|
MENISCAL CINCH
|
Facility
|
IP
|
$513.00
|
|
| Hospital Charge Code |
8026234
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of IA Commercial |
$461.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$461.70
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$384.75
|
| Rate for Payer: Medical Associates Commercial |
$384.75
|
| Rate for Payer: Midlands Choice Commercial |
$359.10
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
|
|
MENISCAL CINCH
|
Facility
|
OP
|
$513.00
|
|
| Hospital Charge Code |
8026234
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.85 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of IA Commercial |
$461.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$461.70
|
| Rate for Payer: Aetna of IA Medicare |
$292.41
|
| Rate for Payer: Amerigroup Medicaid |
$295.90
|
| Rate for Payer: Amerigroup Medicare |
$233.16
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$384.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$230.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$293.03
|
| Rate for Payer: Medical Associates Commercial |
$384.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$230.85
|
| Rate for Payer: Midlands Choice Commercial |
$359.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$297.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$265.48
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$302.67
|
|
|
Mentholatum/Camphor 9%-1.3% Ointment 28gm [VDMC]
|
Facility
|
OP
|
$13.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
20114761
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$11.95 |
| Rate for Payer: Aetna of IA Commercial |
$11.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.95
|
| Rate for Payer: Aetna of IA Medicare |
$7.57
|
| Rate for Payer: Amerigroup Medicaid |
$7.66
|
| Rate for Payer: Amerigroup Medicare |
$6.04
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.96
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.59
|
| Rate for Payer: Medical Associates Commercial |
$9.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.98
|
| Rate for Payer: Midlands Choice Commercial |
$9.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$6.87
|
| Rate for Payer: United Healthcare Commercial |
$11.95
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.84
|
|
|
Mentholatum/Camphor 9%-1.3% Ointment 28gm [VDMC]
|
Facility
|
IP
|
$13.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
20114761
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$11.95 |
| Rate for Payer: Aetna of IA Commercial |
$11.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.95
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.96
|
| Rate for Payer: Medical Associates Commercial |
$9.96
|
| Rate for Payer: Midlands Choice Commercial |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$11.95
|
|
|
menthol topical 4% Gel 89ml [VDMC]
|
Facility
|
IP
|
$36.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
19495881
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.54 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Aetna of IA Commercial |
$32.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.83
|
| Rate for Payer: Cash Price |
$29.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.36
|
| Rate for Payer: Medical Associates Commercial |
$27.36
|
| Rate for Payer: Midlands Choice Commercial |
$25.54
|
| Rate for Payer: United Healthcare Commercial |
$32.83
|
|
|
menthol topical 4% Gel 89ml [VDMC]
|
Facility
|
OP
|
$36.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
19495881
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Aetna of IA Commercial |
$32.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.83
|
| Rate for Payer: Aetna of IA Medicare |
$20.79
|
| Rate for Payer: Amerigroup Medicaid |
$21.04
|
| Rate for Payer: Amerigroup Medicare |
$16.58
|
| Rate for Payer: Cash Price |
$29.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.84
|
| Rate for Payer: Medical Associates Commercial |
$27.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.42
|
| Rate for Payer: Midlands Choice Commercial |
$25.54
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.88
|
| Rate for Payer: United Healthcare Commercial |
$32.83
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.52
|
|
|
menthol-zinc oxide Top 0.44%-20.625% Oint [VDMC]
|
Facility
|
OP
|
$27.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403035
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.42 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Aetna of IA Commercial |
$24.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.84
|
| Rate for Payer: Aetna of IA Medicare |
$15.73
|
| Rate for Payer: Amerigroup Medicaid |
$15.92
|
| Rate for Payer: Amerigroup Medicare |
$12.54
|
| Rate for Payer: Cash Price |
$22.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.70
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.76
|
| Rate for Payer: Medical Associates Commercial |
$20.70
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.42
|
| Rate for Payer: Midlands Choice Commercial |
$19.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.28
|
| Rate for Payer: United Healthcare Commercial |
$24.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.28
|
|
|
menthol-zinc oxide Top 0.44%-20.625% Oint [VDMC]
|
Facility
|
IP
|
$27.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403035
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Aetna of IA Commercial |
$24.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.84
|
| Rate for Payer: Cash Price |
$22.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.70
|
| Rate for Payer: Medical Associates Commercial |
$20.70
|
| Rate for Payer: Midlands Choice Commercial |
$19.32
|
| Rate for Payer: United Healthcare Commercial |
$24.84
|
|
|
mepivacaine 2% 20 ml SDV PF Inj Sol [VDMC]
|
Facility
|
IP
|
$59.88
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
28919314
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$41.91 |
| Max. Negotiated Rate |
$53.89 |
| Rate for Payer: Aetna of IA Commercial |
$53.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.89
|
| Rate for Payer: Cash Price |
$47.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.91
|
| Rate for Payer: Medical Associates Commercial |
$44.91
|
| Rate for Payer: Midlands Choice Commercial |
$41.91
|
| Rate for Payer: United Healthcare Commercial |
