|
ketorolac 10 mg Tab [VDMC]
|
Facility
|
OP
|
$3.96
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10398333
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna of IA Commercial |
$3.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.56
|
| Rate for Payer: Aetna of IA Medicare |
$2.26
|
| Rate for Payer: Amerigroup Medicaid |
$2.28
|
| Rate for Payer: Amerigroup Medicare |
$1.80
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.97
|
| 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 |
$2.26
|
| Rate for Payer: Medical Associates Commercial |
$2.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.78
|
| Rate for Payer: Midlands Choice Commercial |
$2.77
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.05
|
| Rate for Payer: United Healthcare Commercial |
$3.56
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.34
|
|
|
ketorolac 10 mg Tab [VDMC]
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10398333
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna of IA Commercial |
$3.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.56
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.97
|
| Rate for Payer: Medical Associates Commercial |
$2.97
|
| Rate for Payer: Midlands Choice Commercial |
$2.77
|
| Rate for Payer: United Healthcare Commercial |
$3.56
|
|
|
ketorolac 15 mg/mL 1ml Inj SDV [VDMC]
|
Facility
|
OP
|
$22.28
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
10398402
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna of IA Commercial |
$20.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.05
|
| Rate for Payer: Aetna of IA Medicare |
$12.70
|
| Rate for Payer: Amerigroup Medicaid |
$12.85
|
| Rate for Payer: Amerigroup Medicare |
$10.13
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.71
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.03
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.73
|
| Rate for Payer: Medical Associates Commercial |
$16.71
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.03
|
| Rate for Payer: Midlands Choice Commercial |
$15.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.53
|
| Rate for Payer: United Healthcare Commercial |
$20.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.15
|
|
|
ketorolac 15 mg/mL 1ml Inj SDV [VDMC]
|
Facility
|
IP
|
$22.28
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
10398402
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna of IA Commercial |
$20.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.05
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.71
|
| Rate for Payer: Medical Associates Commercial |
$16.71
|
| Rate for Payer: Midlands Choice Commercial |
$15.60
|
| Rate for Payer: United Healthcare Commercial |
$20.05
|
|
|
ketorolac 30 mg/mL Inj 1ml SDV [VDMC]
|
Facility
|
IP
|
$26.44
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
10398471
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.51 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Aetna of IA Commercial |
$23.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.80
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.83
|
| Rate for Payer: Medical Associates Commercial |
$19.83
|
| Rate for Payer: Midlands Choice Commercial |
$18.51
|
| Rate for Payer: United Healthcare Commercial |
$23.80
|
|
|
ketorolac 30 mg/mL Inj 1ml SDV [VDMC]
|
Facility
|
OP
|
$26.44
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
10398471
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Aetna of IA Commercial |
$23.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.80
|
| Rate for Payer: Aetna of IA Medicare |
$15.07
|
| Rate for Payer: Amerigroup Medicaid |
$15.25
|
| Rate for Payer: Amerigroup Medicare |
$12.02
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.83
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.10
|
| Rate for Payer: Medical Associates Commercial |
$19.83
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.90
|
| Rate for Payer: Midlands Choice Commercial |
$18.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$13.68
|
| Rate for Payer: United Healthcare Commercial |
$23.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.60
|
|
|
ketorolac 60 mg/mL 2 ml SDV inj [VDMC]
|
Facility
|
IP
|
$23.23
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
10398540
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$20.90 |
| Rate for Payer: Aetna of IA Commercial |
$20.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.90
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.42
|
| Rate for Payer: Medical Associates Commercial |
$17.42
|
| Rate for Payer: Midlands Choice Commercial |
$16.26
|
| Rate for Payer: United Healthcare Commercial |
$20.90
|
|
|
ketorolac 60 mg/mL 2 ml SDV inj [VDMC]
|
Facility
|
OP
|
$23.23
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
10398540
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$20.90 |
| Rate for Payer: Aetna of IA Commercial |
$20.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.90
|
| Rate for Payer: Aetna of IA Medicare |
$13.24
|
| Rate for Payer: Amerigroup Medicaid |
$13.40
|
| Rate for Payer: Amerigroup Medicare |
$10.56
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.27
|
| Rate for Payer: Medical Associates Commercial |
$17.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.45
|
| Rate for Payer: Midlands Choice Commercial |
$16.26
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.02
|
| Rate for Payer: United Healthcare Commercial |
$20.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.70
|
|
|
ketotifen 0.025% 5 ml Ophth Sol [VDMC]
|
Facility
|
OP
|
$41.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10435314
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.67 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna of IA Commercial |
$37.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$37.33
|
| Rate for Payer: Aetna of IA Medicare |
$23.64
|
| Rate for Payer: Amerigroup Medicaid |
$23.93
|
| Rate for Payer: Amerigroup Medicare |
$18.85
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.11
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.67
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.69
|
| Rate for Payer: Medical Associates Commercial |
$31.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.67
|
| Rate for Payer: Midlands Choice Commercial |
$29.04
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.47
|
| Rate for Payer: United Healthcare Commercial |
$37.33
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.47
|
|
|
ketotifen 0.025% 5 ml Ophth Sol [VDMC]
|
Facility
|
IP
|
$41.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10435314
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.04 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna of IA Commercial |
$37.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$37.33
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.11
|
| Rate for Payer: Medical Associates Commercial |
$31.11
|
| Rate for Payer: Midlands Choice Commercial |
$29.04
|
| Rate for Payer: United Healthcare Commercial |
$37.33
|
|
|
KIT FOR 3.5MM PUSHLOCK WITH SPEAR AND DRILL
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna of IA Commercial |
$486.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$486.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$405.00
|
| Rate for Payer: Medical Associates Commercial |
$405.00
|
| Rate for Payer: Midlands Choice Commercial |
$378.00
|
| Rate for Payer: United Healthcare Commercial |
$486.00
|
|
|
KIT FOR 3.5MM PUSHLOCK WITH SPEAR AND DRILL
