|
Glutamic Acid Decarboxylase Ab DMCL
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
8694176
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.83 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$65.76
|
| Rate for Payer: Amerigroup Medicare |
$51.81
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.12
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.30
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$59.00
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
glyBURIDE 5 mg Tab [VDMC]
|
Facility
|
IP
|
$1.15
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10392383
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of IA Commercial |
$1.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.04
|
| Rate for Payer: Cash Price |
$0.92
|
| 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 |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
|
|
glyBURIDE 5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.15
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10392383
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of IA Commercial |
$1.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.04
|
| Rate for Payer: Aetna of IA Medicare |
$0.66
|
| Rate for Payer: Amerigroup Medicaid |
$0.66
|
| Rate for Payer: Amerigroup Medicare |
$0.52
|
| Rate for Payer: Cash Price |
$0.92
|
| 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 |
$0.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.66
|
| Rate for Payer: Medical Associates Commercial |
$0.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.52
|
| Rate for Payer: Midlands Choice Commercial |
$0.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.60
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.68
|
|
|
glyBURIDE micronized 3 mg Tab [VDMC]
|
Facility
|
OP
|
$1.85
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10392452
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Aetna of IA Commercial |
$1.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.66
|
| Rate for Payer: Aetna of IA Medicare |
$1.05
|
| Rate for Payer: Amerigroup Medicaid |
$1.07
|
| Rate for Payer: Amerigroup Medicare |
$0.84
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.39
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.83
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.06
|
| Rate for Payer: Medical Associates Commercial |
$1.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.83
|
| Rate for Payer: Midlands Choice Commercial |
$1.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.96
|
| Rate for Payer: United Healthcare Commercial |
$1.66
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.09
|
|
|
glyBURIDE micronized 3 mg Tab [VDMC]
|
Facility
|
IP
|
$1.85
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10392452
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Aetna of IA Commercial |
$1.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.66
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.39
|
| Rate for Payer: Medical Associates Commercial |
$1.39
|
| Rate for Payer: Midlands Choice Commercial |
$1.29
|
| Rate for Payer: United Healthcare Commercial |
$1.66
|
|
|
glycerin pediatric Supp Jar [VDMC]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
16842475
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Aetna of IA Commercial |
$7.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7.20
|
| Rate for Payer: Aetna of IA Medicare |
$4.56
|
| Rate for Payer: Amerigroup Medicaid |
$4.61
|
| Rate for Payer: Amerigroup Medicare |
$3.64
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4.57
|
| Rate for Payer: Medical Associates Commercial |
$6.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.60
|
| Rate for Payer: Midlands Choice Commercial |
$5.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$4.14
|
| Rate for Payer: United Healthcare Commercial |
$7.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$4.72
|
|
|
glycerin pediatric Supp Jar [VDMC]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
16842475
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Aetna of IA Commercial |
$7.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7.20
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6.00
|
| Rate for Payer: Medical Associates Commercial |
$6.00
|
| Rate for Payer: Midlands Choice Commercial |
$5.60
|
| Rate for Payer: United Healthcare Commercial |
$7.20
|
|
|
glycerin pediatric Supp [VDMC]
|
Facility
|
IP
|
$5.66
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10392521
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Aetna of IA Commercial |
$5.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.09
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.24
|
| Rate for Payer: Medical Associates Commercial |
$4.24
|
| Rate for Payer: Midlands Choice Commercial |
$3.96
|
| Rate for Payer: United Healthcare Commercial |
$5.09
|
|
|
glycerin pediatric Supp [VDMC]
|
Facility
|
OP
|
$5.66
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10392521
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Aetna of IA Commercial |
$5.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.09
|
| Rate for Payer: Aetna of IA Medicare |
$3.23
|
| Rate for Payer: Amerigroup Medicaid |
$3.26
|
| Rate for Payer: Amerigroup Medicare |
$2.57
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.23
|
| Rate for Payer: Medical Associates Commercial |
$4.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.55
|