$53.89
|
|
|
mepivacaine 2% 20 ml SDV PF Inj Sol [VDMC]
|
Facility
|
OP
|
$59.88
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
28919314
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$53.89 |
| Rate for Payer: Aetna of IA Commercial |
$53.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.89
|
| Rate for Payer: Aetna of IA Medicare |
$34.13
|
| Rate for Payer: Amerigroup Medicaid |
$34.54
|
| Rate for Payer: Amerigroup Medicare |
$27.21
|
| Rate for Payer: Cash Price |
$47.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.91
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.20
|
| Rate for Payer: Medical Associates Commercial |
$44.91
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.95
|
| Rate for Payer: Midlands Choice Commercial |
$41.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.99
|
| Rate for Payer: United Healthcare Commercial |
$53.89
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.33
|
|
|
mepolizumab 100 mg/mL Syringe PFS [VDMC]
|
Facility
|
IP
|
$7,477.66
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
23618580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5,234.36 |
| Max. Negotiated Rate |
$6,729.89 |
| Rate for Payer: Aetna of IA Commercial |
$6,729.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,729.89
|
| Rate for Payer: Cash Price |
$5,982.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,608.24
|
| Rate for Payer: Medical Associates Commercial |
$5,608.24
|
| Rate for Payer: Midlands Choice Commercial |
$5,234.36
|
| Rate for Payer: United Healthcare Commercial |
$6,729.89
|
|
|
mepolizumab 100 mg/mL Syringe PFS [VDMC]
|
Facility
|
OP
|
$7,477.66
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
23618580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3,364.95 |
| Max. Negotiated Rate |
$6,729.89 |
| Rate for Payer: Aetna of IA Commercial |
$6,729.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,729.89
|
| Rate for Payer: Aetna of IA Medicare |
$4,262.27
|
| Rate for Payer: Amerigroup Medicaid |
$4,313.11
|
| Rate for Payer: Amerigroup Medicare |
$3,398.60
|
| Rate for Payer: Cash Price |
$5,982.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,608.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,364.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,271.24
|
| Rate for Payer: Medical Associates Commercial |
$5,608.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,364.95
|
| Rate for Payer: Midlands Choice Commercial |
$5,234.36
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,334.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,869.69
|
| Rate for Payer: United Healthcare Commercial |
$6,729.89
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,411.82
|
|
|
meropenem 500 mg IV Inj SDV [VDMC]
|
Facility
|
IP
|
$27.96
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
10403376
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.57 |
| Max. Negotiated Rate |
$25.17 |
| Rate for Payer: Aetna of IA Commercial |
$25.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.17
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.97
|
| Rate for Payer: Medical Associates Commercial |
$20.97
|
| Rate for Payer: Midlands Choice Commercial |
$19.57
|
| Rate for Payer: United Healthcare Commercial |
$25.17
|
|
|
meropenem 500 mg IV Inj SDV [VDMC]
|
Facility
|
OP
|
$27.96
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
10403376
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$25.17 |
| Rate for Payer: Aetna of IA Commercial |
$25.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.17
|
| Rate for Payer: Aetna of IA Medicare |
$15.94
|
| Rate for Payer: Amerigroup Medicaid |
$16.13
|
| Rate for Payer: Amerigroup Medicare |
$12.71
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.97
|
| Rate for Payer: Medical Associates Commercial |
$20.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.58
|
| Rate for Payer: Midlands Choice Commercial |
$19.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.47
|
| Rate for Payer: United Healthcare Commercial |
$25.17
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.50
|
|
|
mesalamine 250 mg ERCap [VDMC]
|
Facility
|
IP
|
$12.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403514
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Aetna of IA Commercial |
$10.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.90
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.08
|
| Rate for Payer: Medical Associates Commercial |
$9.08
|
| Rate for Payer: Midlands Choice Commercial |
$8.48
|
| Rate for Payer: United Healthcare Commercial |
$10.90
|
|
|
mesalamine 250 mg ERCap [VDMC]
|
Facility
|
OP
|
$12.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403514
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Aetna of IA Commercial |
$10.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.90
|
| Rate for Payer: Aetna of IA Medicare |
$6.90
|
| Rate for Payer: Amerigroup Medicaid |
$6.99
|
| Rate for Payer: Amerigroup Medicare |
$5.51
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.08
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.92
|
| Rate for Payer: Medical Associates Commercial |
$9.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.45
|
| Rate for Payer: Midlands Choice Commercial |
$8.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$6.27
|
| Rate for Payer: United Healthcare Commercial |
$10.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.15
|
|
|
mesalamine 400 mg Cap DR [VDMC]
|
Facility
|
IP
|
$7.18
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403583
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$6.46 |
| Rate for Payer: Aetna of IA Commercial |
$6.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.46
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.39
|
| Rate for Payer: Medical Associates Commercial |
$5.39
|
| Rate for Payer: Midlands Choice Commercial |
$5.03
|
| Rate for Payer: United Healthcare Commercial |
$6.46
|
|
|
mesalamine 400 mg Cap DR [VDMC]
|
Facility
|
OP
|
$7.18
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403583
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$6.46 |
| Rate for Payer: Aetna of IA Commercial |
$6.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.46
|
| Rate for Payer: Aetna of IA Medicare |
$4.09
|
| Rate for Payer: Amerigroup Medicaid |
