|
gentamicin Ophth 0.3% Sol 5ml Bottle
|
Facility
IP
|
$27.48
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702388
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$24.73 |
| Rate for Payer: Aetna of IA Commercial |
$24.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.73
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.61
|
| Rate for Payer: Medical Associates Commercial |
$20.61
|
| Rate for Payer: Midlands Choice Commercial |
$19.24
|
| Rate for Payer: United Healthcare Commercial |
$24.73
|
|
|
gentamicin Ophth 0.3% Sol 5ml Bottle
|
Facility
OP
|
$27.48
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702388
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$24.73 |
| Rate for Payer: Aetna of IA Commercial |
$24.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.73
|
| Rate for Payer: Aetna of IA Medicare |
$15.66
|
| Rate for Payer: Amerigroup Medicaid |
$13.87
|
| Rate for Payer: Amerigroup Medicare |
$13.88
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.61
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.74
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.73
|
| Rate for Payer: Medical Associates Commercial |
$20.61
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.74
|
| Rate for Payer: Midlands Choice Commercial |
$19.24
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.61
|
| Rate for Payer: United Healthcare Commercial |
$24.73
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.21
|
|
|
GENTAMYCIN LEVEL
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
633736
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna of IA Commercial |
$100.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$100.80
|
| Rate for Payer: Aetna of IA Medicare |
$63.84
|
| Rate for Payer: Amerigroup Medicaid |
$56.53
|
| Rate for Payer: Amerigroup Medicare |
$56.56
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$84.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$56.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$55.98
|
| Rate for Payer: Medical Associates Commercial |
$84.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.00
|
| Rate for Payer: Midlands Choice Commercial |
$78.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$56.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$84.00
|
| Rate for Payer: United Healthcare Commercial |
$100.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$66.08
|
| Rate for Payer: Wellmark IA HMO |
$49.60
|
| Rate for Payer: Wellmark IA PPO |
$54.56
|
|
|
GENTAMYCIN LEVEL
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
633735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna of IA Commercial |
$100.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$100.80
|
| Rate for Payer: Aetna of IA Medicare |
$63.84
|
| Rate for Payer: Amerigroup Medicaid |
$56.53
|
| Rate for Payer: Amerigroup Medicare |
$56.56
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$84.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$56.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$55.98
|
| Rate for Payer: Medical Associates Commercial |
$84.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.00
|
| Rate for Payer: Midlands Choice Commercial |
$78.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$56.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$84.00
|
| Rate for Payer: United Healthcare Commercial |
$100.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$66.08
|
| Rate for Payer: Wellmark IA HMO |
$49.60
|
| Rate for Payer: Wellmark IA PPO |
$54.56
|
|
|
GENTAMYCIN LEVEL
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
633735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna of IA Commercial |
$100.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$100.80
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$84.00
|
| Rate for Payer: Medical Associates Commercial |
$84.00
|
| Rate for Payer: Midlands Choice Commercial |
$78.40
|
| Rate for Payer: United Healthcare Commercial |
$100.80
|
|
|
GENTAMYCIN LEVEL
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
633736
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna of IA Commercial |
$100.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$100.80
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$84.00
|
| Rate for Payer: Medical Associates Commercial |
$84.00
|
| Rate for Payer: Midlands Choice Commercial |
$78.40
|
| Rate for Payer: United Healthcare Commercial |
$100.80
|
|
|
gentian violet 1% topical solution
|
Facility
IP
|
$19.24
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna of IA Commercial |
$17.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.32
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.43
|
| Rate for Payer: Medical Associates Commercial |
$14.43
|
| Rate for Payer: Midlands Choice Commercial |
$13.47
|
| Rate for Payer: United Healthcare Commercial |
$17.32
|
|
|
gentian violet 1% topical solution
|
Facility
OP
|
$19.24
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna of IA Commercial |
$17.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.32
|
| Rate for Payer: Aetna of IA Medicare |
$10.97
|
| Rate for Payer: Amerigroup Medicaid |
$9.71
|
| Rate for Payer: Amerigroup Medicare |
$9.72
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.43
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9.62
|
| Rate for Payer: Medical Associates Commercial |
$14.43
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.62
|
| Rate for Payer: Midlands Choice Commercial |
$13.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.43
|
| Rate for Payer: United Healthcare Commercial |
$17.32
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.35
|
|
|
GESTATIONAL DIAB ED INDIV T19
|
Facility
IP
|
$1,255.00
|
|
|
Service Code
|
CPT S9455
|
| Hospital Charge Code |
8059034
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$878.50 |
| Max. Negotiated Rate |
$1,129.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,129.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,129.50
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$941.25
|
| Rate for Payer: Medical Associates Commercial |
$941.25
|
| Rate for Payer: Midlands Choice Commercial |
$878.50
|
| Rate for Payer: United Healthcare Commercial |
$1,129.50
|
|
|
GESTATIONAL DIAB ED INDIV T19
|
Facility
OP
|
$1,255.00
|
|
|
Service Code
|
CPT S9455
|
| Hospital Charge Code |
8059034
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$1,129.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,129.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,129.50
