|
LOCKING SCREW 2.7MMX14MM
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8759896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.30 |
| Max. Negotiated Rate |
$332.10 |
| Rate for Payer: Aetna of IA Commercial |
$332.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$332.10
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$276.75
|
| Rate for Payer: Medical Associates Commercial |
$276.75
|
| Rate for Payer: Midlands Choice Commercial |
$258.30
|
| Rate for Payer: United Healthcare Commercial |
$332.10
|
|
|
LOCKING SCREW 2.7MMX14MM
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8759896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.43 |
| Max. Negotiated Rate |
$332.10 |
| Rate for Payer: Aetna of IA Commercial |
$332.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$332.10
|
| Rate for Payer: Aetna of IA Medicare |
$210.33
|
| Rate for Payer: Amerigroup Medicaid |
$186.23
|
| Rate for Payer: Amerigroup Medicare |
$186.34
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$276.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$184.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$184.43
|
| Rate for Payer: Medical Associates Commercial |
$276.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$184.50
|
| Rate for Payer: Midlands Choice Commercial |
$258.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$187.27
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$187.16
|
| Rate for Payer: Oscar Health of IA Commercial |
$276.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$276.75
|
| Rate for Payer: United Healthcare Commercial |
$332.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$217.71
|
|
|
LOCKING SCREW 2.7MMX16MM
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8759898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.30 |
| Max. Negotiated Rate |
$332.10 |
| Rate for Payer: Aetna of IA Commercial |
$332.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$332.10
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$276.75
|
| Rate for Payer: Medical Associates Commercial |
$276.75
|
| Rate for Payer: Midlands Choice Commercial |
$258.30
|
| Rate for Payer: United Healthcare Commercial |
$332.10
|
|
|
LOCKING SCREW 2.7MMX16MM
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8759898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.43 |
| Max. Negotiated Rate |
$332.10 |
| Rate for Payer: Aetna of IA Commercial |
$332.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$332.10
|
| Rate for Payer: Aetna of IA Medicare |
$210.33
|
| Rate for Payer: Amerigroup Medicaid |
$186.23
|
| Rate for Payer: Amerigroup Medicare |
$186.34
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$276.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$184.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$184.43
|
| Rate for Payer: Medical Associates Commercial |
$276.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$184.50
|
| Rate for Payer: Midlands Choice Commercial |
$258.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$187.27
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$187.16
|
| Rate for Payer: Oscar Health of IA Commercial |
$276.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$276.75
|
| Rate for Payer: United Healthcare Commercial |
$332.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$217.71
|
|
|
LOCKING SCREW 2.7MMX24MM
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.42 |
| 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 |
$204.40
|
| Rate for Payer: Amerigroup Medicare |
$204.52
|
| 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 |
$202.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.42
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$205.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$205.42
|
| Rate for Payer: Oscar Health of IA Commercial |
$303.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$303.75
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
|
LOCKING SCREW 2.7MMX24MM
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956488
|
|
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
|
|
|
LOCKING SCREW 2.7MMX26MM
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.42 |
| 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 |
$204.40
|
| Rate for Payer: Amerigroup Medicare |
$204.52
|
| 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 |
$202.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.42
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$205.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$205.42
|
| Rate for Payer: Oscar Health of IA Commercial |
$303.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$303.75
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
|
LOCKING SCREW 2.7MMX26MM
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956490
|
|
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
|
|
|
LOCKING SCREW 2.7MMX28MM
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.96 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna of IA Commercial |
$194.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$194.40
|
| Rate for Payer: Aetna of IA Medicare |
$123.12
|
| Rate for Payer: Amerigroup Medicaid |
$109.02
|
| Rate for Payer: Amerigroup Medicare |
$109.08
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$162.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$108.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.96
|
| Rate for Payer: Medical Associates Commercial |
$162.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$108.00
|
| Rate for Payer: Midlands Choice Commercial |
$151.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$109.62
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$109.56
|
| Rate for Payer: Oscar Health of IA Commercial |
$162.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$162.00
|
| Rate for Payer: United Healthcare Commercial |
$194.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$127.44
|
|
|
LOCKING SCREW 2.7MMX28MM
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna of IA Commercial |
$194.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$194.40
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$162.00
|
| Rate for Payer: Medical Associates Commercial |
$162.00
|
| Rate for Payer: Midlands Choice Commercial |
$151.20
|
| Rate for Payer: United Healthcare Commercial |
$194.40
|
|
|
LOCKING SCREW 2.7MMX8MM
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8793253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.43 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Aetna of IA Medicare |
$189.81
|
| Rate for Payer: Amerigroup Medicaid |
$168.07
|
| Rate for Payer: Amerigroup Medicare |
$168.16
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$166.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$166.43
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$166.50
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$169.00
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$168.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$249.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$249.75
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
|
|
LOCKING SCREW 2.7MMX8MM
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8793253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
|
|
LOCKING SCREW 3.0X14MM
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8700312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.94 |
| 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 |
$145.35
|
| Rate for Payer: Amerigroup Medicare |
$145.44
|
| 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 |
