|
GLENOID W/KEEL MEDIUM
|
Facility
|
OP
|
$2,835.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.75 |
| 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 |
$1,635.23
|
| Rate for Payer: Amerigroup Medicare |
$1,288.51
|
| 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 |
$1,275.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,619.35
|
| Rate for Payer: Medical Associates Commercial |
$2,126.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,275.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,984.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,643.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,467.11
|
| Rate for Payer: United Healthcare Commercial |
$2,551.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,672.65
|
|
|
GLENOID W/KEEL MEDIUM
|
Facility
|
IP
|
$2,835.00
|
|
|
Service Code
|
HCPCS 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 SMALL
|
Facility
|
IP
|
$2,835.00
|
|
|
Service Code
|
HCPCS 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
|
|
|
GLENOID W/KEEL SMALL
|
Facility
|
OP
|
$2,835.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.75 |
| 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 |
$1,635.23
|
| Rate for Payer: Amerigroup Medicare |
$1,288.51
|
| 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 |
$1,275.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,619.35
|
| Rate for Payer: Medical Associates Commercial |
$2,126.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,275.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,984.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,643.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,467.11
|
| Rate for Payer: United Healthcare Commercial |
$2,551.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,672.65
|
|
|
glimepiride 2 mg Tab [VDMC]
|
Facility
|
IP
|
$2.10
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10391902
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Aetna of IA Commercial |
$1.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.89
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.58
|
| Rate for Payer: Medical Associates Commercial |
$1.58
|
| Rate for Payer: Midlands Choice Commercial |
$1.47
|
| Rate for Payer: United Healthcare Commercial |
$1.89
|
|
|
glimepiride 2 mg Tab [VDMC]
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10391902
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Aetna of IA Commercial |
$1.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.89
|
| Rate for Payer: Aetna of IA Medicare |
$1.20
|
| Rate for Payer: Amerigroup Medicaid |
$1.21
|
| Rate for Payer: Amerigroup Medicare |
$0.95
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.58
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.20
|
| Rate for Payer: Medical Associates Commercial |
$1.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.95
|
| Rate for Payer: Midlands Choice Commercial |
$1.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.09
|
| Rate for Payer: United Healthcare Commercial |
$1.89
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.24
|
|
|
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 |
$1.30 |
| 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 |
$1.67
|
| Rate for Payer: Amerigroup Medicare |
$1.31
|
| 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 |
$1.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.65
|
| Rate for Payer: Medical Associates Commercial |
$2.17
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.30
|
| Rate for Payer: Midlands Choice Commercial |
$2.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.50
|
| 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
|
$4.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
22424481
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Aetna of IA Commercial |
$3.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.85
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.21
|
| Rate for Payer: Medical Associates Commercial |
$3.21
|
| Rate for Payer: Midlands Choice Commercial |
$3.00
|
| Rate for Payer: United Healthcare Commercial |
$3.85
|
|
|
glipiZIDE 2.5 mg ER Tab [VDMC]
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
22424481
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Aetna of IA Commercial |
$3.85
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.85
|
| Rate for Payer: Aetna of IA Medicare |
$2.44
|
| Rate for Payer: Amerigroup Medicaid |
$2.47
|
| Rate for Payer: Amerigroup Medicare |
$1.95
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.21
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.93
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.44
|
| Rate for Payer: Medical Associates Commercial |
$3.21
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.93
|
| Rate for Payer: Midlands Choice Commercial |
$3.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.21
|
| Rate for Payer: United Healthcare Commercial |
$3.85
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.53
|
|
|
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 |
$0.64 |
| 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 |
$0.83
|
| Rate for Payer: Amerigroup Medicare |
$0.65
|
| 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 |
$0.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.82
|
| Rate for Payer: Medical Associates Commercial |
$1.07
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.64
|
| Rate for Payer: Midlands Choice Commercial |
$1.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.74
|
| 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 |
$0.51 |
| 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 |
$0.66
|
| Rate for Payer: Amerigroup Medicare |
$0.52
|
| 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 |
$0.51
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.65
|
| Rate for Payer: Medical Associates Commercial |
$0.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.51
|
| Rate for Payer: Midlands Choice Commercial |
$0.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.59
|
| 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
