|
GROUP THERAPY PROCEDURES
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 97150 GP
|
| Hospital Charge Code |
5520783
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna of IA Commercial |
$66.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.60
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.50
|
| Rate for Payer: Medical Associates Commercial |
$55.50
|
| Rate for Payer: Midlands Choice Commercial |
$51.80
|
| Rate for Payer: United Healthcare Commercial |
$66.60
|
|
|
G TUBE INSERT/REPLACE,SCHEDULE
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
8012932
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$353.50 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Aetna of IA Commercial |
$454.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$454.50
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.75
|
| Rate for Payer: Medical Associates Commercial |
$378.75
|
| Rate for Payer: Midlands Choice Commercial |
$353.50
|
| Rate for Payer: United Healthcare Commercial |
$454.50
|
|
|
G TUBE INSERT/REPLACE,SCHEDULE
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
8012932
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.40 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Aetna of IA Commercial |
$454.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$454.50
|
| Rate for Payer: Aetna of IA Medicare |
$287.85
|
| Rate for Payer: Amerigroup Medicaid |
$254.87
|
| Rate for Payer: Amerigroup Medicare |
$255.02
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$252.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$252.40
|
| Rate for Payer: Medical Associates Commercial |
$378.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$252.50
|
| Rate for Payer: Midlands Choice Commercial |
$353.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$256.29
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$256.14
|
| Rate for Payer: Oscar Health of IA Commercial |
$378.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$378.75
|
| Rate for Payer: United Healthcare Commercial |
$454.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$297.95
|
|
|
guaiFENesin 200 mg/10 mL Liq 10ml UD [VDMC]
|
Facility
|
IP
|
$7.38
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11221333
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$6.64 |
| Rate for Payer: Aetna of IA Commercial |
$6.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.64
|
| Rate for Payer: Cash Price |
$5.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.54
|
| Rate for Payer: Medical Associates Commercial |
$5.54
|
| Rate for Payer: Midlands Choice Commercial |
$5.17
|
| Rate for Payer: United Healthcare Commercial |
$6.64
|
|
|
guaiFENesin 200 mg/10 mL Liq 10ml UD [VDMC]
|
Facility
|
OP
|
$7.38
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11221333
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$6.64 |
| Rate for Payer: Aetna of IA Commercial |
$6.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.64
|
| Rate for Payer: Aetna of IA Medicare |
$4.21
|
| Rate for Payer: Amerigroup Medicaid |
$3.72
|
| Rate for Payer: Amerigroup Medicare |
$3.73
|
| Rate for Payer: Cash Price |
$5.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.54
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.69
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.69
|
| Rate for Payer: Medical Associates Commercial |
$5.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.69
|
| Rate for Payer: Midlands Choice Commercial |
$5.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.75
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$3.74
|
| Rate for Payer: Oscar Health of IA Commercial |
$5.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$5.54
|
| Rate for Payer: United Healthcare Commercial |
$6.64
|
| Rate for Payer: United Healthcare Managed Medicare |
$4.35
|
|
|
guaiFENesin 600 mg ER Tab [VDMC]
|
Facility
|
OP
|
$2.37
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10392793
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.13 |
| Rate for Payer: Aetna of IA Commercial |
$2.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.13
|
| Rate for Payer: Aetna of IA Medicare |
$1.35
|
| Rate for Payer: Amerigroup Medicaid |
$1.20
|
| Rate for Payer: Amerigroup Medicare |
$1.20
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.18
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.18
|
| Rate for Payer: Medical Associates Commercial |
$1.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.18
|
| Rate for Payer: Midlands Choice Commercial |
$1.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.20
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.78
|
| Rate for Payer: United Healthcare Commercial |
$2.13
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.40
|
|
|
guaiFENesin 600 mg ER Tab [VDMC]
|
Facility
|
IP
|
$2.37
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10392793
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$2.13 |
| Rate for Payer: Aetna of IA Commercial |
$2.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.13
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.78
|
| Rate for Payer: Medical Associates Commercial |
$1.78
|
| Rate for Payer: Midlands Choice Commercial |
$1.66
|
| Rate for Payer: United Healthcare Commercial |
$2.13
|
|
|
guaiFENesin-codeine 100 mg-10mg/5 mL Oral Syrup 5 mL [VDMC]
|
Facility
|
OP
|
$4.10
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10379162
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna of IA Commercial |
$3.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.69
|
| Rate for Payer: Aetna of IA Medicare |
$2.34
|
| Rate for Payer: Amerigroup Medicaid |
$2.07
|
| Rate for Payer: Amerigroup Medicare |
$2.07
|
| Rate for Payer: Cash Price |
$3.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.08
