|
PUNCH FOR 3.5MM PUNCHLOCK
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$178.93 |
| Max. Negotiated Rate |
$322.20 |
| Rate for Payer: Aetna of IA Commercial |
$322.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$322.20
|
| Rate for Payer: Aetna of IA Medicare |
$204.06
|
| Rate for Payer: Amerigroup Medicaid |
$180.68
|
| Rate for Payer: Amerigroup Medicare |
$180.79
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$268.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$179.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$178.93
|
| Rate for Payer: Medical Associates Commercial |
$268.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$179.00
|
| Rate for Payer: Midlands Choice Commercial |
$250.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$181.68
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$181.58
|
| Rate for Payer: Oscar Health of IA Commercial |
$268.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$268.50
|
| Rate for Payer: United Healthcare Commercial |
$322.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$211.22
|
|
|
PUNCTURE DRAINAGE OF LESION
|
Professional
|
Both
|
$294.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
7982854
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$88.17 |
| Max. Negotiated Rate |
$205.80 |
| Rate for Payer: Aetna of IA Medicare |
$88.17
|
| Rate for Payer: Amerigroup Medicaid |
$91.17
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.93
|
| Rate for Payer: Medical Associates Commercial |
$158.71
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.17
|
| Rate for Payer: Midlands Choice Commercial |
$205.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$152.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$132.26
|
|
|
PUSHLOCK DISPOSABLE KIT FOR HIP
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
|
|
PUSHLOCK DISPOSABLE KIT FOR HIP
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Aetna of IA Medicare |
$179.55
|
| Rate for Payer: Amerigroup Medicaid |
$158.98
|
| Rate for Payer: Amerigroup Medicare |
$159.08
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$157.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$157.44
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$159.86
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$159.77
|
| Rate for Payer: Oscar Health of IA Commercial |
$236.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$236.25
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
|
PUSHLOCK KIT
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
|
|
PUSHLOCK KIT
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Aetna of IA Medicare |
$179.55
|
| Rate for Payer: Amerigroup Medicaid |
$158.98
|
| Rate for Payer: Amerigroup Medicare |
$159.08
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$157.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$157.44
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$159.86
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$159.77
|
| Rate for Payer: Oscar Health of IA Commercial |
$236.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$236.25
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
|
PUTTY BONE GRAFT MATRIXCELLECT 100 ALLOGRAFT 2.5ML
|
Facility
|
OP
|
$1,090.32
|
|
|
Service Code
|
CPT C9359
|
| Hospital Charge Code |
8935709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.94 |
| Max. Negotiated Rate |
$981.29 |
| Rate for Payer: Aetna of IA Commercial |
$981.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$981.29
|
| Rate for Payer: Aetna of IA Medicare |
$621.48
|
| Rate for Payer: Amerigroup Medicaid |
$550.28
|
| Rate for Payer: Amerigroup Medicare |
$550.61
|
| Rate for Payer: Cash Price |
$872.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$817.74
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$545.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$544.94
|
| Rate for Payer: Medical Associates Commercial |
$817.74
|
| Rate for Payer: Medical Associates Managed Medicare |
$545.16
|
| Rate for Payer: Midlands Choice Commercial |
$763.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$553.34
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$553.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$817.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$817.74
|
| Rate for Payer: United Healthcare Commercial |
$981.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$643.29
|
|
|
PUTTY BONE GRAFT MATRIXCELLECT 100 ALLOGRAFT 2.5ML
|
Facility
|
IP
|
$1,090.32
|
|
|
Service Code
|
CPT C9359
|
| Hospital Charge Code |
8935709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$763.22 |
| Max. Negotiated Rate |
$981.29 |
| Rate for Payer: Aetna of IA Commercial |
$981.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$981.29
|
| Rate for Payer: Cash Price |
$872.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$817.74
|
| Rate for Payer: Medical Associates Commercial |
$817.74
|
| Rate for Payer: Midlands Choice Commercial |
$763.22
|
| Rate for Payer: United Healthcare Commercial |
$981.29
|
|
|
pyridostiGMine 5 mg/mL Inj Sol [VDMC]
|
Facility
|
OP
|
$140.62
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10417699
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$70.28 |
| Max. Negotiated Rate |
$126.56 |
| Rate for Payer: Aetna of IA Commercial |
$126.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.56
|
| Rate for Payer: Aetna of IA Medicare |
$80.15
|
| Rate for Payer: Amerigroup Medicaid |
$70.97
|
| Rate for Payer: Amerigroup Medicare |
$71.01
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.46
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.31
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$70.28
|
| Rate for Payer: Medical Associates Commercial |
$105.46
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.31
|
| Rate for Payer: Midlands Choice Commercial |
$98.43
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.36
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$71.32
