|
raloxifene 60 mg Tab
|
Facility
IP
|
$2.60
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna of IA Commercial |
$2.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.34
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.95
|
| Rate for Payer: Medical Associates Commercial |
$1.95
|
| Rate for Payer: Midlands Choice Commercial |
$1.82
|
| Rate for Payer: United Healthcare Commercial |
$2.34
|
|
|
raloxifene 60 mg Tab
|
Facility
OP
|
$2.60
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna of IA Commercial |
$2.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.34
|
| Rate for Payer: Aetna of IA Medicare |
$1.48
|
| Rate for Payer: Amerigroup Medicaid |
$1.31
|
| Rate for Payer: Amerigroup Medicare |
$1.31
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.30
|
| Rate for Payer: Medical Associates Commercial |
$1.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.30
|
| Rate for Payer: Midlands Choice Commercial |
$1.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.95
|
| Rate for Payer: United Healthcare Commercial |
$2.34
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.53
|
|
|
ramipril 1.25 mg Cap
|
Facility
OP
|
$1.30
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700361
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Aetna of IA Commercial |
$1.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.17
|
| Rate for Payer: Aetna of IA Medicare |
$0.74
|
| Rate for Payer: Amerigroup Medicaid |
$0.66
|
| Rate for Payer: Amerigroup Medicare |
$0.66
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.98
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.65
|
| Rate for Payer: Medical Associates Commercial |
$0.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.65
|
| Rate for Payer: Midlands Choice Commercial |
$0.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.98
|
| Rate for Payer: United Healthcare Commercial |
$1.17
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.77
|
|
|
ramipril 1.25 mg Cap
|
Facility
IP
|
$1.30
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700361
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Aetna of IA Commercial |
$1.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.17
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.98
|
| Rate for Payer: Medical Associates Commercial |
$0.98
|
| Rate for Payer: Midlands Choice Commercial |
$0.91
|
| Rate for Payer: United Healthcare Commercial |
$1.17
|
|
|
ramipril 5 mg Cap
|
Facility
IP
|
$1.11
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of IA Commercial |
$1.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.00
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.83
|
| Rate for Payer: Medical Associates Commercial |
$0.83
|
| Rate for Payer: Midlands Choice Commercial |
$0.78
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
|
|
ramipril 5 mg Cap
|
Facility
OP
|
$1.11
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of IA Commercial |
$1.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.00
|
| Rate for Payer: Aetna of IA Medicare |
$0.63
|
| Rate for Payer: Amerigroup Medicaid |
$0.56
|
| Rate for Payer: Amerigroup Medicare |
$0.56
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.83
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.55
|
| Rate for Payer: Medical Associates Commercial |
$0.83
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.56
|
| Rate for Payer: Midlands Choice Commercial |
$0.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.83
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.65
|
|
|
RANGE OF MOTION (NOT HAND)
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 95851 GP
|
| Hospital Charge Code |
6344972
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna of IA Commercial |
$45.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.00
|
| Rate for Payer: Aetna of IA Medicare |
$28.50
|
| Rate for Payer: Amerigroup Medicaid |
$25.24
|
| Rate for Payer: Amerigroup Medicare |
$25.25
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$24.99
|
| Rate for Payer: Medical Associates Commercial |
$37.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.00
|
| Rate for Payer: Midlands Choice Commercial |
$35.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$37.50
|
| Rate for Payer: United Healthcare Commercial |
$45.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$29.50
|
|
|
RANGE OF MOTION (NOT HAND)
|
Facility
IP
|
$50.00
|
|
|
Service Code
|
CPT 95851 GP
|
| Hospital Charge Code |
6344972
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna of IA Commercial |
$45.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.50
|
| Rate for Payer: Medical Associates Commercial |
$37.50
|
| Rate for Payer: Midlands Choice Commercial |
$35.00
|
| Rate for Payer: United Healthcare Commercial |
$45.00
|
|
|
ranolazine 500 mg oral ER (12hr) Tab
|
Facility
OP
|
$2.81
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43721313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Aetna of IA Commercial |
$2.53
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.53
|
| Rate for Payer: Aetna of IA Medicare |
$1.60
|
| Rate for Payer: Amerigroup Medicaid |
$1.42
|