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.05
|
| Rate for Payer: Medical Associates Commercial |
$3.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.05
|
| Rate for Payer: Midlands Choice Commercial |
$2.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.08
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$2.08
|
| Rate for Payer: Oscar Health of IA Commercial |
$3.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.08
|
| Rate for Payer: United Healthcare Commercial |
$3.69
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.42
|
|
|
guaiFENesin-codeine 100 mg-10mg/5 mL Oral Syrup 5 mL [VDMC]
|
Facility
|
IP
|
$4.10
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10379162
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna of IA Commercial |
$3.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.69
|
| Rate for Payer: Cash Price |
$3.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.08
|
| Rate for Payer: Medical Associates Commercial |
$3.08
|
| Rate for Payer: Midlands Choice Commercial |
$2.87
|
| Rate for Payer: United Healthcare Commercial |
$3.69
|
|
|
guaiFENesin-dextromethorphan100 mg-10 mg/5 mL Oral Liq 5 mL [VDMC]
|
Facility
|
IP
|
$3.56
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10382035
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
|
guaiFENesin-dextromethorphan100 mg-10 mg/5 mL Oral Liq 5 mL [VDMC]
|
Facility
|
OP
|
$3.56
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10382035
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$1.81
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.67
|
| 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
|
|
|
GUIDEWIRE .035 X 4
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
8046429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Aetna of IA Commercial |
$26.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$26.10
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.75
|
| Rate for Payer: Medical Associates Commercial |
$21.75
|
| Rate for Payer: Midlands Choice Commercial |
$20.30
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
|
|
GUIDEWIRE .035 X 4
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
8046429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.49 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Aetna of IA Commercial |
$26.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$26.10
|
| Rate for Payer: Aetna of IA Medicare |
$16.53
|
| Rate for Payer: Amerigroup Medicaid |
$14.64
|
| Rate for Payer: Amerigroup Medicare |
$14.64
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.49
|
| Rate for Payer: Medical Associates Commercial |
$21.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.50
|
| Rate for Payer: Midlands Choice Commercial |
$20.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$14.71
|
| Rate for Payer: Oscar Health of IA Commercial |
$21.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.75
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$17.11
|
|
|
GUIDEWIRE .045 X 6''
|
Facility
|
IP
|
$17.00
|
|
| Hospital Charge Code |
8046463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of IA Commercial |
$15.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$15.30
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.75
|
| Rate for Payer: Medical Associates Commercial |
$12.75
|
| Rate for Payer: Midlands Choice Commercial |
$11.90
|
| Rate for Payer: United Healthcare Commercial |
$15.30
|
|
|
GUIDEWIRE .045 X 6''
|
Facility
|
OP
|
$17.00
|
|
| Hospital Charge Code |
8046463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of IA Commercial |
$15.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$15.30
|
| Rate for Payer: Aetna of IA Medicare |
$9.69
|
| Rate for Payer: Amerigroup Medicaid |
$8.58
|
| Rate for Payer: Amerigroup Medicare |
$8.58
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.50
|
| Rate for Payer: Medical Associates Commercial |
$12.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.50
|
| Rate for Payer: Midlands Choice Commercial |
$11.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.63
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$8.62
|
| Rate for Payer: Oscar Health of IA Commercial |
$12.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.75
|
| Rate for Payer: United Healthcare Commercial |
$15.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$10.03
|
|
|
GUIDE WIRE,.062''
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
8047219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Aetna of IA Commercial |
$6.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.30
|
| Rate for Payer: Aetna of IA Medicare |
$3.99
|
| Rate for Payer: Amerigroup Medicaid |
$3.53
|
| Rate for Payer: Amerigroup Medicare |
$3.54
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.50
|
| Rate for Payer: Medical Associates Commercial |
$5.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.50
|
| Rate for Payer: Midlands Choice Commercial |
$4.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.55
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$3.55
|
| Rate for Payer: Oscar Health of IA Commercial |
$5.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$5.25
|
| Rate for Payer: United Healthcare Commercial |
$6.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$4.13
|
|
|
GUIDE WIRE,.062''
|
Facility
|
IP
|
$7.00
|
|
| Hospital Charge Code |
8047219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Aetna of IA Commercial |
$6.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.30
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.25
|
| Rate for Payer: Medical Associates Commercial |
$5.25
|
| Rate for Payer: Midlands Choice Commercial |
$4.90
|
| Rate for Payer: United Healthcare Commercial |
$6.30
|
|
|
GUIDE WIRE,.094'' 2.4MM X8''
|
Facility
|
OP
|
$18.00
|
|
| Hospital Charge Code |
