|
DRAIN/INJ JOINT/BURSA W/O US
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
7982814
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$40.97 |
| Max. Negotiated Rate |
$98.23 |
| Rate for Payer: Aetna of IA Medicare |
$40.97
|
| Rate for Payer: Amerigroup Medicaid |
$42.36
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.79
|
| Rate for Payer: Medical Associates Commercial |
$73.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.97
|
| Rate for Payer: Midlands Choice Commercial |
$98.23
|
| Rate for Payer: Oscar Health of IA Commercial |
$70.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$61.46
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
7982815
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$77.70 |
| Rate for Payer: Aetna of IA Medicare |
$32.52
|
| Rate for Payer: Amerigroup Medicaid |
$33.63
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.17
|
| Rate for Payer: Medical Associates Commercial |
$58.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.52
|
| Rate for Payer: Midlands Choice Commercial |
$77.70
|
| Rate for Payer: Oscar Health of IA Commercial |
$56.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.78
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
4864802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.40 |
| Max. Negotiated Rate |
$361.80 |
| Rate for Payer: Aetna of IA Commercial |
$361.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$361.80
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$301.50
|
| Rate for Payer: Medical Associates Commercial |
$301.50
|
| Rate for Payer: Midlands Choice Commercial |
$281.40
|
| Rate for Payer: United Healthcare Commercial |
$361.80
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
4864802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.92 |
| Max. Negotiated Rate |
$705.87 |
| Rate for Payer: Aetna of IA Commercial |
$361.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$361.80
|
| Rate for Payer: Aetna of IA Medicare |
$229.14
|
| Rate for Payer: Amerigroup Medicaid |
$202.89
|
| Rate for Payer: Amerigroup Medicare |
$203.01
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$301.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$201.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$200.92
|
| Rate for Payer: Medical Associates Commercial |
$301.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$201.00
|
| Rate for Payer: Midlands Choice Commercial |
$281.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$204.02
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$203.89
|
| Rate for Payer: Oscar Health of IA Commercial |
$301.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$301.50
|
| Rate for Payer: United Healthcare Commercial |
$361.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$237.18
|
| Rate for Payer: Wellmark IA HMO |
$641.70
|
| Rate for Payer: Wellmark IA PPO |
$705.87
|
|
|
DRAIN LOWER LEG LESION
|
Professional
|
Both
|
$1,761.00
|
|
|
Service Code
|
CPT 27603
|
| Hospital Charge Code |
7982865
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$354.08 |
| Max. Negotiated Rate |
$1,232.70 |
| Rate for Payer: Aetna of IA Medicare |
$354.08
|
| Rate for Payer: Amerigroup Medicaid |
$366.12
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$424.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$361.16
|
| Rate for Payer: Medical Associates Commercial |
$637.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$354.08
|
| Rate for Payer: Midlands Choice Commercial |
$1,232.70
|
| Rate for Payer: Oscar Health of IA Commercial |
$612.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$531.12
|
|
|
DRAIN THIGH/KNEE LESION
|
Professional
|
Both
|
$2,238.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
7982796
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$460.74 |
| Max. Negotiated Rate |
$1,566.60 |
| Rate for Payer: Aetna of IA Medicare |
$460.74
|
| Rate for Payer: Amerigroup Medicaid |
$476.41
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$552.89
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$469.95
|
| Rate for Payer: Medical Associates Commercial |
$829.33
|
| Rate for Payer: Medical Associates Managed Medicare |
$460.74
|
| Rate for Payer: Midlands Choice Commercial |
$1,566.60
|
| Rate for Payer: Oscar Health of IA Commercial |
$797.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$691.11
|
|
|
DRESS/DEBRID P-THICK BURN M
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
7982817
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$100.48 |
| Max. Negotiated Rate |
$342.30 |
| Rate for Payer: Aetna of IA Medicare |
$100.48
|
| Rate for Payer: Amerigroup Medicaid |
$103.90
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$102.49
|
| Rate for Payer: Medical Associates Commercial |
$180.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$100.48
|
| Rate for Payer: Midlands Choice Commercial |
$342.30
|
| Rate for Payer: Oscar Health of IA Commercial |
$173.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$150.72
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Professional
|
Both
|
$219.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
7982818
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$50.46 |
| Max. Negotiated Rate |
$153.30 |
| Rate for Payer: Aetna of IA Medicare |
$50.46
|
| Rate for Payer: Amerigroup Medicaid |
$52.18
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$60.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.47
|
| Rate for Payer: Medical Associates Commercial |
$90.83
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.46
|
| Rate for Payer: Midlands Choice Commercial |
$153.30
|
| Rate for Payer: Oscar Health of IA Commercial |
$87.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.69
|
|
|
DRILL BIT 4.2X180MM AO SMALL
|
Facility
|
IP
|
$214.00
|
|
| Hospital Charge Code |
8046331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Aetna of IA Commercial |
$192.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$192.60
