|
32550 Insertion of indwelling tunnelled pleural catheter w/cuff
|
Professional
|
Both
|
$2,357.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
8799166
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$668.00 |
| Max. Negotiated Rate |
$1,767.75 |
| Rate for Payer: Amerigroup Medicaid |
$674.55
|
| Rate for Payer: Cash Price |
$1,885.60
|
| Rate for Payer: Cash Price |
$1,885.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$668.00
|
| Rate for Payer: Medical Associates Commercial |
$1,767.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,649.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$671.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,767.75
|
| Rate for Payer: United Healthcare Commercial |
$1,182.05
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,449.20
|
| Rate for Payer: Wellmark IA PPO |
$1,705.00
|
|
|
32554 Thoracentesis- diagnostic- PROFEE
|
Professional
|
Both
|
$336.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
8799167
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Amerigroup Medicaid |
$501.02
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$496.16
|
| Rate for Payer: Medical Associates Commercial |
$252.00
|
| Rate for Payer: Midlands Choice Commercial |
$235.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$498.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$252.00
|
| Rate for Payer: United Healthcare Commercial |
$336.00
|
| Rate for Payer: Wellmark IA HMO WHPI |
$440.90
|
| Rate for Payer: Wellmark IA PPO |
$518.70
|
|
|
32555 Thoracentesis aspiration of the pleural space; w/imaging guidance
|
Professional
|
Both
|
$1,032.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
8799168
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$470.40 |
| Max. Negotiated Rate |
$774.00 |
| Rate for Payer: Amerigroup Medicaid |
$577.92
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$572.31
|
| Rate for Payer: Medical Associates Commercial |
$774.00
|
| Rate for Payer: Midlands Choice Commercial |
$722.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$575.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$774.00
|
| Rate for Payer: United Healthcare Commercial |
$470.40
|
| Rate for Payer: Wellmark IA HMO WHPI |
$588.10
|
| Rate for Payer: Wellmark IA PPO |
$691.90
|
|
|
3.4MM TWO-STEP HAMMER TOE IMPLANT 3.4X3.0X14
|
Facility
|
OP
|
$2,880.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8463421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,296.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,592.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,592.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,641.60
|
| Rate for Payer: Amerigroup Medicaid |
$1,661.18
|
| Rate for Payer: Amerigroup Medicare |
$1,308.96
|
| Rate for Payer: Cash Price |
$2,304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,160.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,296.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,645.06
|
| Rate for Payer: Medical Associates Commercial |
$2,160.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,296.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,016.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,669.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,490.40
|
| Rate for Payer: United Healthcare Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,699.20
|
|
|
3.4MM TWO-STEP HAMMER TOE IMPLANT 3.4X3.0X14
|
Facility
|
IP
|
$2,880.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8463421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,592.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,160.00
|
| Rate for Payer: Medical Associates Commercial |
$2,160.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare Commercial |
$2,592.00
|
|
|
3.4MMX3.0MMX16MM SPADE TWO-STEP HAMMER TOE IMPLANT
|
Facility
|
OP
|
$2,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8749763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,053.00 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,106.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,106.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,333.80
|
| Rate for Payer: Amerigroup Medicaid |
$1,349.71
|
| Rate for Payer: Amerigroup Medicare |
$1,063.53
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,755.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,053.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,336.61
|
| Rate for Payer: Medical Associates Commercial |
$1,755.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,053.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,638.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,356.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,210.95
|
| Rate for Payer: United Healthcare Commercial |
$2,106.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,380.60
|
|
|
3.4MMX3.0MMX16MM SPADE TWO-STEP HAMMER TOE IMPLANT
|
Facility
|
IP
|
$2,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8749763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.00 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,106.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,755.00
|
| Rate for Payer: Medical Associates Commercial |
$1,755.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,638.00
|
| Rate for Payer: United Healthcare Commercial |
$2,106.00
|
|
|
3.4MMX3.0MMX8MM SPADE TWO STEP HAMMER
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8470646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$810.00 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,620.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,620.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,026.00
|
| Rate for Payer: Amerigroup Medicaid |
$1,038.24
|
| Rate for Payer: Amerigroup Medicare |
$818.10
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,350.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$810.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,028.16
|
| Rate for Payer: Medical Associates Commercial |
$1,350.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$810.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,260.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,043.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$931.50
|
| Rate for Payer: United Healthcare Commercial |
$1,620.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,062.00
|
|
|
3.4MMX3.0MMX8MM SPADE TWO STEP HAMMER
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8470646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,260.00 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,620.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,350.00
|
| Rate for Payer: Medical Associates Commercial |
$1,350.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,260.00
|
| Rate for Payer: United Healthcare Commercial |
$1,620.00
|
|
|
3.55MM X 10MM LOCKING SCREW
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8812772
|
|
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
|
|
|
3.55MM X 10MM LOCKING SCREW
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8812772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.85 |