8047264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of IA Commercial |
$16.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.20
|
| Rate for Payer: Aetna of IA Medicare |
$10.26
|
| Rate for Payer: Amerigroup Medicaid |
$9.08
|
| Rate for Payer: Amerigroup Medicare |
$9.09
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9.00
|
| Rate for Payer: Medical Associates Commercial |
$13.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.00
|
| Rate for Payer: Midlands Choice Commercial |
$12.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9.14
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$9.13
|
| Rate for Payer: Oscar Health of IA Commercial |
$13.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$13.50
|
| Rate for Payer: United Healthcare Commercial |
$16.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$10.62
|
|
|
GUIDE WIRE,.094'' 2.4MM X8''
|
Facility
|
IP
|
$18.00
|
|
| Hospital Charge Code |
8047264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of IA Commercial |
$16.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.20
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.50
|
| Rate for Payer: Medical Associates Commercial |
$13.50
|
| Rate for Payer: Midlands Choice Commercial |
$12.60
|
| Rate for Payer: United Healthcare Commercial |
$16.20
|
|
|
GUIDE WIRE ASNIS III 1.4X150MM
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT C1763
|
| Hospital Charge Code |
8046966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna of IA Commercial |
$37.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$37.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.50
|
| Rate for Payer: Medical Associates Commercial |
$31.50
|
| Rate for Payer: Midlands Choice Commercial |
$29.40
|
| Rate for Payer: United Healthcare Commercial |
$37.80
|
|
|
GUIDE WIRE ASNIS III 1.4X150MM
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT C1763
|
| Hospital Charge Code |
8046966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna of IA Commercial |
$37.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$37.80
|
| Rate for Payer: Aetna of IA Medicare |
$23.94
|
| Rate for Payer: Amerigroup Medicaid |
$21.20
|
| Rate for Payer: Amerigroup Medicare |
$21.21
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$21.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.99
|
| Rate for Payer: Medical Associates Commercial |
$31.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$21.00
|
| Rate for Payer: Midlands Choice Commercial |
$29.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21.32
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$21.30
|
| Rate for Payer: Oscar Health of IA Commercial |
$31.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.50
|
| Rate for Payer: United Healthcare Commercial |
$37.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.78
|
|
|
GUIDEWIRE BALLTIP 3.0X800MM
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8046329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna of IA Commercial |
$176.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$176.40
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.00
|
| Rate for Payer: Medical Associates Commercial |
$147.00
|
| Rate for Payer: Midlands Choice Commercial |
$137.20
|
| Rate for Payer: United Healthcare Commercial |
$176.40
|
|
|
GUIDEWIRE BALLTIP 3.0X800MM
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8046329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.96 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna of IA Commercial |
$176.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$176.40
|
| Rate for Payer: Aetna of IA Medicare |
$111.72
|
| Rate for Payer: Amerigroup Medicaid |
$98.92
|
| Rate for Payer: Amerigroup Medicare |
$98.98
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$98.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$97.96
|
| Rate for Payer: Medical Associates Commercial |
$147.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$98.00
|
| Rate for Payer: Midlands Choice Commercial |
$137.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$99.47
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$99.41
|
| Rate for Payer: Oscar Health of IA Commercial |
$147.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$147.00
|
| Rate for Payer: United Healthcare Commercial |
$176.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$115.64
|
|
|
GUIDEWIRE BENTSON .035X150
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8046312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.49 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of IA Commercial |
$29.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.70
|
| Rate for Payer: Aetna of IA Medicare |
$18.81
|
| Rate for Payer: Amerigroup Medicaid |
$16.66
|
| Rate for Payer: Amerigroup Medicare |
$16.66
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.49
|
| Rate for Payer: Medical Associates Commercial |
$24.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.50
|
| Rate for Payer: Midlands Choice Commercial |
$23.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.75
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$16.74
|
| Rate for Payer: Oscar Health of IA Commercial |
$24.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.75
|
| Rate for Payer: United Healthcare Commercial |
$29.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$19.47
|
|
|
GUIDEWIRE BENTSON .035X150
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8046312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of IA Commercial |
$29.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.70
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.75
|
| Rate for Payer: Medical Associates Commercial |
$24.75
|
| Rate for Payer: Midlands Choice Commercial |
$23.10
|
| Rate for Payer: United Healthcare Commercial |
$29.70
|
|
