|
3.5MM X 20MM LOCKING SCREW
|
Facility
IP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8812778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
|
|
3.5MM X 20MM LOCKING SCREW
|
Facility
OP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8812778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.43 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Aetna of IA Medicare |
$189.81
|
| Rate for Payer: Amerigroup Medicaid |
$168.07
|
| Rate for Payer: Amerigroup Medicare |
$168.16
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$166.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$166.43
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$166.50
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$169.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$249.75
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
|
|
3.5 MM X 22MM
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8812770
|
|
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: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
3.5 MM X 22MM
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8812770
|
|
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
|
|
|
3.5MM X 2.2MM ARSENAL LOCKING SCREW
|
Facility
IP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8955189
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
|
|
3.5MM X 2.2MM ARSENAL LOCKING SCREW
|
Facility
OP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8955189
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$202.42 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Aetna of IA Medicare |
$230.85
|
| Rate for Payer: Amerigroup Medicaid |
$204.40
|
| Rate for Payer: Amerigroup Medicare |
$204.52
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$202.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.42
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$205.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$303.75
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
|
3.5MMX22MM GL ANKLE LOCKING SCREW
|
Facility
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8760637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Aetna of IA Commercial |
$291.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$291.60
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$243.00
|
| Rate for Payer: Medical Associates Commercial |
$243.00
|
| Rate for Payer: Midlands Choice Commercial |
$226.80
|
| Rate for Payer: United Healthcare Commercial |
$291.60
|
|
|
3.5MMX22MM GL ANKLE LOCKING SCREW
|
Facility
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8760637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.94 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Aetna of IA Commercial |
$291.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$291.60
|
| Rate for Payer: Aetna of IA Medicare |
$184.68
|
| Rate for Payer: Amerigroup Medicaid |
$163.52
|
| Rate for Payer: Amerigroup Medicare |
$163.62
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$243.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$162.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$161.94
|
| Rate for Payer: Medical Associates Commercial |
$243.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$162.00
|
| Rate for Payer: Midlands Choice Commercial |
$226.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$164.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$243.00
|
| Rate for Payer: United Healthcare Commercial |
$291.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$191.16
|
|
|
3.5MMX24MM GL ANKLE LOCKING SCREW
|
Facility
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8760639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Aetna of IA Commercial |
$291.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$291.60
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$243.00
|
| Rate for Payer: Medical Associates Commercial |
$243.00
|
| Rate for Payer: Midlands Choice Commercial |
$226.80
|
| Rate for Payer: United Healthcare Commercial |
$291.60
|
|
|
3.5MMX24MM GL ANKLE LOCKING SCREW
|
Facility
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8760639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.94 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Aetna of IA Commercial |
$291.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$291.60
|
| Rate for Payer: Aetna of IA Medicare |
$184.68
|
| Rate for Payer: Amerigroup Medicaid |
$163.52
|
| Rate for Payer: Amerigroup Medicare |
$163.62
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$243.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$162.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$161.94
|
| Rate for Payer: Medical Associates Commercial |
$243.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$162.00
|
| Rate for Payer: Midlands Choice Commercial |
$226.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$164.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$243.00
|
| Rate for Payer: United Healthcare Commercial |
$291.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$191.16
|
|
|
36556 INS NON-TUNNEL CV CATH 5 YRS/>
|
Professional
|
$774.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
8069072
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.99 |
| Max. Negotiated Rate |
$541.80 |
| Rate for Payer: Aetna of IA Medicare |
$75.99
|
| Rate for Payer: Amerigroup Medicaid |
$78.57
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$91.19
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$77.51
|
| Rate for Payer: Medical Associates Commercial |