$144.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$143.94
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$144.00
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$146.16
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$146.07
|
| Rate for Payer: Oscar Health of IA Commercial |
$216.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$216.00
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$169.92
|
|
|
LOCKING SCREW 3.0X14MM
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8700312
|
|
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
|
|
|
LONG LESSER MET-Z PLATE "300-81-008"
|
Facility
|
IP
|
$1,602.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8908709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.40 |
| Max. Negotiated Rate |
$1,441.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,441.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,441.80
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,201.50
|
| Rate for Payer: Medical Associates Commercial |
$1,201.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,121.40
|
| Rate for Payer: United Healthcare Commercial |
$1,441.80
|
|
|
LONG LESSER MET-Z PLATE "300-81-008"
|
Facility
|
OP
|
$1,602.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8908709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$800.68 |
| Max. Negotiated Rate |
$1,441.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,441.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,441.80
|
| Rate for Payer: Aetna of IA Medicare |
$913.14
|
| Rate for Payer: Amerigroup Medicaid |
$808.53
|
| Rate for Payer: Amerigroup Medicare |
$809.01
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,201.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$801.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$800.68
|
| Rate for Payer: Medical Associates Commercial |
$1,201.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$801.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,121.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$813.02
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$812.53
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,201.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,201.50
|
| Rate for Payer: United Healthcare Commercial |
$1,441.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$945.18
|
|
|
loperamide 1 mg/7.5 mL 120ml oral susp [VDMC]
|
Facility
|
IP
|
$17.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11221430
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: Aetna of IA Commercial |
$15.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$15.41
|
| Rate for Payer: Cash Price |
$13.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.84
|
| Rate for Payer: Medical Associates Commercial |
$12.84
|
| Rate for Payer: Midlands Choice Commercial |
$11.98
|
| Rate for Payer: United Healthcare Commercial |
$15.41
|
|
|
loperamide 1 mg/7.5 mL 120ml oral susp [VDMC]
|
Facility
|
OP
|
$17.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11221430
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: Aetna of IA Commercial |
$15.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$15.41
|
| Rate for Payer: Aetna of IA Medicare |
$9.76
|
| Rate for Payer: Amerigroup Medicaid |
$8.64
|
| Rate for Payer: Amerigroup Medicare |
$8.65
|
| Rate for Payer: Cash Price |
$13.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.84
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.56
|
| Rate for Payer: Medical Associates Commercial |
$12.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.56
|
| Rate for Payer: Midlands Choice Commercial |
$11.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.69
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$8.68
|
| Rate for Payer: Oscar Health of IA Commercial |
$12.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.84
|
| Rate for Payer: United Healthcare Commercial |
$15.41
|
| Rate for Payer: United Healthcare Managed Medicare |
$10.10
|
|
|
loperamide 2 mg Cap [VDMC]
|
Facility
|
OP
|
$2.03
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10401368
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: Aetna of IA Commercial |
$1.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.83
|
| Rate for Payer: Aetna of IA Medicare |
$1.16
|
| Rate for Payer: Amerigroup Medicaid |
$1.02
|
| Rate for Payer: Amerigroup Medicare |
$1.03
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.01
|
| Rate for Payer: Medical Associates Commercial |
$1.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.02
|
| Rate for Payer: Midlands Choice Commercial |
$1.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.03
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.03
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.52
|
| Rate for Payer: United Healthcare Commercial |
$1.83
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.20
|
|
|
loperamide 2 mg Cap [VDMC]
|
Facility
|
IP
|
$2.03
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10401368
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: Aetna of IA Commercial |
$1.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.83
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.52
|
| Rate for Payer: Medical Associates Commercial |
$1.52
|
| Rate for Payer: Midlands Choice Commercial |
$1.42
|
| Rate for Payer: United Healthcare Commercial |
$1.83
|
|
|
LO-PRO LOCK SCREW, TI,3.5MMX12MM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8783530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
|
|
LO-PRO LOCK SCREW, TI,3.5MMX12MM
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8783530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.95 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Aetna of IA Medicare |
$153.90
|
| Rate for Payer: Amerigroup Medicaid |
$136.27
|
| Rate for Payer: Amerigroup Medicare |
$136.35
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$135.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$134.95
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$137.02
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$136.94
|
| Rate for Payer: Oscar Health of IA Commercial |
$202.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$202.50
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.30
|
|
|
LO-PRO LOCK SCREW, TI,3.5X14MM
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8783532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.95 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Aetna of IA Medicare |
$153.90
|
| Rate for Payer: Amerigroup Medicaid |
$136.27
|
| Rate for Payer: Amerigroup Medicare |
$136.35
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$135.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$134.95
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$137.02
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$136.94
|
| Rate for Payer: Oscar Health of IA Commercial |
$202.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$202.50
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.30
|
|
|
LO-PRO LOCK SCREW, TI,3.5X14MM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8783532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
|
|
LO-PRO SCREW, TI, 3.5MMX10MM
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8783218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of IA Commercial |
$97.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.20
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.00
|
| Rate for Payer: Medical Associates Commercial |
$81.00
|
| Rate for Payer: Midlands Choice Commercial |
$75.60
|
| Rate for Payer: United Healthcare Commercial |
$97.20
|
|