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.00 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna of IA Commercial |
$486.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$486.00
|
| Rate for Payer: Aetna of IA Medicare |
$307.80
|
| Rate for Payer: Amerigroup Medicaid |
$311.47
|
| Rate for Payer: Amerigroup Medicare |
$245.43
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$405.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$243.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$308.45
|
| Rate for Payer: Medical Associates Commercial |
$405.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$243.00
|
| Rate for Payer: Midlands Choice Commercial |
$378.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$312.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$279.45
|
| Rate for Payer: United Healthcare Commercial |
$486.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$318.60
|
|
|
KOH PREP FUNGUS
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
4022879
|
|
Hospital Revenue Code
|
306
|
| 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
|
|
|
KOH PREP FUNGUS
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
4022879
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.70 |
| 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: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
|
|
Kools Solution Compound [VDMC]
|
Facility
|
OP
|
$386.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11590592
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$173.97 |
| Max. Negotiated Rate |
$347.94 |
| Rate for Payer: Aetna of IA Commercial |
$347.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$347.94
|
| Rate for Payer: Aetna of IA Medicare |
$220.36
|
| Rate for Payer: Amerigroup Medicaid |
$222.99
|
| Rate for Payer: Amerigroup Medicare |
$175.71
|
| Rate for Payer: Cash Price |
$309.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$289.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$173.97
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$220.83
|
| Rate for Payer: Medical Associates Commercial |
$289.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$173.97
|
| Rate for Payer: Midlands Choice Commercial |
$270.62
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$224.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$200.07
|
| Rate for Payer: United Healthcare Commercial |
$347.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$228.09
|
|
|
Kools Solution Compound [VDMC]
|
Facility
|
IP
|
$386.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11590592
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$270.62 |
| Max. Negotiated Rate |
$347.94 |
| Rate for Payer: Aetna of IA Commercial |
$347.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$347.94
|
| Rate for Payer: Cash Price |
$309.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$289.95
|
| Rate for Payer: Medical Associates Commercial |
$289.95
|
| Rate for Payer: Midlands Choice Commercial |
$270.62
|
| Rate for Payer: United Healthcare Commercial |
$347.94
|
|
|
K-WIRE 0.062X6
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8750332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of IA Commercial |
$14.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.40
|
| Rate for Payer: Aetna of IA Medicare |
$9.12
|
| Rate for Payer: Amerigroup Medicaid |
$9.23
|
| Rate for Payer: Amerigroup Medicare |
$7.27
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9.14
|
| Rate for Payer: Medical Associates Commercial |
$12.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.20
|
| Rate for Payer: Midlands Choice Commercial |
$11.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$8.28
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$9.44
|
|
|
K-WIRE 0.062X6
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8750332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of IA Commercial |
$14.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.40
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.00
|
| Rate for Payer: Medical Associates Commercial |
$12.00
|
| Rate for Payer: Midlands Choice Commercial |
$11.20
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
|
|
K-WIRE 1.0MM
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of IA Commercial |
$14.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.40
|
| Rate for Payer: Aetna of IA Medicare |
$9.12
|
| Rate for Payer: Amerigroup Medicaid |
$9.23
|
| Rate for Payer: Amerigroup Medicare |
$7.27
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9.14
|
| Rate for Payer: Medical Associates Commercial |
$12.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.20
|
| Rate for Payer: Midlands Choice Commercial |
$11.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$8.28
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$9.44
|
|
|
K-WIRE 1.0MM
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of IA Commercial |
$14.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.40
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.00
|
| Rate for Payer: Medical Associates Commercial |
$12.00
|
| Rate for Payer: Midlands Choice Commercial |
$11.20
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
|
|
K-WIRE 1.2MM
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna of IA Commercial |
$33.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.30
|
| Rate for Payer: Aetna of IA Medicare |
$21.09
|
| Rate for Payer: Amerigroup Medicaid |
$21.34
|
| Rate for Payer: Amerigroup Medicare |
$16.82
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.13
|
| Rate for Payer: Medical Associates Commercial |
$27.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.65
|
| Rate for Payer: Midlands Choice Commercial |
$25.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.15
|
| Rate for Payer: United Healthcare Commercial |
$33.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.83
|
|
|
K-WIRE 1.2MM
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna of IA Commercial |
$33.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.30
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.75
|
| Rate for Payer: Medical Associates Commercial |
$27.75
|
| Rate for Payer: Midlands Choice Commercial |
$25.90
|
| Rate for Payer: United Healthcare Commercial |
$33.30
|
|
|
K-WIRE, 1.35MM, THREADED TROCAR TIP
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of IA Commercial |
$32.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.40
|
| Rate for Payer: Aetna of IA Medicare |
$20.52
|
| Rate for Payer: Amerigroup Medicaid |
$20.76
|
| Rate for Payer: Amerigroup Medicare |
$16.36
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.56
|
| Rate for Payer: Medical Associates Commercial |
$27.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.20
|
| Rate for Payer: Midlands Choice Commercial |
$25.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.63
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.24
|
|
|
K-WIRE, 1.35MM, THREADED TROCAR TIP
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of IA Commercial |
$32.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.00
|
| Rate for Payer: Medical Associates Commercial |
$27.00
|
| Rate for Payer: Midlands Choice Commercial |
$25.20
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
|
|
K-WIRE, 1.35MM, TROCAR TIP
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of IA Commercial |
$32.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.00
|
| Rate for Payer: Medical Associates Commercial |
$27.00
|
| Rate for Payer: Midlands Choice Commercial |
$25.20
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
|