| 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 |
$192.07
|
| Rate for Payer: Amerigroup Medicare |
$151.35
|
| 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 |
$149.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$190.21
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$149.85
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$193.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$172.33
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
|
|
3.5MMX10MM GL ANKLE LOCKING SCREW
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8760631
|
|
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
|
|
|
3.5MMX10MM GL ANKLE LOCKING SCREW
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8760631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.80 |
| 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: Aetna of IA Medicare |
$184.68
|
| Rate for Payer: Amerigroup Medicaid |
$186.88
|
| Rate for Payer: Amerigroup Medicare |
$147.26
|
| 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 |
$145.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$185.07
|
| Rate for Payer: Medical Associates Commercial |
$243.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$145.80
|
| Rate for Payer: Midlands Choice Commercial |
$226.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$187.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$167.67
|
| Rate for Payer: United Healthcare Commercial |
$291.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$191.16
|
|
|
3.5MMX12MM GL ANKLE SCREW
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8759027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.10 |
| 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 |
$114.21
|
| Rate for Payer: Amerigroup Medicare |
$89.99
|
| 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 |
$89.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.10
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.10
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.46
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
3.5MMX12MM GL ANKLE SCREW
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8758432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.10 |
| 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 |
$114.21
|
| Rate for Payer: Amerigroup Medicare |
$89.99
|
| 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 |
$89.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.10
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.10
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.46
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
3.5MMX12MM GL ANKLE SCREW
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8758430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna of IA Commercial |
$226.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$226.80
|
| Rate for Payer: Aetna of IA Medicare |
$143.64
|
| Rate for Payer: Amerigroup Medicaid |
$145.35
|
| Rate for Payer: Amerigroup Medicare |
$114.53
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$113.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$143.94
|
| Rate for Payer: Medical Associates Commercial |
$189.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$113.40
|
| Rate for Payer: Midlands Choice Commercial |
$176.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$146.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$130.41
|
| Rate for Payer: United Healthcare Commercial |
$226.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$148.68
|
|
|
3.5MMX12MM GL ANKLE SCREW
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8758430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna of IA Commercial |
$226.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$226.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.00
|
| Rate for Payer: Medical Associates Commercial |
$189.00
|
| Rate for Payer: Midlands Choice Commercial |
$176.40
|
| Rate for Payer: United Healthcare Commercial |
$226.80
|
|
|
3.5MMX12MM GL ANKLE SCREW
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8758432
|
|
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
|
|
|
3.5MMX12MM GL ANKLE SCREW
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8759027
|
|
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
|
|
|
3.5MMX12MM GL LOCKING SCREW
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8759029
|
|
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
|
|
|
3.5MMX12MM GL LOCKING SCREW
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8759029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.80 |
| 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: Aetna of IA Medicare |
$184.68
|
| Rate for Payer: Amerigroup Medicaid |
$186.88
|
| Rate for Payer: Amerigroup Medicare |
$147.26
|
| 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 |
$145.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$185.07
|
| Rate for Payer: Medical Associates Commercial |
$243.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$145.80
|
| Rate for Payer: Midlands Choice Commercial |
$226.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$187.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$167.67
|
| Rate for Payer: United Healthcare Commercial |
$291.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$191.16
|
|
|
3.5MMX14MM GL ANKLE LOCKING SCREW
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8760633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.80 |
| 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: Aetna of IA Medicare |
$184.68
|
| Rate for Payer: Amerigroup Medicaid |
$186.88
|
| Rate for Payer: Amerigroup Medicare |
$147.26
|
| 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 |
$145.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$185.07
|
| Rate for Payer: Medical Associates Commercial |
$243.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$145.80
|
| Rate for Payer: Midlands Choice Commercial |
$226.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$187.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$167.67
|
| Rate for Payer: United Healthcare Commercial |
$291.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$191.16
|
|
|
3.5MMX14MM GL ANKLE LOCKING SCREW
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8760633
|
|
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
|
|
|
3.5MM X 14MM LOCKING SCREW
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8812774
|
|
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 14MM LOCKING SCREW
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8812774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.85 |
| 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 |
$192.07
|
| Rate for Payer: Amerigroup Medicare |
$151.35
|
| 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 |
$149.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$190.21
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$149.85
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$193.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$172.33
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
|
