|
PIN STEINMANN 9X.079 DIAMOND POINT
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.99 |
| 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 |
$28.26
|
| Rate for Payer: Amerigroup Medicare |
$28.28
|
| 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 |
$28.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.99
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.42
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$28.40
|
| Rate for Payer: Oscar Health of IA Commercial |
$42.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.00
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.04
|
|
|
PIN STEINMANN 9X.110 TROCAR POINTS
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.99 |
| 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 |
$26.24
|
| Rate for Payer: Amerigroup Medicare |
$26.26
|
| 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 |
$26.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.99
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.39
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$26.37
|
| Rate for Payer: Oscar Health of IA Commercial |
$39.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.00
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.68
|
|
|
PIN STEINMANN 9X.110 TROCAR POINTS
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026226
|
|
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.126 DIAMOND POINT
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046464
|
|
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.126 DIAMOND POINT
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.99 |
| 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 |
$28.26
|
| Rate for Payer: Amerigroup Medicare |
$28.28
|
| 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 |
$28.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.99
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.42
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$28.40
|
| Rate for Payer: Oscar Health of IA Commercial |
$42.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.00
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.04
|
|
|
PIN STEINMANN 9X.126 TROCAR POINTS
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.99 |
| 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 |
$26.24
|
| Rate for Payer: Amerigroup Medicare |
$26.26
|
| 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 |
$26.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.99
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.39
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$26.37
|
| Rate for Payer: Oscar Health of IA Commercial |
$39.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.00
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.68
|
|
|
PIN STEINMANN 9X.126 TROCAR POINTS
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046940
|
|
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.142 DIAMOND POINT
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| 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: 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
|
CPT C1713
|
| Hospital Charge Code |
8046466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.99 |
| 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 |
$28.26
|
| Rate for Payer: Amerigroup Medicare |
$28.28
|
| 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 |
$28.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.99
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.42
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$28.40
|
| Rate for Payer: Oscar Health of IA Commercial |
$42.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.00
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.04
|
|
|
PIN STEINMANN 9X.142 TROCAR POINTS
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 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.142 TROCAR POINTS
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046959
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.99 |
| 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 |
$26.24
|
| Rate for Payer: Amerigroup Medicare |
$26.26
|
| 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 |
$26.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.99
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.39
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$26.37
|
| Rate for Payer: Oscar Health of IA Commercial |
$39.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.00
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.68
|
|
|
PIN STEINMANN 9X.157 DIAMOND POINT
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.99 |
| 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 |
$28.26
|
| Rate for Payer: Amerigroup Medicare |
$28.28
|
| 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 |
$28.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.99
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.42
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$28.40
|
| Rate for Payer: Oscar Health of IA Commercial |
$42.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.00
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.04
|
|
|
PIN STEINMANN 9X.157 DIAMOND POINT
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 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 TROCAR POINTS
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.99 |
| 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 |
$26.24
|
| Rate for Payer: Amerigroup Medicare |
$26.26
|
| 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 |
$26.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.99
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.39
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$26.37
|
| Rate for Payer: Oscar Health of IA Commercial |
$39.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.00
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.68
|
|
|
PIN STEINMANN 9X.157 TROCAR POINTS
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 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.189 DIAMOND POINT
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.99 |
| 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 |
$28.26
|
| Rate for Payer: Amerigroup Medicare |
$28.28
|
| 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 |
$28.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.99
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.42
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$28.40
|
| Rate for Payer: Oscar Health of IA Commercial |
$42.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.00
|
| 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
|
CPT 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
|
CPT C1713
|
| Hospital Charge Code |
8046920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.99 |
| 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 |
$26.24
|
| Rate for Payer: Amerigroup Medicare |
$26.26
|
| 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 |
$26.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.99
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.39
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$26.37
|
| Rate for Payer: Oscar Health of IA Commercial |
$39.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.00
|
| 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
|
CPT 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
|
CPT C1713
|
| Hospital Charge Code |
8026109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.99 |
| 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 |
$28.26
|
| Rate for Payer: Amerigroup Medicare |
$28.28
|
| 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 |
$28.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.99
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.42
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$28.40
|
| Rate for Payer: Oscar Health of IA Commercial |
$42.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.00
|
| 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
|
CPT 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
|
$1.49
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10413715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna of IA Commercial |
$1.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.34
|
| Rate for Payer: Aetna of IA Medicare |
$0.85
|
| Rate for Payer: Amerigroup Medicaid |
$0.75
|
| Rate for Payer: Amerigroup Medicare |
$0.75
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.74
|
| Rate for Payer: Medical Associates Commercial |
$1.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.75
|
| Rate for Payer: Midlands Choice Commercial |
$1.04
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.76
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.76
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.12
|
| Rate for Payer: United Healthcare Commercial |
$1.34
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.88
|
|
|
pioglitazone 15 mg Tab [VDMC]
|
Facility
|
IP
|
$1.49
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10413715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna of IA Commercial |
$1.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.34
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.12
|
| Rate for Payer: Medical Associates Commercial |
$1.12
|
| Rate for Payer: Midlands Choice Commercial |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.34
|
|
|
piperacillin-tazobactam 2 g-0.25 g IV SDV Inj [VDMC]
|
Facility
|
IP
|
$25.44
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
10413786
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$22.90 |
| Rate for Payer: Aetna of IA Commercial |
$22.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.90
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.08
|
| Rate for Payer: Medical Associates Commercial |
$19.08
|
| Rate for Payer: Midlands Choice Commercial |
$17.81
|
| Rate for Payer: United Healthcare Commercial |
$22.90
|
|
|
piperacillin-tazobactam 2 g-0.25 g IV SDV Inj [VDMC]
|
Facility
|
OP
|
$25.44
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
10413786
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$22.90 |
| Rate for Payer: Aetna of IA Commercial |
$22.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.90
|
| Rate for Payer: Aetna of IA Medicare |
$14.50
|
| Rate for Payer: Amerigroup Medicaid |
$12.84
|
| Rate for Payer: Amerigroup Medicare |
$12.85
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.08
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.71
|
| Rate for Payer: Medical Associates Commercial |
$19.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.72
|
| Rate for Payer: Midlands Choice Commercial |
$17.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.91
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$12.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$19.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.08
|
| Rate for Payer: United Healthcare Commercial |
$22.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.01
|
|