$144.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.99
|
| Rate for Payer: Midlands Choice Commercial |
$541.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.98
|
| Rate for Payer: Wellmark IA HMO |
$148.00
|
| Rate for Payer: Wellmark IA PPO |
$174.00
|
|
|
36561 INS TUNNELED CVAD W PORT AGE 5 YRS/>
|
Professional
|
$3,608.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
8069173
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$295.43 |
| Max. Negotiated Rate |
$2,525.60 |
| Rate for Payer: Aetna of IA Medicare |
$295.43
|
| Rate for Payer: Amerigroup Medicaid |
$305.47
|
| Rate for Payer: Cash Price |
$2,886.40
|
| Rate for Payer: Cash Price |
$2,886.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$354.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$301.34
|
| Rate for Payer: Medical Associates Commercial |
$561.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$295.43
|
| Rate for Payer: Midlands Choice Commercial |
$2,525.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$443.14
|
| Rate for Payer: Wellmark IA HMO |
$625.00
|
| Rate for Payer: Wellmark IA PPO |
$734.00
|
|
|
36573 Insertion of PICC w/o port including imaging- age 5+
|
Professional
|
$651.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
8799169
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.25 |
| Max. Negotiated Rate |
$455.70 |
| Rate for Payer: Aetna of IA Medicare |
$75.25
|
| Rate for Payer: Amerigroup Medicaid |
$77.81
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$90.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$76.76
|
| Rate for Payer: Medical Associates Commercial |
$142.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.25
|
| Rate for Payer: Midlands Choice Commercial |
$455.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$112.88
|
| Rate for Payer: Wellmark IA HMO |
$157.00
|
| Rate for Payer: Wellmark IA PPO |
$185.00
|
|
|
36589 Removal tunneled central venous catheter
|
Professional
|
$465.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
8799170
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$121.90 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna of IA Medicare |
$121.90
|
| Rate for Payer: Amerigroup Medicaid |
$126.04
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$146.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$124.34
|
| Rate for Payer: Medical Associates Commercial |
$231.61
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.90
|
| Rate for Payer: Midlands Choice Commercial |
$325.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$182.85
|
| Rate for Payer: Wellmark IA HMO |
$257.00
|
| Rate for Payer: Wellmark IA PPO |
$302.00
|
|
|
36590 Removal tunneled VAD w/sub q port/pump central/peripheral
|
Professional
|
$741.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
8799171
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$168.78 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Aetna of IA Medicare |
$168.78
|
| Rate for Payer: Amerigroup Medicaid |
$174.52
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$172.16
|
| Rate for Payer: Medical Associates Commercial |
$320.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$168.78
|
| Rate for Payer: Midlands Choice Commercial |
$518.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$253.17
|
| Rate for Payer: Wellmark IA HMO |
$336.00
|
| Rate for Payer: Wellmark IA PPO |
$395.00
|
|
|
36590 REMOVE TUNNELED CVAD W PORT/PUMP
|
Professional
|
$741.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
8069119
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$168.78 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Aetna of IA Medicare |
$168.78
|
| Rate for Payer: Amerigroup Medicaid |
$174.52
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$172.16
|
| Rate for Payer: Medical Associates Commercial |
$320.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$168.78
|
| Rate for Payer: Midlands Choice Commercial |
$518.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$253.17
|
| Rate for Payer: Wellmark IA HMO |
$336.00
|
| Rate for Payer: Wellmark IA PPO |
$395.00
|
|
|
37785 LIGATE/DIVIDE/EXCISE VEIN 1 LEG
|
Professional
|
$1,190.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
8069149
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.32 |
| Max. Negotiated Rate |
$833.00 |
| Rate for Payer: Aetna of IA Medicare |
$223.32
|
| Rate for Payer: Amerigroup Medicaid |
$230.91
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$267.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$227.79
|
| Rate for Payer: Medical Associates Commercial |
$424.31
|
| Rate for Payer: Medical Associates Managed Medicare |
$223.32
|
| Rate for Payer: Midlands Choice Commercial |
$833.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$334.98
|
| Rate for Payer: Wellmark IA HMO |
$479.00
|
| Rate for Payer: Wellmark IA PPO |
$562.00
|
|
|
38220 Bone marrow; aspiration only
|
Professional
|
$556.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
8799172
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$61.42 |
| Max. Negotiated Rate |
$389.20 |
| Rate for Payer: Aetna of IA Medicare |
$61.42
|
| Rate for Payer: Amerigroup Medicaid |
$63.51
|
| Rate for Payer: Cash Price |
$444.80
|
| Rate for Payer: Cash Price |
$444.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$62.65
|
| Rate for Payer: Medical Associates Commercial |
$116.70
|
| Rate for Payer: Medical Associates Managed Medicare |
$61.42
|
| Rate for Payer: Midlands Choice Commercial |
