|
Vitamin B6 Level
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
8519185
|
|
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
|
|
|
Vitamin B6 Level
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
8519185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| 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 |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| 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 |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$70.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$104.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Vitamin D 1 25 Dihydroxy DMCL
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
8037828
|
|
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
|
|
|
Vitamin D 1 25 Dihydroxy DMCL
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
8037828
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.47 |
| 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 |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| 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 |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$70.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$104.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$102.92
|
| Rate for Payer: Wellmark IA PPO |
$113.21
|
|
|
Vitamin D 25 Hydroxy DMCL
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
8037829
|
|
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
|
|
|
Vitamin D 25 Hydroxy DMCL
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
8037829
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.47 |
| 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 |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| 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 |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$70.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$104.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$102.92
|
| Rate for Payer: Wellmark IA PPO |
$113.21
|
|
|
vitamin E 400 intl units Cap [VDMC]
|
Facility
|
IP
|
$1.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10428414
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of IA Commercial |
$1.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.05
|
| 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 |
$1.05
|
|
|
vitamin E 400 intl units Cap [VDMC]
|
Facility
|
OP
|
$1.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10428414
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of IA Commercial |
$1.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.05
|
| Rate for Payer: Aetna of IA Medicare |
$0.67
|
| Rate for Payer: Amerigroup Medicaid |
$0.59
|
| Rate for Payer: Amerigroup Medicare |
$0.59
|
| 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 |
$0.59
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.58
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.59
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.59
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.59
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$1.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.69
|
|
|
VRE CULTURE
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
4024793
|
|
Hospital Revenue Code
|
306
|
| 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: 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
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
VRE CULTURE
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
4024793
|
|
Hospital Revenue Code
|
306
|
| 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
|
|
|
warfarin 1 mg Tab [VDMC]
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10432468
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna of IA Commercial |
$1.35
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.35
|
| Rate for Payer: Cash Price |
$1.20
|
| 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 |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$1.35
|
|
|
warfarin 1 mg Tab [VDMC]
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10432468
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna of IA Commercial |
$1.35
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.35
|
| Rate for Payer: Aetna of IA Medicare |
$0.86
|
| Rate for Payer: Amerigroup Medicaid |
$0.76
|
| Rate for Payer: Amerigroup Medicare |
$0.76
|
| Rate for Payer: Cash Price |
$1.20
|
| 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 |
$0.75
|
| Rate for Payer: Medical Associates Commercial |
$1.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.75
|
| Rate for Payer: Midlands Choice Commercial |
$1.05
|
| 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 |
$1.35
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.89
|
|
|
warfarin 2 mg Tab [VDMC]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10428554
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna of IA Commercial |
$1.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.30
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.08
|
| Rate for Payer: Medical Associates Commercial |
$1.08
|
| Rate for Payer: Midlands Choice Commercial |
$1.01
|
| Rate for Payer: United Healthcare Commercial |
$1.30
|
|
|
warfarin 2 mg Tab [VDMC]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10428554
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna of IA Commercial |
$1.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.30
|
| Rate for Payer: Aetna of IA Medicare |
$0.82
|
| Rate for Payer: Amerigroup Medicaid |
$0.73
|
| Rate for Payer: Amerigroup Medicare |
$0.73
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.08
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.72
|
| Rate for Payer: Medical Associates Commercial |
$1.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.72
|
| Rate for Payer: Midlands Choice Commercial |
$1.01
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.73
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.73
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.85
|
|
|
warfarin 3 mg Tab [VDMC]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10432533
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna of IA Commercial |
$1.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.30
|
| Rate for Payer: Aetna of IA Medicare |
$0.82
|
| Rate for Payer: Amerigroup Medicaid |
$0.73
|
| Rate for Payer: Amerigroup Medicare |
$0.73
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.08
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.72
|
| Rate for Payer: Medical Associates Commercial |
