|
pneumococcal 13-valent vaccine inj Dip CR Syr 0.5ml [VDMC]
|
Facility
|
IP
|
$434.50
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
10429979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$304.15 |
| Max. Negotiated Rate |
$391.05 |
| Rate for Payer: Aetna of IA Commercial |
$391.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$391.05
|
| Rate for Payer: Cash Price |
$347.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$325.87
|
| Rate for Payer: Medical Associates Commercial |
$325.87
|
| Rate for Payer: Midlands Choice Commercial |
$304.15
|
| Rate for Payer: United Healthcare Commercial |
$391.05
|
|
|
pneumococcal 20-valent vaccine inj Dip CR Syr 0.5ml [VDMC]
|
Facility
|
OP
|
$457.27
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
23914697
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$205.77 |
| Max. Negotiated Rate |
$411.54 |
| Rate for Payer: Aetna of IA Commercial |
$411.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$411.54
|
| Rate for Payer: Aetna of IA Medicare |
$260.64
|
| Rate for Payer: Amerigroup Medicaid |
$263.75
|
| Rate for Payer: Amerigroup Medicare |
$207.83
|
| Rate for Payer: Cash Price |
$365.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$342.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$205.77
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$261.19
|
| Rate for Payer: Medical Associates Commercial |
$342.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$205.77
|
| Rate for Payer: Midlands Choice Commercial |
$320.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$265.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$236.64
|
| Rate for Payer: United Healthcare Commercial |
$411.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$269.79
|
|
|
pneumococcal 20-valent vaccine inj Dip CR Syr 0.5ml [VDMC]
|
Facility
|
IP
|
$457.27
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
23914697
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$320.09 |
| Max. Negotiated Rate |
$411.54 |
| Rate for Payer: Aetna of IA Commercial |
$411.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$411.54
|
| Rate for Payer: Cash Price |
$365.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$342.95
|
| Rate for Payer: Medical Associates Commercial |
$342.95
|
| Rate for Payer: Midlands Choice Commercial |
$320.09
|
| Rate for Payer: United Healthcare Commercial |
$411.54
|
|
|
pneumococcal 23-valent vaccine Inj Sol 0.5ml [VDMC]
|
Facility
|
IP
|
$227.88
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
10414054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$159.51 |
| Max. Negotiated Rate |
$205.09 |
| Rate for Payer: Aetna of IA Commercial |
$205.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$205.09
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$170.91
|
| Rate for Payer: Medical Associates Commercial |
$170.91
|
| Rate for Payer: Midlands Choice Commercial |
$159.51
|
| Rate for Payer: United Healthcare Commercial |
$205.09
|
|
|
pneumococcal 23-valent vaccine Inj Sol 0.5ml [VDMC]
|
Facility
|
OP
|
$227.88
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
10414054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$102.54 |
| Max. Negotiated Rate |
$205.09 |
| Rate for Payer: Aetna of IA Commercial |
$205.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$205.09
|
| Rate for Payer: Aetna of IA Medicare |
$129.89
|
| Rate for Payer: Amerigroup Medicaid |
$131.44
|
| Rate for Payer: Amerigroup Medicare |
$103.57
|
| Rate for Payer: Cash Price |
$182.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$170.91
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$102.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$130.16
|
| Rate for Payer: Medical Associates Commercial |
$170.91
|
| Rate for Payer: Medical Associates Managed Medicare |
$102.54
|
| Rate for Payer: Midlands Choice Commercial |
$159.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$132.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$117.93
|
| Rate for Payer: United Healthcare Commercial |
$205.09
|
| Rate for Payer: United Healthcare Managed Medicare |
$134.45
|
|
|
poliovirus vaccine, inactivated - Sus MDV [VDMC]
|
Facility
|
OP
|
$98.56
|
|
|
Service Code
|
HCPCS 90713
|
| Hospital Charge Code |
21494404
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$44.35 |
| Max. Negotiated Rate |
$88.70 |
| Rate for Payer: Aetna of IA Commercial |
$88.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.70
|
| Rate for Payer: Aetna of IA Medicare |
$56.18
|
| Rate for Payer: Amerigroup Medicaid |
$56.85
|
| Rate for Payer: Amerigroup Medicare |
$44.79
|
| Rate for Payer: Cash Price |
$78.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.92
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$44.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.30
|
| Rate for Payer: Medical Associates Commercial |
$73.92
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.35
|
| Rate for Payer: Midlands Choice Commercial |
$68.99
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.00
|
| Rate for Payer: United Healthcare Commercial |
$88.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.15
|
|
|
poliovirus vaccine, inactivated - Sus MDV [VDMC]
|
Facility
|
IP
|
$98.56
|
|
|
Service Code
|
HCPCS 90713
|
| Hospital Charge Code |
21494404
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$68.99 |
| Max. Negotiated Rate |
$88.70 |
| Rate for Payer: Aetna of IA Commercial |
$88.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.70
|
| Rate for Payer: Cash Price |
$78.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.92
|
| Rate for Payer: Medical Associates Commercial |
$73.92
|
| Rate for Payer: Midlands Choice Commercial |
$68.99
|
| Rate for Payer: United Healthcare Commercial |
$88.70
|
|
|
polycarbophil 625 mg Tab [VDMC]
|
Facility
|
IP
|
$1.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10414125
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Aetna of IA Commercial |
$1.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.06
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.88
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
|
|
polycarbophil 625 mg Tab [VDMC]
|
Facility
|
OP
|
$1.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10414125
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Aetna of IA Commercial |
$1.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.06
|