| Rate for Payer: Amerigroup Medicare |
$1.42
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.11
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.40
|
| Rate for Payer: Medical Associates Commercial |
$2.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.40
|
| Rate for Payer: Midlands Choice Commercial |
$1.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.11
|
| Rate for Payer: United Healthcare Commercial |
$2.53
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.66
|
|
|
ranolazine 500 mg oral ER (12hr) Tab
|
Facility
IP
|
$2.81
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43721313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Aetna of IA Commercial |
$2.53
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.53
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.11
|
| Rate for Payer: Medical Associates Commercial |
$2.11
|
| Rate for Payer: Midlands Choice Commercial |
$1.97
|
| Rate for Payer: United Healthcare Commercial |
$2.53
|
|
|
Rapid Plasma Reagin DMCL
|
Facility
OP
|
$58.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
8037793
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Aetna of IA Medicare |
$33.06
|
| Rate for Payer: Amerigroup Medicaid |
$29.27
|
| Rate for Payer: Amerigroup Medicare |
$29.29
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.99
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.00
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.22
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Rapid Plasma Reagin DMCL
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
8037793
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
|
|
rasagiline 1 mg oral tablet
|
Facility
OP
|
$11.60
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700072
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Aetna of IA Commercial |
$10.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.44
|
| Rate for Payer: Aetna of IA Medicare |
$6.61
|
| Rate for Payer: Amerigroup Medicaid |
$5.85
|
| Rate for Payer: Amerigroup Medicare |
$5.86
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.70
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5.80
|
| Rate for Payer: Medical Associates Commercial |
$8.70
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.80
|
| Rate for Payer: Midlands Choice Commercial |
$8.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$8.70
|
| Rate for Payer: United Healthcare Commercial |
$10.44
|
| Rate for Payer: United Healthcare Managed Medicare |
$6.84
|
|
|
rasagiline 1 mg oral tablet
|
Facility
IP
|
$11.60
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700072
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Aetna of IA Commercial |
$10.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.44
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.70
|
| Rate for Payer: Medical Associates Commercial |
$8.70
|
| Rate for Payer: Midlands Choice Commercial |
$8.12
|
| Rate for Payer: United Healthcare Commercial |
$10.44
|
|
|
RBC AUTOMATED CELL COUNT
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
CPT 85041
|
| Hospital Charge Code |
4006787
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Aetna of IA Medicare |
$19.38
|
| Rate for Payer: Amerigroup Medicaid |
$17.16
|
| Rate for Payer: Amerigroup Medicare |
$17.17
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.99
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.00
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$25.50
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.06
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
|
RBC AUTOMATED CELL COUNT
|
Facility
IP
|
$34.00
|
|
|
Service Code
|
CPT 85041
|
| Hospital Charge Code |
4006787
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
|
|
RBC Folate DMCL
|
Facility
IP
|
$165.00
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
8037794
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna of IA Commercial |
$148.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$148.50
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$123.75
|
| Rate for Payer: Medical Associates Commercial |
$123.75
|
| Rate for Payer: Midlands Choice Commercial |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$148.50
|
|
|
RBC Folate DMCL
|
Facility
OP
|
$165.00
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
8037794
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna of IA Commercial |
$148.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$148.50
|
| Rate for Payer: Aetna of IA Medicare |
$94.05
|
| Rate for Payer: Amerigroup Medicaid |
$83.28
|
| Rate for Payer: Amerigroup Medicare |
$83.32
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$123.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$82.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$82.47
|
| Rate for Payer: Medical Associates Commercial |
$123.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$82.50
|
| Rate for Payer: Midlands Choice Commercial |
$115.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$83.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$123.75
|
| Rate for Payer: United Healthcare Commercial |