$389.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$92.13
|
| Rate for Payer: Wellmark IA HMO |
$127.00
|
| Rate for Payer: Wellmark IA PPO |
$150.00
|
|
|
38221 Bone marrow; biopsy needle or trocar- PROFEE
|
Professional
|
$556.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
8799173
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$389.20 |
| Rate for Payer: Aetna of IA Medicare |
$64.34
|
| Rate for Payer: Amerigroup Medicaid |
$66.53
|
| Rate for Payer: Cash Price |
$444.80
|
| Rate for Payer: Cash Price |
$444.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.21
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.63
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.34
|
| Rate for Payer: Midlands Choice Commercial |
$389.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$96.51
|
| Rate for Payer: Wellmark IA HMO |
$132.00
|
| Rate for Payer: Wellmark IA PPO |
$155.00
|
|
|
38500 LYMPH NODE BIOSPY/REMOVAL
|
Professional
|
$1,107.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
8069132
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.55 |
| Max. Negotiated Rate |
$774.90 |
| Rate for Payer: Aetna of IA Medicare |
$227.55
|
| Rate for Payer: Amerigroup Medicaid |
$235.29
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$273.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$232.10
|
| Rate for Payer: Medical Associates Commercial |
$432.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$227.55
|
| Rate for Payer: Midlands Choice Commercial |
$774.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$341.32
|
| Rate for Payer: Wellmark IA HMO |
$487.00
|
| Rate for Payer: Wellmark IA PPO |
$572.00
|
|
|
38792 INJ SENTINEL NODE BIOPSY
|
Professional
|
$276.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
8069131
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna of IA Medicare |
$29.06
|
| Rate for Payer: Amerigroup Medicaid |
$30.05
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.87
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.64
|
| Rate for Payer: Medical Associates Commercial |
$55.21
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.06
|
| Rate for Payer: Midlands Choice Commercial |
$193.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.59
|
| Rate for Payer: Wellmark IA HMO |
$60.00
|
| Rate for Payer: Wellmark IA PPO |
$71.00
|
|
|
3D MAX LIGHT-LEFT LARGE
|
Facility
OP
|
$364.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8417552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.93 |
| Max. Negotiated Rate |
$327.60 |
| Rate for Payer: Aetna of IA Commercial |
$327.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$327.60
|
| Rate for Payer: Aetna of IA Medicare |
$207.48
|
| Rate for Payer: Amerigroup Medicaid |
$183.71
|
| Rate for Payer: Amerigroup Medicare |
$183.82
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$273.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$182.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$181.93
|
| Rate for Payer: Medical Associates Commercial |
$273.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$182.00
|
| Rate for Payer: Midlands Choice Commercial |
$254.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$184.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$273.00
|
| Rate for Payer: United Healthcare Commercial |
$327.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$214.76
|
|
|
3D MAX LIGHT-LEFT LARGE
|
Facility
IP
|
$364.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8417552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.80 |
| Max. Negotiated Rate |
$327.60 |
| Rate for Payer: Aetna of IA Commercial |
$327.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$327.60
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$273.00
|
| Rate for Payer: Medical Associates Commercial |
$273.00
|
| Rate for Payer: Midlands Choice Commercial |
$254.80
|
| Rate for Payer: United Healthcare Commercial |
$327.60
|
|
|
3D MAX LIGHT RT LRG
|
Facility
OP
|
$364.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8417554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.93 |
| Max. Negotiated Rate |
$327.60 |
| Rate for Payer: Aetna of IA Commercial |
$327.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$327.60
|
| Rate for Payer: Aetna of IA Medicare |
$207.48
|
| Rate for Payer: Amerigroup Medicaid |
$183.71
|
| Rate for Payer: Amerigroup Medicare |
$183.82
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$273.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$182.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$181.93
|
| Rate for Payer: Medical Associates Commercial |
$273.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$182.00
|
| Rate for Payer: Midlands Choice Commercial |
$254.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$184.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$273.00
|
| Rate for Payer: United Healthcare Commercial |
$327.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$214.76
|
|
|
3D MAX LIGHT RT LRG
|
Facility
IP
|
$364.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8417554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.80 |
| Max. Negotiated Rate |
$327.60 |
| Rate for Payer: Aetna of IA Commercial |
$327.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$327.60
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$273.00
|
| Rate for Payer: Medical Associates Commercial |
$273.00
|
| Rate for Payer: Midlands Choice Commercial |
$254.80
|
| Rate for Payer: United Healthcare Commercial |
$327.60
|
|