|
| Rate for Payer: Oscar Health of IA Commercial |
$105.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$105.46
|
| Rate for Payer: United Healthcare Commercial |
$126.56
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.97
|
|
|
pyridostiGMine 5 mg/mL Inj Sol [VDMC]
|
Facility
|
IP
|
$140.62
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10417699
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$98.43 |
| Max. Negotiated Rate |
$126.56 |
| Rate for Payer: Aetna of IA Commercial |
$126.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.56
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.46
|
| Rate for Payer: Medical Associates Commercial |
$105.46
|
| Rate for Payer: Midlands Choice Commercial |
$98.43
|
| Rate for Payer: United Healthcare Commercial |
$126.56
|
|
|
pyridostiGMine 60 mg Tab [VDMC]
|
Facility
|
IP
|
$2.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of IA Commercial |
$1.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.90
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.58
|
| Rate for Payer: Medical Associates Commercial |
$1.58
|
| Rate for Payer: Midlands Choice Commercial |
$1.48
|
| Rate for Payer: United Healthcare Commercial |
$1.90
|
|
|
pyridostiGMine 60 mg Tab [VDMC]
|
Facility
|
OP
|
$2.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of IA Commercial |
$1.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.90
|
| Rate for Payer: Aetna of IA Medicare |
$1.20
|
| Rate for Payer: Amerigroup Medicaid |
$1.06
|
| Rate for Payer: Amerigroup Medicare |
$1.07
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.58
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.05
|
| Rate for Payer: Medical Associates Commercial |
$1.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.06
|
| Rate for Payer: Midlands Choice Commercial |
$1.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.07
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.07
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.58
|
| Rate for Payer: United Healthcare Commercial |
$1.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.24
|
|
|
pyridoxine 100 mg/mL 1ml MDV Inj [VDMC]
|
Facility
|
IP
|
$51.07
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
10417841
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$45.96 |
| Rate for Payer: Aetna of IA Commercial |
$45.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.96
|
| Rate for Payer: Cash Price |
$40.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.30
|
| Rate for Payer: Medical Associates Commercial |
$38.30
|
| Rate for Payer: Midlands Choice Commercial |
$35.75
|
| Rate for Payer: United Healthcare Commercial |
$45.96
|
|
|
pyridoxine 100 mg/mL 1ml MDV Inj [VDMC]
|
Facility
|
OP
|
$51.07
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
10417841
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$45.96 |
| Rate for Payer: Aetna of IA Commercial |
$45.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.96
|
| Rate for Payer: Aetna of IA Medicare |
$29.11
|
| Rate for Payer: Amerigroup Medicaid |
$25.78
|
| Rate for Payer: Amerigroup Medicare |
$25.79
|
| Rate for Payer: Cash Price |
$40.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.30
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.52
|
| Rate for Payer: Medical Associates Commercial |
$38.30
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.54
|
| Rate for Payer: Midlands Choice Commercial |
$35.75
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.92
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$25.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$38.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$38.30
|
| Rate for Payer: United Healthcare Commercial |
$45.96
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.13
|
|
|
pyridoxine 50 mg Tab [VDMC]
|
Facility
|
OP
|
$1.05
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417910
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of IA Commercial |
$0.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.95
|
| Rate for Payer: Aetna of IA Medicare |
$0.60
|
| Rate for Payer: Amerigroup Medicaid |
$0.53
|
| Rate for Payer: Amerigroup Medicare |
$0.53
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.79
|
| 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 |
$0.52
|
| Rate for Payer: Medical Associates Commercial |
$0.79
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.53
|
| Rate for Payer: Midlands Choice Commercial |
$0.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.53
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.53
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.62
|
|
|
pyridoxine 50 mg Tab [VDMC]
|
Facility
|
IP
|
$1.05
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417910
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of IA Commercial |
$0.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.95
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.79
|
| Rate for Payer: Medical Associates Commercial |
$0.79
|
| Rate for Payer: Midlands Choice Commercial |
$0.74
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
Quantiferon TB Gold Plus DMCL
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
8488909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.97 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of IA Commercial |
$126.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.00
|
| Rate for Payer: Aetna of IA Medicare |
$79.80
|
| Rate for Payer: Amerigroup Medicaid |
$70.66
|
| Rate for Payer: Amerigroup Medicare |
$70.70
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.97
|
| Rate for Payer: Medical Associates Commercial |
$105.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.00
|
| Rate for Payer: Midlands Choice Commercial |
$98.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.05
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$71.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$105.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$105.00