$148.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$97.35
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
REAMER, LOW PROFILE
|
Facility
IP
|
$351.00
|
|
| Hospital Charge Code |
8047061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.70 |
| Max. Negotiated Rate |
$315.90 |
| Rate for Payer: Aetna of IA Commercial |
$315.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.90
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$263.25
|
| Rate for Payer: Medical Associates Commercial |
$263.25
|
| Rate for Payer: Midlands Choice Commercial |
$245.70
|
| Rate for Payer: United Healthcare Commercial |
$315.90
|
|
|
REAMER, LOW PROFILE
|
Facility
OP
|
$351.00
|
|
| Hospital Charge Code |
8047061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.43 |
| Max. Negotiated Rate |
$315.90 |
| Rate for Payer: Aetna of IA Commercial |
$315.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.90
|
| Rate for Payer: Aetna of IA Medicare |
$200.07
|
| Rate for Payer: Amerigroup Medicaid |
$177.15
|
| Rate for Payer: Amerigroup Medicare |
$177.26
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$263.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$175.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$175.43
|
| Rate for Payer: Medical Associates Commercial |
$263.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$175.50
|
| Rate for Payer: Midlands Choice Commercial |
$245.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$178.13
|
| Rate for Payer: Partners Health Alliance Commercial |
$263.25
|
| Rate for Payer: United Healthcare Commercial |
$315.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$207.09
|
|
|
REAMER SHAFT 8.0X448MM
|
Facility
OP
|
$355.00
|
|
| Hospital Charge Code |
8025851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.43 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Amerigroup Medicare |
$179.28
|
| Rate for Payer: Aetna of IA Commercial |
$319.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$319.50
|
| Rate for Payer: Aetna of IA Medicare |
$202.35
|
| Rate for Payer: Amerigroup Medicaid |
$179.17
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$266.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$177.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$177.43
|
| Rate for Payer: Medical Associates Commercial |
$266.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$177.50
|
| Rate for Payer: Midlands Choice Commercial |
$248.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$180.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$266.25
|
| Rate for Payer: United Healthcare Commercial |
$319.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$209.45
|
|
|
REAMER SHAFT 8.0X448MM
|
Facility
IP
|
$355.00
|
|
| Hospital Charge Code |
8025851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Aetna of IA Commercial |
$319.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$319.50
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$266.25
|
| Rate for Payer: Medical Associates Commercial |
$266.25
|
| Rate for Payer: Midlands Choice Commercial |
$248.50
|
| Rate for Payer: United Healthcare Commercial |
$319.50
|
|
|
RECHARGER FOR INTELLIS ADAPTIVESTIM
|
Facility
OP
|
$2,700.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8558056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,349.46 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,430.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,430.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,539.00
|
| Rate for Payer: Amerigroup Medicaid |
$1,362.69
|
| Rate for Payer: Amerigroup Medicare |
$1,363.50
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,025.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,350.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,349.46
|
| Rate for Payer: Medical Associates Commercial |
$2,025.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,350.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,890.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,370.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,025.00
|
| Rate for Payer: United Healthcare Commercial |
$2,430.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,593.00
|
|
|
RECHARGER FOR INTELLIS ADAPTIVESTIM
|
Facility
IP
|
$2,700.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8558056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,890.00 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,430.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,430.00
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,025.00
|
| Rate for Payer: Medical Associates Commercial |
$2,025.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,890.00
|
| Rate for Payer: United Healthcare Commercial |
$2,430.00
|
|
|
RECOVERY PHASE 2
|
Facility
IP
|
$2.00
|
|
| Hospital Charge Code |
8025190
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of IA Commercial |
$1.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.80
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.50
|
| Rate for Payer: Medical Associates Commercial |
$1.50
|
| Rate for Payer: Midlands Choice Commercial |
$1.40
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
|
