Rate for Payer: Midlands Choice Commercial |
$1.13
|
| Rate for Payer: United Healthcare Commercial |
$1.45
|
|
|
glucosamine-chondroitin 500 mg-400 mg oral capsule [VDMC]
|
Facility
|
OP
|
$1.61
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10377778
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Aetna of IA Commercial |
$1.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.45
|
| Rate for Payer: Aetna of IA Medicare |
$0.92
|
| Rate for Payer: Amerigroup Medicaid |
$0.81
|
| Rate for Payer: Amerigroup Medicare |
$0.81
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.21
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.81
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.80
|
| Rate for Payer: Medical Associates Commercial |
$1.21
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.81
|
| Rate for Payer: Midlands Choice Commercial |
$1.13
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.82
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.21
|
| Rate for Payer: United Healthcare Commercial |
$1.45
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.95
|
|
|
GLUCOSE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
4016418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Aetna of IA Medicare |
$23.37
|
| Rate for Payer: Amerigroup Medicaid |
$20.69
|
| Rate for Payer: Amerigroup Medicare |
$20.70
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.49
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.50
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.81
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$20.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$30.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.75
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.19
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