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$160.50
|
| Rate for Payer: Medical Associates Commercial |
$160.50
|
| Rate for Payer: Midlands Choice Commercial |
$149.80
|
| Rate for Payer: United Healthcare Commercial |
$192.60
|
|
|
DRILL BIT 4.2X180MM AO SMALL
|
Facility
|
OP
|
$214.00
|
|
| Hospital Charge Code |
8046331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.96 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Aetna of IA Commercial |
$192.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$192.60
|
| Rate for Payer: Aetna of IA Medicare |
$121.98
|
| Rate for Payer: Amerigroup Medicaid |
$108.01
|
| Rate for Payer: Amerigroup Medicare |
$108.07
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$160.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$107.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$106.96
|
| Rate for Payer: Medical Associates Commercial |
$160.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$107.00
|
| Rate for Payer: Midlands Choice Commercial |
$149.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$108.60
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$108.54
|
| Rate for Payer: Oscar Health of IA Commercial |
$160.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$160.50
|
| Rate for Payer: United Healthcare Commercial |
$192.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$126.26
|
|
|
DRILL BIT JUGGER KNOT 1.4MM SHORT SINGLE
|
Facility
|
OP
|
$198.00
|
|
| Hospital Charge Code |
8026375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$100.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$148.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
DRILL BIT JUGGER KNOT 1.4MM SHORT SINGLE
|
Facility
|
IP
|
$198.00
|
|
| Hospital Charge Code |
8026375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
DRILL PIN 2MM X 100MM
|
Facility
|
OP
|
$441.00
|
|
| Hospital Charge Code |
8046948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.41 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna of IA Commercial |
$396.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$396.90
|
| Rate for Payer: Aetna of IA Medicare |
$251.37
|
| Rate for Payer: Amerigroup Medicaid |
$222.57
|
| Rate for Payer: Amerigroup Medicare |
$222.70
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$330.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$220.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$220.41
|
| Rate for Payer: Medical Associates Commercial |
$330.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$220.50
|
| Rate for Payer: Midlands Choice Commercial |
$308.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$223.81
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$223.68
|
| Rate for Payer: Oscar Health of IA Commercial |
$330.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$330.75
|
| Rate for Payer: United Healthcare Commercial |
$396.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$260.19
|
|
|
DRILL PIN 2MM X 100MM
|
Facility
|
IP
|
$441.00
|
|
| Hospital Charge Code |
8046948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$308.70 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna of IA Commercial |
$396.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$396.90
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$330.75
|
| Rate for Payer: Medical Associates Commercial |
$330.75
|
| Rate for Payer: Midlands Choice Commercial |
$308.70
|
| Rate for Payer: United Healthcare Commercial |
$396.90
|
|
|
DRILL PIN II
|
Facility
|
OP
|
$207.00
|
|
| Hospital Charge Code |
8026406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$186.30 |
| Rate for Payer: Aetna of IA Commercial |
$186.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$186.30
|
| Rate for Payer: Aetna of IA Medicare |
$117.99
|
| Rate for Payer: Amerigroup Medicaid |
$104.47
|
| Rate for Payer: Amerigroup Medicare |
$104.54
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$155.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$103.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$103.46
|
| Rate for Payer: Medical Associates Commercial |
$155.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$103.50
|
| Rate for Payer: Midlands Choice Commercial |
$144.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$105.05
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$104.99
|
| Rate for Payer: Oscar Health of IA Commercial |
$155.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$155.25
|
| Rate for Payer: United Healthcare Commercial |
$186.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$122.13
|
|
|
DRILL PIN II
|
Facility
|
IP
|
$207.00
|
|
| Hospital Charge Code |
8026406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$186.30 |
| Rate for Payer: Aetna of IA Commercial |
$186.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$186.30
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$155.25
|
| Rate for Payer: Medical Associates Commercial |
$155.25
|
| Rate for Payer: Midlands Choice Commercial |
$144.90
|
| Rate for Payer: United Healthcare Commercial |
$186.30
|
|
|
DRILL SPEEDGUIDE AO DIA 2.6MM
|
Facility
|
IP
|
$253.00
|
|
| Hospital Charge Code |
8046967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.10 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Aetna of IA Commercial |
$227.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$227.70
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.75
|
| Rate for Payer: Medical Associates Commercial |
$189.75
|
| Rate for Payer: Midlands Choice Commercial |
$177.10
|
| Rate for Payer: United Healthcare Commercial |
$227.70
|
|
|
DRILL SPEEDGUIDE AO DIA 2.6MM
|
Facility
|
OP
|
$253.00
|
|
| Hospital Charge Code |
8046967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Aetna of IA Commercial |
$227.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$227.70
|
| Rate for Payer: Aetna of IA Medicare |
$144.21
|
| Rate for Payer: Amerigroup Medicaid |
$127.69
|
| Rate for Payer: Amerigroup Medicare |