|
| Rate for Payer: Aetna of IA Medicare |
$715.35
|
| Rate for Payer: Amerigroup Medicaid |
$633.40
|
| Rate for Payer: Amerigroup Medicare |
$633.78
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$941.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$627.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$627.25
|
| Rate for Payer: Medical Associates Commercial |
$941.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$627.50
|
| Rate for Payer: Midlands Choice Commercial |
$878.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$636.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$941.25
|
| Rate for Payer: United Healthcare Commercial |
$1,129.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$740.45
|
|
|
GGTP (GAMMA-GLUT)
|
Facility
OP
|
$69.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
1628895
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna of IA Commercial |
$62.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$62.10
|
| Rate for Payer: Aetna of IA Medicare |
$39.33
|
| Rate for Payer: Amerigroup Medicaid |
$34.82
|
| Rate for Payer: Amerigroup Medicare |
$34.84
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.49
|
| Rate for Payer: Medical Associates Commercial |
$51.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.50
|
| Rate for Payer: Midlands Choice Commercial |
$48.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.75
|
| Rate for Payer: United Healthcare Commercial |
$62.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$40.71
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
GGTP (GAMMA-GLUT)
|
Facility
IP
|
$69.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
1628895
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna of IA Commercial |
$62.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$62.10
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.75
|
| Rate for Payer: Medical Associates Commercial |
$51.75
|
| Rate for Payer: Midlands Choice Commercial |
$48.30
|
| Rate for Payer: United Healthcare Commercial |
$62.10
|
|
|
Giardia Antigen
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
8059691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$57.54
|
| Rate for Payer: Amerigroup Medicare |
$57.57
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.98
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
Giardia Antigen
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
4022858
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$57.54
|
| Rate for Payer: Amerigroup Medicare |
$57.57
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.98
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
Giardia Antigen
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
4022858
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
Giardia Antigen
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
8059691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
GL ANKLE SCREW 3.5MM X 14MM
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8773165
|
|
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
|
|
|
GL ANKLE SCREW 3.5MM X 14MM
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8773165
|
|
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
|
|
|
GL ANKLE SCREW 3.5MM X 16MM
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8773167
|
|
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
|
|
|
GL ANKLE SCREW 3.5MM X 16MM
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8773167
|
|
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
|
|
|
GL ANKLE SCREW 3.5MM X 18MM
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8773169
|
|
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
|
|
|
GL ANKLE SCREW 3.5MM X 18MM
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8773169
|
|
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
|
|
|
GL ANKLE SYNDESMOTIC SCREW LOW PROFILE 4.00MMX52MM
|
Facility
IP
|
$477.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8823376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.90 |
| Max. Negotiated Rate |
$429.30 |
| Rate for Payer: Aetna of IA Commercial |
$429.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$429.30
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$357.75
|
| Rate for Payer: Medical Associates Commercial |
$357.75
|
| Rate for Payer: Midlands Choice Commercial |
$333.90
|
| Rate for Payer: United Healthcare Commercial |
$429.30
|
|
|
GL ANKLE SYNDESMOTIC SCREW LOW PROFILE 4.00MMX52MM
|
Facility
OP
|
$477.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8823376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.40 |
| Max. Negotiated Rate |
$429.30 |
| Rate for Payer: Aetna of IA Commercial |
$429.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$429.30
|
| Rate for Payer: Aetna of IA Medicare |
$271.89
|
| Rate for Payer: Amerigroup Medicaid |
$240.74
|
| Rate for Payer: Amerigroup Medicare |
$240.88
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$357.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$238.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$238.40
|
| Rate for Payer: Medical Associates Commercial |
$357.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$238.50
|
| Rate for Payer: Midlands Choice Commercial |
$333.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$242.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$357.75
|
| Rate for Payer: United Healthcare Commercial |
$429.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$281.43
|
|
|
GL ANKLE SYNDESMOTIC SCREW LOW PROFILE 4.0MMX40MM
|
Facility
OP
|
$477.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8831369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.40 |
| Max. Negotiated Rate |
$429.30 |
| Rate for Payer: Aetna of IA Commercial |
$429.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$429.30
|
| Rate for Payer: Aetna of IA Medicare |
$271.89
|
| Rate for Payer: Amerigroup Medicaid |
$240.74
|
| Rate for Payer: Amerigroup Medicare |
$240.88
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$357.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$238.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$238.40
|
| Rate for Payer: Medical Associates Commercial |
$357.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$238.50
|
| Rate for Payer: Midlands Choice Commercial |
$333.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$242.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$357.75
|
| Rate for Payer: United Healthcare Commercial |
$429.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$281.43
|
|
