|
LOCKING SCREW 2.7MMX24MM
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8956488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Aetna of IA Medicare |
$230.85
|
| Rate for Payer: Amerigroup Medicaid |
$233.60
|
| Rate for Payer: Amerigroup Medicare |
$184.07
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$182.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$231.34
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$182.25
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$234.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$209.59
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
|
LOCKING SCREW 2.7MMX26MM
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
HCPCS 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 2.7MMX26MM
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8956490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Aetna of IA Medicare |
$230.85
|
| Rate for Payer: Amerigroup Medicaid |
$233.60
|
| Rate for Payer: Amerigroup Medicare |
$184.07
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$182.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$231.34
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$182.25
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$234.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$209.59
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
|
LOCKING SCREW 2.7MMX28MM
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8956492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.20 |
| 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: Aetna of IA Medicare |
$123.12
|
| Rate for Payer: Amerigroup Medicaid |
$124.59
|
| Rate for Payer: Amerigroup Medicare |
$98.17
|
| 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 |
$97.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$123.38
|
| Rate for Payer: Medical Associates Commercial |
$162.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$97.20
|
| Rate for Payer: Midlands Choice Commercial |
$151.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$125.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.78
|
| 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
|
HCPCS 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
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS 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 2.7MMX8MM
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8793253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.85 |
| 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 |
$192.07
|
| Rate for Payer: Amerigroup Medicare |
$151.35
|
| 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 |
$149.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$190.21
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$149.85
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$193.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$172.33
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
|
|
LOCKING SCREW 3.0X14MM
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8700312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| 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: Aetna of IA Medicare |
$164.16
|
| Rate for Payer: Amerigroup Medicaid |
$166.12
|
| Rate for Payer: Amerigroup Medicare |
$130.90
|
| 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 |
$129.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$164.51
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$129.60
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$166.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$149.04
|
| 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
|
HCPCS 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
|
|
|
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 |
$7.70 |
| 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 |
$9.87
|
| Rate for Payer: Amerigroup Medicare |
$7.78
|
| 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 |
$7.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9.78
|
| Rate for Payer: Medical Associates Commercial |
$12.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.70
|
| Rate for Payer: Midlands Choice Commercial |
$11.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$8.86
|
| Rate for Payer: United Healthcare Commercial |
$15.41
|
| Rate for Payer: United Healthcare Managed Medicare |
$10.10
|
|
|
loperamide 2 mg Cap [VDMC]
|
Facility
|
IP
|
$2.95
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10401368
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna of IA Commercial |
$2.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.66
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.21
|
| Rate for Payer: Medical Associates Commercial |
$2.21
|
| Rate for Payer: Midlands Choice Commercial |
$2.07
|
| Rate for Payer: United Healthcare Commercial |
$2.66
|
|
|
loperamide 2 mg Cap [VDMC]
|
Facility
|
OP
|
$2.95
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10401368
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna of IA Commercial |
$2.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.66
|
| Rate for Payer: Aetna of IA Medicare |
$1.68
|
| Rate for Payer: Amerigroup Medicaid |
$1.70
|
| Rate for Payer: Amerigroup Medicare |
$1.34
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.21
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.33
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.69
|
| Rate for Payer: Medical Associates Commercial |
$2.21
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.33
|
| Rate for Payer: Midlands Choice Commercial |
$2.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.53
|
| Rate for Payer: United Healthcare Commercial |
$2.66
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.74
|
|
|
LO-PRO LOCK SCREW, TI,3.5MMX12MM
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8783530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.50 |
| 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 |
$155.74
|
| Rate for Payer: Amerigroup Medicare |
$122.72
|
| 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 |
$121.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$154.22
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$156.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$139.72
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.30
|
|
|
LO-PRO LOCK SCREW, TI,3.5MMX12MM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 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,3.5X14MM
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8783532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.50 |
| 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 |
$155.74
|
| Rate for Payer: Amerigroup Medicare |
$122.72
|
| 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 |
$121.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$154.22
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$156.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$139.72
|
| 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
|
HCPCS 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
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8783218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.60 |
| 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: Aetna of IA Medicare |
$61.56
|
| Rate for Payer: Amerigroup Medicaid |
$62.29
|
| Rate for Payer: Amerigroup Medicare |
$49.09
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$48.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.69
|
| Rate for Payer: Medical Associates Commercial |
$81.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$48.60
|
| Rate for Payer: Midlands Choice Commercial |
$75.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.89
|
| Rate for Payer: United Healthcare Commercial |
$97.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.72
|
|
|
LO-PRO SCREW, TI, 3.5MMX10MM
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 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
|
|
|
LO-PRO SCREW,TI,3.5MMX14MM
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8783220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.60 |
| 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: Aetna of IA Medicare |
$61.56
|
| Rate for Payer: Amerigroup Medicaid |
$62.29
|
| Rate for Payer: Amerigroup Medicare |
$49.09
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$48.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.69
|
| Rate for Payer: Medical Associates Commercial |
$81.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$48.60
|
| Rate for Payer: Midlands Choice Commercial |
$75.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.89
|
| Rate for Payer: United Healthcare Commercial |
$97.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.72
|
|
|
LO-PRO SCREW,TI,3.5MMX14MM
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8783220
|
|
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
|
|
|
loratadine 10 mg Tab [VDMC]
|
Facility
|
IP
|
$1.58
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10401437
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of IA Commercial |
$1.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.42
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.19
|
| Rate for Payer: Medical Associates Commercial |
$1.19
|
| Rate for Payer: Midlands Choice Commercial |
$1.11
|
| Rate for Payer: United Healthcare Commercial |
$1.42
|
|
|
loratadine 10 mg Tab [VDMC]
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10401437
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of IA Commercial |
$1.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.42
|
| Rate for Payer: Aetna of IA Medicare |
$0.90
|
| Rate for Payer: Amerigroup Medicaid |
$0.91
|
| Rate for Payer: Amerigroup Medicare |
$0.72
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.19
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.90
|
| Rate for Payer: Medical Associates Commercial |
$1.19
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.71
|
| Rate for Payer: Midlands Choice Commercial |
$1.11
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.42
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.93
|
|
|
LORazepam 0.5 mg Tab [VDMC]
|
Facility
|
IP
|
$3.23
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10401508
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Aetna of IA Commercial |
$2.91
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.91
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.42
|
| Rate for Payer: Medical Associates Commercial |
$2.42
|
| Rate for Payer: Midlands Choice Commercial |
$2.26
|
| Rate for Payer: United Healthcare Commercial |
$2.91
|
|
|
LORazepam 0.5 mg Tab [VDMC]
|
Facility
|
OP
|
$3.23
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10401508
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Aetna of IA Commercial |
$2.91
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.91
|
| Rate for Payer: Aetna of IA Medicare |
$1.84
|
| Rate for Payer: Amerigroup Medicaid |
$1.86
|
| Rate for Payer: Amerigroup Medicare |
$1.47
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.85
|
| Rate for Payer: Medical Associates Commercial |
$2.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.45
|
| Rate for Payer: Midlands Choice Commercial |
$2.26
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.67
|
| Rate for Payer: United Healthcare Commercial |
$2.91
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.91
|
|