$1.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.72
|
| Rate for Payer: Midlands Choice Commercial |
$1.01
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.73
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.73
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.85
|
|
|
warfarin 3 mg Tab [VDMC]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10432533
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna of IA Commercial |
$1.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.30
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.08
|
| Rate for Payer: Medical Associates Commercial |
$1.08
|
| Rate for Payer: Midlands Choice Commercial |
$1.01
|
| Rate for Payer: United Healthcare Commercial |
$1.30
|
|
|
warfarin 5 mg Tab [VDMC]
|
Facility
|
IP
|
$2.13
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10428621
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Aetna of IA Commercial |
$1.92
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.92
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.60
|
| Rate for Payer: Medical Associates Commercial |
$1.60
|
| Rate for Payer: Midlands Choice Commercial |
$1.49
|
| Rate for Payer: United Healthcare Commercial |
$1.92
|
|
|
warfarin 5 mg Tab [VDMC]
|
Facility
|
OP
|
$2.13
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10428621
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Aetna of IA Commercial |
$1.92
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.92
|
| Rate for Payer: Aetna of IA Medicare |
$1.21
|
| Rate for Payer: Amerigroup Medicaid |
$1.08
|
| Rate for Payer: Amerigroup Medicare |
$1.08
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.60
|
| 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 |
$1.06
|
| Rate for Payer: Medical Associates Commercial |
$1.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.06
|
| Rate for Payer: Midlands Choice Commercial |
$1.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.08
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.08
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.60
|
| Rate for Payer: United Healthcare Commercial |
$1.92
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.26
|
|
|
WASHER 10MM TITANIUM 4.5NN SCREW
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Medical Associates Commercial |
$108.00
|
| Rate for Payer: Aetna of IA Commercial |
$129.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$129.60
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.00
|
| Rate for Payer: Midlands Choice Commercial |
$100.80
|
| Rate for Payer: United Healthcare Commercial |
$129.60
|
|
|
WASHER 10MM TITANIUM 4.5NN SCREW
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.97 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna of IA Commercial |
$129.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$129.60
|
| Rate for Payer: Aetna of IA Medicare |
$82.08
|
| Rate for Payer: Amerigroup Medicaid |
$72.68
|
| Rate for Payer: Amerigroup Medicare |
$72.72
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$72.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.97
|
| Rate for Payer: Medical Associates Commercial |
$108.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.00
|
| Rate for Payer: Midlands Choice Commercial |
$100.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$73.08
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$73.04
|
| Rate for Payer: Oscar Health of IA Commercial |
$108.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$108.00
|
| Rate for Payer: United Healthcare Commercial |
$129.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.96
|
|
|
WASHER 13MM TITANIUM 5.5MM SCREW
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Aetna of IA Medicare |
$59.28
|
| Rate for Payer: Amerigroup Medicaid |
$52.49
|
| Rate for Payer: Amerigroup Medicare |
$52.52
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.78
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$52.75
|
| Rate for Payer: Oscar Health of IA Commercial |
$78.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.00
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.36
|
|
|
WASHER 13MM TITANIUM 5.5MM SCREW
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
|
|
WASHER AXSOS SMALL FRAGMENT 7MM
|
Facility
|
IP
|
$37.00
|
|
| Hospital Charge Code |
8046700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna of IA Commercial |
$33.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.30
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.75
|
| Rate for Payer: Medical Associates Commercial |
$27.75
|
| Rate for Payer: Midlands Choice Commercial |
$25.90
|
| Rate for Payer: United Healthcare Commercial |
$33.30
|
|
|
WASHER AXSOS SMALL FRAGMENT 7MM
|
Facility
|
OP
|
$37.00
|
|
| Hospital Charge Code |
8046700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna of IA Commercial |
$33.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.30
|
| Rate for Payer: Aetna of IA Medicare |
$21.09
|
| Rate for Payer: Amerigroup Medicaid |
$18.67
|
| Rate for Payer: Amerigroup Medicare |
$18.68
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.49
|
| Rate for Payer: Medical Associates Commercial |
$27.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.50
|
| Rate for Payer: Midlands Choice Commercial |
$25.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.78
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$18.77
|
| Rate for Payer: Oscar Health of IA Commercial |
$27.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.75
|
| Rate for Payer: United Healthcare Commercial |
$33.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.83
|
|
|
WASHER AXSOS SMALL FRAGMENT 9MM
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.99 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of IA Commercial |
$34.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.20
|
| Rate for Payer: Aetna of IA Medicare |
$21.66
|
| Rate for Payer: Amerigroup Medicaid |
$19.18
|
| Rate for Payer: Amerigroup Medicare |
$19.19
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$19.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.99
|
| Rate for Payer: Medical Associates Commercial |
$28.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.00
|
| Rate for Payer: Midlands Choice Commercial |
$26.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19.28
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$19.27
|
| Rate for Payer: Oscar Health of IA Commercial |
$28.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.50
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$22.42
|
|