$127.76
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$126.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.45
|
| Rate for Payer: Medical Associates Commercial |
$189.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$126.50
|
| Rate for Payer: Midlands Choice Commercial |
$177.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.40
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$128.32
|
| Rate for Payer: Oscar Health of IA Commercial |
$189.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$189.75
|
| Rate for Payer: United Healthcare Commercial |
$227.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$149.27
|
|
|
DRILL SPEEDGUIDE AO DIA 2.6MM-1
|
Facility
|
OP
|
$253.00
|
|
| Hospital Charge Code |
8046968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Aetna of IA Commercial |
$227.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$227.70
|
| Rate for Payer: Aetna of IA Medicare |
$144.21
|
| Rate for Payer: Amerigroup Medicaid |
$127.69
|
| Rate for Payer: Amerigroup Medicare |
$127.76
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$126.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.45
|
| Rate for Payer: Medical Associates Commercial |
$189.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$126.50
|
| Rate for Payer: Midlands Choice Commercial |
$177.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.40
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$128.32
|
| Rate for Payer: Oscar Health of IA Commercial |
$189.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$189.75
|
| Rate for Payer: United Healthcare Commercial |
$227.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$149.27
|
|
|
DRILL SPEEDGUIDE AO DIA 2.6MM-1
|
Facility
|
IP
|
$253.00
|
|
| Hospital Charge Code |
8046968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.10 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Aetna of IA Commercial |
$227.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$227.70
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.75
|
| Rate for Payer: Medical Associates Commercial |
$189.75
|
| Rate for Payer: Midlands Choice Commercial |
$177.10
|
| Rate for Payer: United Healthcare Commercial |
$227.70
|
|
|
DRILL TWIST 1.9 DIAM AO END 105MM L41MM
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
8046887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of IA Commercial |
$63.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.50
|
| Rate for Payer: Medical Associates Commercial |
$52.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.00
|
| Rate for Payer: United Healthcare Commercial |
$63.00
|
|
|
DRILL TWIST 1.9 DIAM AO END 105MM L41MM
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
8046887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of IA Commercial |
$63.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.00
|
| Rate for Payer: Aetna of IA Medicare |
$39.90
|
| Rate for Payer: Amerigroup Medicaid |
$35.33
|
| Rate for Payer: Amerigroup Medicare |
$35.35
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.99
|
| Rate for Payer: Medical Associates Commercial |
$52.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.00
|
| Rate for Payer: Midlands Choice Commercial |
$49.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.52
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$35.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$52.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$52.50
|
| Rate for Payer: United Healthcare Commercial |
$63.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.30
|
|
|
DRILL TWIST2.0 DIAM AO END 105MM L41MM
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
8046888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of IA Commercial |
$63.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.00
|
| Rate for Payer: Aetna of IA Medicare |
$39.90
|
| Rate for Payer: Amerigroup Medicaid |
$35.33
|
| Rate for Payer: Amerigroup Medicare |
$35.35
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.99
|
| Rate for Payer: Medical Associates Commercial |
$52.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.00
|
| Rate for Payer: Midlands Choice Commercial |
$49.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.52
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$35.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$52.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$52.50
|
| Rate for Payer: United Healthcare Commercial |
$63.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.30
|
|
|
DRILL TWIST2.0 DIAM AO END 105MM L41MM
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
8046888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of IA Commercial |
$63.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.50
|
| Rate for Payer: Medical Associates Commercial |
$52.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.00
|
| Rate for Payer: United Healthcare Commercial |
$63.00
|
|
|
DRUG SCREEN-TRIAGE
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
4022799
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna of IA Commercial |
$133.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$133.20
|
| Rate for Payer: Aetna of IA Medicare |
$84.36
|
| Rate for Payer: Amerigroup Medicaid |
$74.70
|
| Rate for Payer: Amerigroup Medicare |
$74.74
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$74.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.97
|
| Rate for Payer: Medical Associates Commercial |
$111.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$74.00
|
| Rate for Payer: Midlands Choice Commercial |
$103.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.11
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$75.07
|
| Rate for Payer: Oscar Health of IA Commercial |
$111.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.00
|
| Rate for Payer: United Healthcare Commercial |
$133.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.32
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
