|
PIN STEINMANN 9X.142 DIAMOND POINT
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
|
|
PIN STEINMANN 9X.142 DIAMOND POINT
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Aetna of IA Medicare |
$31.92
|
| Rate for Payer: Amerigroup Medicaid |
$32.30
|
| Rate for Payer: Amerigroup Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.99
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.20
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.98
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.04
|
|
|
PIN STEINMANN 9X.142 TROCAR POINTS
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046959
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Aetna of IA Medicare |
$29.64
|
| Rate for Payer: Amerigroup Medicaid |
$29.99
|
| Rate for Payer: Amerigroup Medicare |
$23.63
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.70
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.40
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.91
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.68
|
|
|
PIN STEINMANN 9X.142 TROCAR POINTS
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046959
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
|
|
PIN STEINMANN 9X.157 DIAMOND POINT
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
|
|
PIN STEINMANN 9X.157 DIAMOND POINT
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Aetna of IA Medicare |
$31.92
|
| Rate for Payer: Amerigroup Medicaid |
$32.30
|
| Rate for Payer: Amerigroup Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.99
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.20
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.98
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.04
|
|
|
PIN STEINMANN 9X.157 TROCAR POINTS
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
|
|
PIN STEINMANN 9X.157 TROCAR POINTS
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Aetna of IA Medicare |
$29.64
|
| Rate for Payer: Amerigroup Medicaid |
$29.99
|
| Rate for Payer: Amerigroup Medicare |
$23.63
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.70
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.40
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.91
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.68
|
|
|
PIN STEINMANN 9X.189 DIAMOND POINT
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Aetna of IA Medicare |
$31.92
|
| Rate for Payer: Amerigroup Medicaid |
$32.30
|
| Rate for Payer: Amerigroup Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.99
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.20
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.98
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.04
|
|
|
PIN STEINMANN 9X.189 DIAMOND POINT
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
|
|
PIN STEINMANN 9X.189 TROCAR POINTS
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Aetna of IA Medicare |
$29.64
|
| Rate for Payer: Amerigroup Medicaid |
$29.99
|
| Rate for Payer: Amerigroup Medicare |
$23.63
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.70
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.40
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.91
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.68
|
|
|
PIN STEINMANN 9X.189 TROCAR POINTS
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
|
|
PIN STEINMANN 9X9.094 DIAMOND POINT
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Aetna of IA Medicare |
$31.92
|
| Rate for Payer: Amerigroup Medicaid |
$32.30
|
| Rate for Payer: Amerigroup Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.99
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.20
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.98
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.04
|
|
|
PIN STEINMANN 9X9.094 DIAMOND POINT
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
|
|
pioglitazone 15 mg Tab [VDMC]
|
Facility
|
OP
|
$1.29
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10413715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of IA Commercial |
$1.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.16
|
| Rate for Payer: Aetna of IA Medicare |
$0.73
|
| Rate for Payer: Amerigroup Medicaid |
$0.74
|
| Rate for Payer: Amerigroup Medicare |
$0.58
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.96
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.73
|
| Rate for Payer: Medical Associates Commercial |
$0.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.58
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.67
|
| Rate for Payer: United Healthcare Commercial |
$1.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.76
|
|
|
pioglitazone 15 mg Tab [VDMC]
|
Facility
|
IP
|
$1.29
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10413715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of IA Commercial |
$1.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.16
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.96
|
| Rate for Payer: Medical Associates Commercial |
$0.96
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.16
|
|
|
piperacillin-tazobactam 2 g-0.25 g IV SDV Inj [VDMC]
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
10413786
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Aetna of IA Commercial |
$27.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.90
|
| Rate for Payer: Aetna of IA Medicare |
$17.67
|
| Rate for Payer: Amerigroup Medicaid |
$17.88
|
| Rate for Payer: Amerigroup Medicare |
$14.09
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.71
|
| Rate for Payer: Medical Associates Commercial |
$23.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.95
|
| Rate for Payer: Midlands Choice Commercial |
$21.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.04
|
| Rate for Payer: United Healthcare Commercial |
$27.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.29