$4.14
|
| Rate for Payer: Amerigroup Medicare |
$3.26
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.39
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.23
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4.10
|
| Rate for Payer: Medical Associates Commercial |
$5.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.23
|
| Rate for Payer: Midlands Choice Commercial |
$5.03
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.72
|
| Rate for Payer: United Healthcare Commercial |
$6.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$4.24
|
|
|
MESH COMPOSITE PARIETEX 10X8
|
Facility
|
OP
|
$1,554.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8047039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.30 |
| Max. Negotiated Rate |
$1,398.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,398.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,398.60
|
| Rate for Payer: Aetna of IA Medicare |
$885.78
|
| Rate for Payer: Amerigroup Medicaid |
$896.35
|
| Rate for Payer: Amerigroup Medicare |
$706.29
|
| Rate for Payer: Cash Price |
$1,243.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,165.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$699.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$887.64
|
| Rate for Payer: Medical Associates Commercial |
$1,165.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$699.30
|
| Rate for Payer: Midlands Choice Commercial |
$1,087.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$900.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$804.20
|
| Rate for Payer: United Healthcare Commercial |
$1,398.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$916.86
|
|
|
MESH COMPOSITE PARIETEX 10X8
|
Facility
|
IP
|
$1,554.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8047039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.80 |
| Max. Negotiated Rate |
$1,398.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,398.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,398.60
|
| Rate for Payer: Cash Price |
$1,243.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,165.50
|
| Rate for Payer: Medical Associates Commercial |
$1,165.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,087.80
|
| Rate for Payer: United Healthcare Commercial |
$1,398.60
|
|
|
MESH COMPOSITE PARIETEX 8X6
|
Facility
|
OP
|
$1,497.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8046389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.65 |
| Max. Negotiated Rate |
$1,347.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,347.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,347.30
|
| Rate for Payer: Aetna of IA Medicare |
$853.29
|
| Rate for Payer: Amerigroup Medicaid |
$863.47
|
| Rate for Payer: Amerigroup Medicare |
$680.39
|
| Rate for Payer: Cash Price |
$1,197.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,122.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$673.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$855.09
|
| Rate for Payer: Medical Associates Commercial |
$1,122.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$673.65
|
| Rate for Payer: Midlands Choice Commercial |
$1,047.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$867.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$774.70
|
| Rate for Payer: United Healthcare Commercial |
$1,347.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$883.23
|
|
|
MESH COMPOSITE PARIETEX 8X6
|
Facility
|
IP
|
$1,497.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8046389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.90 |
| Max. Negotiated Rate |
$1,347.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,347.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,347.30
|
| Rate for Payer: Cash Price |
$1,197.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,122.75
|
| Rate for Payer: Medical Associates Commercial |
$1,122.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,047.90
|
| Rate for Payer: United Healthcare Commercial |
$1,347.30
|
|
|
Mesh Surgical Bard 4x1.8in Groin Pre-Shaped
|
Facility
|
IP
|
$534.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8970697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$374.47 |
| Max. Negotiated Rate |
$481.46 |
| Rate for Payer: Aetna of IA Commercial |
$481.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$481.46
|
| Rate for Payer: Cash Price |
$427.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$401.22
|
| Rate for Payer: Medical Associates Commercial |
$401.22
|
| Rate for Payer: Midlands Choice Commercial |
$374.47
|
| Rate for Payer: United Healthcare Commercial |
$481.46
|
|
|
Mesh Surgical Bard 4x1.8in Groin Pre-Shaped
|
Facility
|
OP
|
$534.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8970697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.73 |
| Max. Negotiated Rate |
$481.46 |
| Rate for Payer: Aetna of IA Commercial |
$481.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$481.46
|
| Rate for Payer: Aetna of IA Medicare |
$304.93
|
| Rate for Payer: Amerigroup Medicaid |
$308.56
|
| Rate for Payer: Amerigroup Medicare |
$243.14
|
| Rate for Payer: Cash Price |
$427.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$401.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$240.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$305.57
|
| Rate for Payer: Medical Associates Commercial |
$401.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$240.73
|
| Rate for Payer: Midlands Choice Commercial |
$374.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$310.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$276.84
|
| Rate for Payer: United Healthcare Commercial |
$481.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$315.63
|
|
|
Mesh Surgical Bard Marlex 5.4x2.4in Pre-Shaped
|
Facility
|
IP
|
$714.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8970699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$500.47 |
| Max. Negotiated Rate |
$643.46 |
| Rate for Payer: Aetna of IA Commercial |
$643.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$643.46
|
| Rate for Payer: Cash Price |
$571.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$536.22
|
| Rate for Payer: Medical Associates Commercial |
$536.22
|
| Rate for Payer: Midlands Choice Commercial |
$500.47
|
| Rate for Payer: United Healthcare Commercial |
$643.46
|
|