|
| Rate for Payer: United Healthcare Commercial |
$126.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.60
|
| Rate for Payer: Wellmark IA HMO |
$96.72
|
| Rate for Payer: Wellmark IA PPO |
$106.39
|
|
|
Quantiferon TB Gold Plus DMCL
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
8488909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of IA Commercial |
$126.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.00
|
| Rate for Payer: Medical Associates Commercial |
$105.00
|
| Rate for Payer: Midlands Choice Commercial |
$98.00
|
| Rate for Payer: United Healthcare Commercial |
$126.00
|
|
|
QUEtiapine 100 mg Tab [VDMC]
|
Facility
|
OP
|
$2.45
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna of IA Commercial |
$2.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.20
|
| Rate for Payer: Aetna of IA Medicare |
$1.40
|
| Rate for Payer: Amerigroup Medicaid |
$1.24
|
| Rate for Payer: Amerigroup Medicare |
$1.24
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.84
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.22
|
| Rate for Payer: Medical Associates Commercial |
$1.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.22
|
| Rate for Payer: Midlands Choice Commercial |
$1.72
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.24
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.24
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.84
|
| Rate for Payer: United Healthcare Commercial |
$2.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.45
|
|
|
QUEtiapine 100 mg Tab [VDMC]
|
Facility
|
IP
|
$2.45
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna of IA Commercial |
$2.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.20
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.84
|
| Rate for Payer: Medical Associates Commercial |
$1.84
|
| Rate for Payer: Midlands Choice Commercial |
$1.72
|
| Rate for Payer: United Healthcare Commercial |
$2.20
|
|
|
QUEtiapine 25 mg Tab [VDMC]
|
Facility
|
IP
|
$1.13
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10418050
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of IA Commercial |
$1.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.02
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.85
|
| Rate for Payer: Medical Associates Commercial |
$0.85
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
|
|
QUEtiapine 25 mg Tab [VDMC]
|
Facility
|
OP
|
$1.13
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10418050
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of IA Commercial |
$1.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.02
|
| Rate for Payer: Aetna of IA Medicare |
$0.64
|
| Rate for Payer: Amerigroup Medicaid |
$0.57
|
| Rate for Payer: Amerigroup Medicare |
$0.57
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.85
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.56
|
| Rate for Payer: Medical Associates Commercial |
$0.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.57
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.57
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.67
|
|
|
QUICKFIX SCREW 2X10MM
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8852325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$215.91 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna of IA Commercial |
$388.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$388.80
|
| Rate for Payer: Aetna of IA Medicare |
$246.24
|
| Rate for Payer: Amerigroup Medicaid |
$218.03
|
| Rate for Payer: Amerigroup Medicare |
$218.16
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$324.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$216.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$215.91
|
| Rate for Payer: Medical Associates Commercial |
$324.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$216.00
|
| Rate for Payer: Midlands Choice Commercial |
$302.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$219.24
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$219.11
|
| Rate for Payer: Oscar Health of IA Commercial |
$324.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$324.00
|
| Rate for Payer: United Healthcare Commercial |
$388.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$254.88
|
|
|
QUICKFIX SCREW 2X10MM
|
Facility
|
IP
|
$432.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8852325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$302.40 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna of IA Commercial |
$388.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$388.80
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$324.00
|
| Rate for Payer: Medical Associates Commercial |
$324.00
|
| Rate for Payer: Midlands Choice Commercial |
$302.40
|
| Rate for Payer: United Healthcare Commercial |
$388.80
|
|
|
QUICKFIX SCREW 2X11MM
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
CPT C1783
|
| Hospital Charge Code |
8463228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$215.91 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna of IA Commercial |
$388.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$388.80
|
| Rate for Payer: Aetna of IA Medicare |
$246.24
|
| Rate for Payer: Amerigroup Medicaid |
$218.03
|
| Rate for Payer: Amerigroup Medicare |
$218.16
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$324.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$216.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$215.91
|
| Rate for Payer: Medical Associates Commercial |
$324.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$216.00
|
| Rate for Payer: Midlands Choice Commercial |
$302.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$219.24
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$219.11
|
| Rate for Payer: Oscar Health of IA Commercial |
$324.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$324.00
|
| Rate for Payer: United Healthcare Commercial |
$388.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$254.88
|
|
