|
K-WIRE 9X.045 TROCAR POINTS
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
K-WIRE 9X.054 TROCAR POINTS
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
K-WIRE 9X.054 TROCAR POINTS
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
K-WIRE 9X.062 TROCAR POINTS
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
K-WIRE 9X.062 TROCAR POINTS
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
K-WIRE GAMMA 3.2X450
|
Facility
OP
|
$138.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of IA Commercial |
$124.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$124.20
|
| Rate for Payer: Aetna of IA Medicare |
$78.66
|
| Rate for Payer: Amerigroup Medicaid |
$69.65
|
| Rate for Payer: Amerigroup Medicare |
$69.69
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$68.97
|
| Rate for Payer: Medical Associates Commercial |
$103.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.00
|
| Rate for Payer: Midlands Choice Commercial |
$96.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$103.50
|
| Rate for Payer: United Healthcare Commercial |
$124.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$81.42
|
|
|
K-WIRE GAMMA 3.2X450
|
Facility
IP
|
$138.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of IA Commercial |
$124.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$124.20
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.50
|
| Rate for Payer: Medical Associates Commercial |
$103.50
|
| Rate for Payer: Midlands Choice Commercial |
$96.60
|
| Rate for Payer: United Healthcare Commercial |
$124.20
|
|
|
K-WIRE STANDARD 0.035
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna of IA Commercial |
$22.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.50
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.75
|
| Rate for Payer: Medical Associates Commercial |
$18.75
|
| Rate for Payer: Midlands Choice Commercial |
$17.50
|
| Rate for Payer: United Healthcare Commercial |
$22.50
|
|
|
K-WIRE STANDARD 0.035
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna of IA Commercial |
$22.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.50
|
| Rate for Payer: Aetna of IA Medicare |
$14.25
|
| Rate for Payer: Amerigroup Medicaid |
$12.62
|
| Rate for Payer: Amerigroup Medicare |
$12.62
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.50
|
| Rate for Payer: Medical Associates Commercial |
$18.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.50
|
| Rate for Payer: Midlands Choice Commercial |
$17.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.75
|
| Rate for Payer: United Healthcare Commercial |
$22.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.75
|
|
|
K-WIRE W/17MM STOP
|
Facility
IP
|
$40.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
|
|
K-WIRE W/17MM STOP
|
Facility
OP
|
$40.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Aetna of IA Medicare |
$22.80
|
| Rate for Payer: Amerigroup Medicaid |
$20.19
|
| Rate for Payer: Amerigroup Medicare |
$20.20
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.99
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.60
|
|
|
K-WIRE W/LENGTH MARKINGS .045IN (1.143MM
|
Facility
IP
|
$40.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
|
|
K-WIRE W/LENGTH MARKINGS .045IN (1.143MM
|
Facility
OP
|
$40.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Aetna of IA Medicare |
$22.80
|
| Rate for Payer: Amerigroup Medicaid |
$20.19
|
| Rate for Payer: Amerigroup Medicare |
$20.20
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.99
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.60
|
|
|
L15 FRAME PLATE
|
Facility
OP
|
$2,006.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8955187
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,002.60 |
| Max. Negotiated Rate |
$1,805.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,805.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,805.40
|
| Rate for Payer: Aetna of IA Medicare |
$1,143.42
|
| Rate for Payer: Amerigroup Medicaid |
$1,012.43
|
| Rate for Payer: Amerigroup Medicare |
$1,013.03
|
| Rate for Payer: Cash Price |
$1,604.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,504.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,003.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,002.60
|
| Rate for Payer: Medical Associates Commercial |
$1,504.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,003.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,404.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,018.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,504.50
|
| Rate for Payer: United Healthcare Commercial |
$1,805.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,183.54
|
|
|
L15 FRAME PLATE
|
Facility
IP
|
$2,006.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8955187
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,404.20 |
| Max. Negotiated Rate |
$1,805.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,805.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,805.40
|
| Rate for Payer: Cash Price |
$1,604.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,504.50
|
| Rate for Payer: Medical Associates Commercial |
$1,504.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,404.20
|
| Rate for Payer: United Healthcare Commercial |
$1,805.40
|
|
|
labetalol 100 mg Tab
|
Facility
OP
|
$1.80
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701762
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna of IA Commercial |
$1.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.62
|
| Rate for Payer: Aetna of IA Medicare |
$1.03
|
| Rate for Payer: Amerigroup Medicaid |
$0.91
|
| Rate for Payer: Amerigroup Medicare |
$0.91
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.35
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.90
|
| Rate for Payer: Medical Associates Commercial |
$1.35
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.90
|
| Rate for Payer: Midlands Choice Commercial |
$1.26
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.35
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.06
|
|
|
labetalol 100 mg Tab
|
Facility
IP
|
$1.80
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701762
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna of IA Commercial |