| Rate for Payer: Aetna of IA Medicare |
$0.67
|
| Rate for Payer: Amerigroup Medicaid |
$0.68
|
| Rate for Payer: Amerigroup Medicare |
$0.53
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.88
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.53
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.67
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.53
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.61
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.69
|
|
|
polyethylene glycol 3350 Oral Pwdr for Recon [VDMC]
|
Facility
|
OP
|
$21.84
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10414194
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna of IA Commercial |
$19.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.66
|
| Rate for Payer: Aetna of IA Medicare |
$12.45
|
| Rate for Payer: Amerigroup Medicaid |
$12.60
|
| Rate for Payer: Amerigroup Medicare |
$9.93
|
| Rate for Payer: Cash Price |
$17.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9.83
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.48
|
| Rate for Payer: Medical Associates Commercial |
$16.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.83
|
| Rate for Payer: Midlands Choice Commercial |
$15.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.30
|
| Rate for Payer: United Healthcare Commercial |
$19.66
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.89
|
|
|
polyethylene glycol 3350 Oral Pwdr for Recon [VDMC]
|
Facility
|
IP
|
$21.84
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10414194
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna of IA Commercial |
$19.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.66
|
| Rate for Payer: Cash Price |
$17.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.38
|
| Rate for Payer: Medical Associates Commercial |
$16.38
|
| Rate for Payer: Midlands Choice Commercial |
$15.29
|
| Rate for Payer: United Healthcare Commercial |
$19.66
|
|
|
polyethylene glycol 3350 - Pow 17 gm UD [VDMC]
|
Facility
|
OP
|
$5.36
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11221532
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna of IA Commercial |
$4.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.82
|
| Rate for Payer: Aetna of IA Medicare |
$3.05
|
| Rate for Payer: Amerigroup Medicaid |
$3.09
|
| Rate for Payer: Amerigroup Medicare |
$2.44
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.02
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.06
|
| Rate for Payer: Medical Associates Commercial |
$4.02
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.41
|
| Rate for Payer: Midlands Choice Commercial |
$3.75
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.77
|
| Rate for Payer: United Healthcare Commercial |
$4.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.16
|
|
|
polyethylene glycol 3350 - Pow 17 gm UD [VDMC]
|
Facility
|
IP
|
$5.36
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11221532
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna of IA Commercial |
$4.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.82
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.02
|
| Rate for Payer: Medical Associates Commercial |
$4.02
|
| Rate for Payer: Midlands Choice Commercial |
$3.75
|
| Rate for Payer: United Healthcare Commercial |
$4.82
|
|
|
Porphobilinogen Urine Timed DMCL
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
8037737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.55 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$80.18
|
| Rate for Payer: Amerigroup Medicare |
$63.18
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$62.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.40
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.55
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.93
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
|
|
Porphobilinogen Urine Timed DMCL
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
8037737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
POST TITANIUM 4.5MM X 25MM
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
|
|
POST TITANIUM 4.5MM X 25MM
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Aetna of IA Medicare |
$102.60
|
| Rate for Payer: Amerigroup Medicaid |
$103.82
|
| Rate for Payer: Amerigroup Medicare |
$81.81
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$102.82
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.15
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.20
|
|
|
POST/WASHER TITANIUM 4.5MM X 27.5MM
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Aetna of IA Medicare |
$102.60
|
| Rate for Payer: Amerigroup Medicaid |
$103.82
|
| Rate for Payer: Amerigroup Medicare |
$81.81
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$102.82
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.15
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.20
|
|
|
POST/WASHER TITANIUM 4.5MM X 27.5MM
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
|
|
POST/WASHER TITANIUM 4.5MMX30MM
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Aetna of IA Medicare |
$102.60
|
| Rate for Payer: Amerigroup Medicaid |
$103.82
|
| Rate for Payer: Amerigroup Medicare |
$81.81
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$102.82
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.15
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.20
|
|
|
POST/WASHER TITANIUM 4.5MMX30MM
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
|
|
POST/WASHER TITANIUM 4.5MM X 35.7MM
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Aetna of IA Medicare |
$102.60
|
| Rate for Payer: Amerigroup Medicaid |
$103.82
|
| Rate for Payer: Amerigroup Medicare |
$81.81
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$102.82
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.15
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.20
|
|
|
POST/WASHER TITANIUM 4.5MM X 35.7MM
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
|
|
POST/ WASHER TITANIUM 4.5MM X 35MM
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
|
|
POST/ WASHER TITANIUM 4.5MM X 35MM
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Aetna of IA Medicare |
$102.60
|
| Rate for Payer: Amerigroup Medicaid |
$103.82
|
| Rate for Payer: Amerigroup Medicare |
$81.81
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$102.82
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.15
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.20
|
|