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 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 LOCKING SCREW 3.0MMX20MM
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8757688
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| 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: Aetna of IA Medicare |
$164.16
|
| Rate for Payer: Amerigroup Medicaid |
$166.12
|
| Rate for Payer: Amerigroup Medicare |
$130.90
|
| 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 |
$129.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$164.51
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$129.60
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$166.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$149.04
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$169.92
|
|
|
GL SCREW 3.0MMX20MM
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8757686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.80 |
| 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: Aetna of IA Medicare |
$82.08
|
| Rate for Payer: Amerigroup Medicaid |
$83.06
|
| Rate for Payer: Amerigroup Medicare |
$65.45
|
| 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 |
$64.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$82.25
|
| Rate for Payer: Medical Associates Commercial |
$108.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.80
|
| Rate for Payer: Midlands Choice Commercial |
$100.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$83.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.52
|
| Rate for Payer: United Healthcare Commercial |
$129.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.96
|
|
|
GL SCREW 3.0MMX20MM
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS 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
|
|
|
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 |
$361.40 |
| 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 |
$463.24
|
| Rate for Payer: Amerigroup Medicare |
$365.02
|
| 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 |
$361.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$458.74
|
| Rate for Payer: Medical Associates Commercial |
$602.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$361.40
|
| Rate for Payer: Midlands Choice Commercial |
$562.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$465.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$415.61
|
| Rate for Payer: United Healthcare Commercial |
$722.81
|
| Rate for Payer: United Healthcare Managed Medicare |
$473.84
|
|
|
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 Vial[VDMC]
|
Facility
|
OP
|
$949.68
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
11406978
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$427.36 |
| Max. Negotiated Rate |
$854.71 |
| Rate for Payer: Aetna of IA Commercial |
$854.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$854.71
|
| Rate for Payer: Aetna of IA Medicare |
$541.32
|
| Rate for Payer: Amerigroup Medicaid |
$547.78
|
| Rate for Payer: Amerigroup Medicare |
$431.63
|
| Rate for Payer: Cash Price |
$759.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$712.26
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$427.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$542.46
|
| Rate for Payer: Medical Associates Commercial |
$712.26
|
| Rate for Payer: Medical Associates Managed Medicare |
$427.36
|
| Rate for Payer: Midlands Choice Commercial |
$664.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$550.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$491.46
|
| Rate for Payer: United Healthcare Commercial |
$854.71
|
| Rate for Payer: United Healthcare Managed Medicare |
$560.31
|
|
|
glucagon recombinant 1 mg Vial[VDMC]
|
Facility
|
IP
|
$949.68
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
11406978
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$664.78 |
| Max. Negotiated Rate |
$854.71 |
| Rate for Payer: Aetna of IA Commercial |
$854.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$854.71
|
| Rate for Payer: Cash Price |
$759.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$712.26
|
| Rate for Payer: Medical Associates Commercial |
$712.26
|
| Rate for Payer: Midlands Choice Commercial |
$664.78
|
| Rate for Payer: United Healthcare Commercial |
$854.71
|
|
|
glucosamine-chondroitin 500 mg-400 mg oral capsule [VDMC]
|
Facility
|
OP
|
$1.46
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10377778
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Aetna of IA Commercial |
$1.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.31
|
| Rate for Payer: Aetna of IA Medicare |
$0.83
|
| Rate for Payer: Amerigroup Medicaid |
$0.84
|
| Rate for Payer: Amerigroup Medicare |
$0.66
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.09
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.83
|
| Rate for Payer: Medical Associates Commercial |
$1.09
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.66
|
| Rate for Payer: Midlands Choice Commercial |
$1.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.75
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.86
|
|
|
glucosamine-chondroitin 500 mg-400 mg oral capsule [VDMC]
|
Facility
|
IP
|
$1.46
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10377778
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Aetna of IA Commercial |
$1.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.31
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.09
|
| Rate for Payer: Medical Associates Commercial |
$1.09
|
| Rate for Payer: Midlands Choice Commercial |
$1.02
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
|
|
GLUCOSE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
4016418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.45 |
| 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 |
$23.65
|
| Rate for Payer: Amerigroup Medicare |
$18.63
|
| 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 |
$18.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.42
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.45
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.22
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.19
|
|