| Rate for Payer: Midlands Choice Commercial |
$3.96
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.93
|
| Rate for Payer: United Healthcare Commercial |
$5.09
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.34
|
|
|
glycopyrrolate 0.2 mg/mL 2ml SDV Sol [VDMC]
|
Facility
|
IP
|
$24.20
|
|
|
Service Code
|
HCPCS J1596
|
| Hospital Charge Code |
11220054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$21.78 |
| Rate for Payer: Aetna of IA Commercial |
$21.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.78
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.15
|
| Rate for Payer: Medical Associates Commercial |
$18.15
|
| Rate for Payer: Midlands Choice Commercial |
$16.94
|
| Rate for Payer: United Healthcare Commercial |
$21.78
|
|
|
glycopyrrolate 0.2 mg/mL 2ml SDV Sol [VDMC]
|
Facility
|
OP
|
$24.20
|
|
|
Service Code
|
HCPCS J1596
|
| Hospital Charge Code |
11220054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.89 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$21.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.78
|
| Rate for Payer: Aetna of IA Medicare |
$13.79
|
| Rate for Payer: Amerigroup Medicaid |
$13.96
|
| Rate for Payer: Amerigroup Medicare |
$11.00
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.15
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.89
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.82
|
| Rate for Payer: Medical Associates Commercial |
$18.15
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.89
|
| Rate for Payer: Midlands Choice Commercial |
$16.94
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.52
|
| Rate for Payer: United Healthcare Commercial |
$21.78
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.28
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
glycopyrrolate 1 mg Tab [VDMC]
|
Facility
|
OP
|
$4.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10392657
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna of IA Commercial |
$3.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.75
|
| Rate for Payer: Aetna of IA Medicare |
$2.38
|
| Rate for Payer: Amerigroup Medicaid |
$2.40
|
| Rate for Payer: Amerigroup Medicare |
$1.89
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.13
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.38
|
| Rate for Payer: Medical Associates Commercial |
$3.13
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.88
|
| Rate for Payer: Midlands Choice Commercial |
$2.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.16
|
| Rate for Payer: United Healthcare Commercial |
$3.75
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.46
|
|
|
glycopyrrolate 1 mg Tab [VDMC]
|
Facility
|
IP
|
$4.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10392657
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna of IA Commercial |
$3.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.75
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.13
|
| Rate for Payer: Medical Associates Commercial |
$3.13
|
| Rate for Payer: Midlands Choice Commercial |
$2.92
|
| Rate for Payer: United Healthcare Commercial |
$3.75
|
|
|
GRAFT CHIPS STERLING CANCELLOUS 1-4MM 15
|
Facility
|
OP
|
$405.00
|
|
| Hospital Charge Code |
8026570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Aetna of IA Medicare |
$230.85
|
| Rate for Payer: Amerigroup Medicaid |
$233.60
|
| Rate for Payer: Amerigroup Medicare |
$184.07
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$182.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$231.34
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$182.25
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$234.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$209.59
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
|
GRAFT CHIPS STERLING CANCELLOUS 1-4MM 15
|
Facility
|
IP
|
$405.00
|
|
| Hospital Charge Code |
8026570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
|
|
GRAFT CHIPS STERLING CANCELLOUS 1-4MM 30
|
Facility
|
OP
|
$630.00
|
|
| Hospital Charge Code |
8026571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna of IA Commercial |
$567.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$567.00
|
| Rate for Payer: Aetna of IA Medicare |
$359.10
|
| Rate for Payer: Amerigroup Medicaid |
$363.38
|
| Rate for Payer: Amerigroup Medicare |
$286.34
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$472.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$283.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$359.86
|
| Rate for Payer: Medical Associates Commercial |
$472.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$283.50
|
| Rate for Payer: Midlands Choice Commercial |
$441.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$365.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$326.02
|
| Rate for Payer: United Healthcare Commercial |
$567.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$371.70
|
|
|
GRAFT CHIPS STERLING CANCELLOUS 1-4MM 30
|
Facility
|
IP
|
$630.00
|
|
| Hospital Charge Code |
8026571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna of IA Commercial |
$567.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$567.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$472.50
|
| Rate for Payer: Medical Associates Commercial |
$472.50
|
| Rate for Payer: Midlands Choice Commercial |
$441.00
|
| Rate for Payer: United Healthcare Commercial |
$567.00
|
|
|
GRAFT PASTE BIOSET ALLOGRAFT 10CC SYRNGE
|
Facility
|
OP
|
$2,070.00
|
|
| Hospital Charge Code |