|
|
|
piperacillin-tazobactam 2 g-0.25 g IV SDV Inj [VDMC]
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
10413786
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Aetna of IA Commercial |
$27.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.90
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.25
|
| Rate for Payer: Medical Associates Commercial |
$23.25
|
| Rate for Payer: Midlands Choice Commercial |
$21.70
|
| Rate for Payer: United Healthcare Commercial |
$27.90
|
|
|
piperacillin-tazobactam 3 g-0.375 g IV SDV Inj [VDMC]
|
Facility
|
IP
|
$27.35
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
10413855
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$24.61 |
| Rate for Payer: Aetna of IA Commercial |
$24.61
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.61
|
| Rate for Payer: Cash Price |
$21.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.51
|
| Rate for Payer: Medical Associates Commercial |
$20.51
|
| Rate for Payer: Midlands Choice Commercial |
$19.14
|
| Rate for Payer: United Healthcare Commercial |
$24.61
|
|
|
piperacillin-tazobactam 3 g-0.375 g IV SDV Inj [VDMC]
|
Facility
|
OP
|
$27.35
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
10413855
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$24.61 |
| Rate for Payer: Aetna of IA Commercial |
$24.61
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.61
|
| Rate for Payer: Aetna of IA Medicare |
$15.59
|
| Rate for Payer: Amerigroup Medicaid |
$15.77
|
| Rate for Payer: Amerigroup Medicare |
$12.43
|
| Rate for Payer: Cash Price |
$21.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.51
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.31
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.62
|
| Rate for Payer: Medical Associates Commercial |
$20.51
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.31
|
| Rate for Payer: Midlands Choice Commercial |
$19.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.15
|
| Rate for Payer: United Healthcare Commercial |
$24.61
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.14
|
|
|
piperacillin-tazobactam 4 g-0.5 g IV SDV Inj [VDMC]
|
Facility
|
OP
|
$30.82
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
10413924
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$27.74 |
| Rate for Payer: Aetna of IA Commercial |
$27.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.74
|
| Rate for Payer: Aetna of IA Medicare |
$17.57
|
| Rate for Payer: Amerigroup Medicaid |
$17.78
|
| Rate for Payer: Amerigroup Medicare |
$14.01
|
| Rate for Payer: Cash Price |
$24.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.11
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.87
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.60
|
| Rate for Payer: Medical Associates Commercial |
$23.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.87
|
| Rate for Payer: Midlands Choice Commercial |
$21.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$15.95
|
| Rate for Payer: United Healthcare Commercial |
$27.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.18
|
|
|
piperacillin-tazobactam 4 g-0.5 g IV SDV Inj [VDMC]
|
Facility
|
IP
|
$30.82
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
10413924
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$27.74 |
| Rate for Payer: Aetna of IA Commercial |
$27.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.74
|
| Rate for Payer: Cash Price |
$24.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.11
|
| Rate for Payer: Medical Associates Commercial |
$23.11
|
| Rate for Payer: Midlands Choice Commercial |
$21.57
|
| Rate for Payer: United Healthcare Commercial |
$27.74
|
|
|
piroxicam 20 mg Cap [VDMC]
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10413993
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna of IA Commercial |
$2.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.69
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.24
|
| Rate for Payer: Medical Associates Commercial |
$2.24
|
| Rate for Payer: Midlands Choice Commercial |
$2.09
|
| Rate for Payer: United Healthcare Commercial |
$2.69
|
|
|
piroxicam 20 mg Cap [VDMC]
|
Facility
|
OP
|
$2.99
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10413993
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna of IA Commercial |
$2.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.69
|
| Rate for Payer: Aetna of IA Medicare |
$1.70
|
| Rate for Payer: Amerigroup Medicaid |
$1.72
|
| Rate for Payer: Amerigroup Medicare |
$1.36
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.71
|
| Rate for Payer: Medical Associates Commercial |
$2.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.35
|
| Rate for Payer: Midlands Choice Commercial |
$2.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.55
|
| Rate for Payer: United Healthcare Commercial |
$2.69
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.76
|
|
|
PLATE 10 HOLE DYNAMIC COMP
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna of IA Commercial |
$247.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$247.50
|
| Rate for Payer: Aetna of IA Medicare |
$156.75
|
| Rate for Payer: Amerigroup Medicaid |
$158.62
|
| Rate for Payer: Amerigroup Medicare |
$124.99
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$206.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$123.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$157.08
|
| Rate for Payer: Medical Associates Commercial |
$206.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$123.75
|
| Rate for Payer: Midlands Choice Commercial |
$192.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$159.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$142.31
|
| Rate for Payer: United Healthcare Commercial |
$247.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$162.25
|
|