$1.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.62
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.35
|
| Rate for Payer: Medical Associates Commercial |
$1.35
|
| Rate for Payer: Midlands Choice Commercial |
$1.26
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
labetalol 5 mg/mL 20 ml IV MDV
|
Facility
OP
|
$27.64
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43701766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna of IA Commercial |
$24.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.88
|
| Rate for Payer: Aetna of IA Medicare |
$15.75
|
| Rate for Payer: Amerigroup Medicaid |
$13.95
|
| Rate for Payer: Amerigroup Medicare |
$13.96
|
| Rate for Payer: Cash Price |
$22.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.81
|
| Rate for Payer: Medical Associates Commercial |
$20.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.82
|
| Rate for Payer: Midlands Choice Commercial |
$19.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.73
|
| Rate for Payer: United Healthcare Commercial |
$24.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.31
|
|
|
labetalol 5 mg/mL 20 ml IV MDV
|
Facility
IP
|
$27.64
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43701766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna of IA Commercial |
$24.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.88
|
| Rate for Payer: Cash Price |
$22.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.73
|
| Rate for Payer: Medical Associates Commercial |
$20.73
|
| Rate for Payer: Midlands Choice Commercial |
$19.35
|
| Rate for Payer: United Healthcare Commercial |
$24.88
|
|
|
labetalol 5 mg/mL 4ml syringe
|
Facility
IP
|
$43.41
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43700327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.39 |
| Max. Negotiated Rate |
$39.07 |
| Rate for Payer: Aetna of IA Commercial |
$39.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.07
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.56
|
| Rate for Payer: Medical Associates Commercial |
$32.56
|
| Rate for Payer: Midlands Choice Commercial |
$30.39
|
| Rate for Payer: United Healthcare Commercial |
$39.07
|
|
|
labetalol 5 mg/mL 4ml syringe
|
Facility
OP
|
$43.41
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43700327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$39.07 |
| Rate for Payer: Aetna of IA Commercial |
$39.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.07
|
| Rate for Payer: Aetna of IA Medicare |
$24.74
|
| Rate for Payer: Amerigroup Medicaid |
$21.91
|
| Rate for Payer: Amerigroup Medicare |
$21.92
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.56
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$21.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.70
|
| Rate for Payer: Medical Associates Commercial |
$32.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$21.70
|
| Rate for Payer: Midlands Choice Commercial |
$30.39
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$32.56
|
| Rate for Payer: United Healthcare Commercial |
$39.07
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.61
|
|
|
LABOR DIRECT ADMIT
|
Facility
IP
|
$460.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
7984750
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$322.00 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna of IA Commercial |
$414.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$414.00
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$345.00
|
| Rate for Payer: Medical Associates Commercial |
$345.00
|
| Rate for Payer: Midlands Choice Commercial |
$322.00
|
| Rate for Payer: United Healthcare Commercial |
$414.00
|
|
|
LABOR DIRECT ADMIT
|
Facility
OP
|
$460.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
7984750
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$229.91 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna of IA Commercial |
$414.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$414.00
|
| Rate for Payer: Aetna of IA Medicare |
$262.20
|
| Rate for Payer: Amerigroup Medicaid |
$232.16
|
| Rate for Payer: Amerigroup Medicare |
$232.30
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$345.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$230.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$229.91
|
| Rate for Payer: Medical Associates Commercial |
$345.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$230.00
|
| Rate for Payer: Midlands Choice Commercial |
$322.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$233.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$345.00
|
| Rate for Payer: United Healthcare Commercial |
$414.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$271.40
|
|
|
LABOR PER HOUR
|
Facility
OP
|
$62.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
7984749
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$30.99 |
| Max. Negotiated Rate |
$2,238.32 |
| Rate for Payer: Aetna of IA Commercial |
$55.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$55.80
|
| Rate for Payer: Aetna of IA Medicare |
$35.34
|
| Rate for Payer: Amerigroup Medicaid |
$31.29
|
| Rate for Payer: Amerigroup Medicare |
$31.31
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.99
|
| Rate for Payer: Medical Associates Commercial |
$46.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.00
|
| Rate for Payer: Midlands Choice Commercial |
$43.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$31.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$46.50
|
| Rate for Payer: United Healthcare Commercial |
$55.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$36.58
|
| Rate for Payer: Wellmark IA HMO |
$2,034.84
|
| Rate for Payer: Wellmark IA PPO |
$2,238.32
|
|
|
LABOR PER HOUR
|
Facility
IP
|
$62.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
7984749
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna of IA Commercial |
$55.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$55.80
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.50
|
| Rate for Payer: Medical Associates Commercial |
$46.50
|
| Rate for Payer: Midlands Choice Commercial |
$43.40
|
| Rate for Payer: United Healthcare Commercial |
$55.80
|
|