8025836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.50 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,863.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,863.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,179.90
|
| Rate for Payer: Amerigroup Medicaid |
$1,193.98
|
| Rate for Payer: Amerigroup Medicare |
$940.82
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,552.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$931.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,182.38
|
| Rate for Payer: Medical Associates Commercial |
$1,552.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$931.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,449.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,199.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,071.22
|
| Rate for Payer: United Healthcare Commercial |
$1,863.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,221.30
|
|
|
GRAFT PASTE BIOSET ALLOGRAFT 10CC SYRNGE
|
Facility
|
IP
|
$2,070.00
|
|
| Hospital Charge Code |
8025836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.00 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,863.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,863.00
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,552.50
|
| Rate for Payer: Medical Associates Commercial |
$1,552.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,449.00
|
| Rate for Payer: United Healthcare Commercial |
$1,863.00
|
|
|
GRAFT PASTE BIOSET ALLOGRAFT 5CC SYRINGE
|
Facility
|
OP
|
$1,341.00
|
|
| Hospital Charge Code |
8046247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$603.45 |
| Max. Negotiated Rate |
$1,206.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,206.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,206.90
|
| Rate for Payer: Aetna of IA Medicare |
$764.37
|
| Rate for Payer: Amerigroup Medicaid |
$773.49
|
| Rate for Payer: Amerigroup Medicare |
$609.48
|
| Rate for Payer: Cash Price |
$1,072.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,005.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$603.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$765.98
|
| Rate for Payer: Medical Associates Commercial |
$1,005.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$603.45
|
| Rate for Payer: Midlands Choice Commercial |
$938.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$777.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$693.97
|
| Rate for Payer: United Healthcare Commercial |
$1,206.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$791.19
|
|
|
GRAFT PASTE BIOSET ALLOGRAFT 5CC SYRINGE
|
Facility
|
IP
|
$1,341.00
|
|
| Hospital Charge Code |
8046247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.70 |
| Max. Negotiated Rate |
$1,206.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,206.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,206.90
|
| Rate for Payer: Cash Price |
$1,072.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,005.75
|
| Rate for Payer: Medical Associates Commercial |
$1,005.75
|
| Rate for Payer: Midlands Choice Commercial |
$938.70
|
| Rate for Payer: United Healthcare Commercial |
$1,206.90
|
|
|
GRAFT SKIN DERMACARRIERS
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
8046248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of IA Commercial |
$34.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.20
|
| Rate for Payer: Aetna of IA Medicare |
$21.66
|
| Rate for Payer: Amerigroup Medicaid |
$21.92
|
| Rate for Payer: Amerigroup Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.71
|
| Rate for Payer: Medical Associates Commercial |
$28.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.10
|
| Rate for Payer: Midlands Choice Commercial |
$26.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.66
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$22.42
|
|
|
GRAFT SKIN DERMACARRIERS
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
8046248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of IA Commercial |
$34.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.20
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.50
|
| Rate for Payer: Medical Associates Commercial |
$28.50
|
| Rate for Payer: Midlands Choice Commercial |
$26.60
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
|
|
GRAFT SKIN DERMACARRIERS II 1.5:1 STERIL
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
8046244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of IA Commercial |
$34.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.20
|
| Rate for Payer: Aetna of IA Medicare |
$21.66
|
| Rate for Payer: Amerigroup Medicaid |
$21.92
|
| Rate for Payer: Amerigroup Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.71
|
| Rate for Payer: Medical Associates Commercial |
$28.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.10
|
| Rate for Payer: Midlands Choice Commercial |
$26.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.66
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$22.42
|
|
|
GRAFT SKIN DERMACARRIERS II 1.5:1 STERIL
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
8046244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of IA Commercial |
$34.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.20
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.50
|
| Rate for Payer: Medical Associates Commercial |
$28.50
|
| Rate for Payer: Midlands Choice Commercial |
$26.60
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
|
