|
gentian violet 1% topical solution [VDMC]
|
Facility
|
OP
|
$19.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11340289
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$9.76
|
| Rate for Payer: Oscar Health of IA Commercial |
$14.43
|
| 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
|
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: Molina Healthcare Managed Medicare |
$636.54
|
| Rate for Payer: Oscar Health of IA Commercial |
$941.25
|
| 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
|
|
|
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
|
|
|
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: Molina Healthcare Managed Medicare |
$35.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$51.75
|
| 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 |
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: Molina Healthcare Managed Medicare |
$57.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$85.50
|
| 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 |
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
|
|
|
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: Molina Healthcare Managed Medicare |
$57.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$85.50
|
| 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
|
|
|
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: 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
|
|
|
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
|
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: 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
|
|
|
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 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 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: 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
|
|
|
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: Molina Healthcare Managed Medicare |
$241.93
|
| Rate for Payer: Oscar Health of IA Commercial |
$357.75
|
| 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 4.00MMX52MM
|
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 4.0MMX40MM
|
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: Molina Healthcare Managed Medicare |
$241.93
|
| Rate for Payer: Oscar Health of IA Commercial |
$357.75
|
| 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
|
IP
|
$477.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8831369
|
|
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 4.0MMX42MM
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8871488
|
|
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 4.0MMX42MM
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8871488
|
|
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: Molina Healthcare Managed Medicare |
$241.93
|
| Rate for Payer: Oscar Health of IA Commercial |
$357.75
|
| 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 4.0MM X 44MM
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8773171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of IA Commercial |
$453.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$453.60
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.00
|
| Rate for Payer: Medical Associates Commercial |
$378.00
|
| Rate for Payer: Midlands Choice Commercial |
$352.80
|
| Rate for Payer: United Healthcare Commercial |
$453.60
|
|
|
GL ANKLE SYNDESMOTIC SCREW LOW PROFILE 4.0MM X 44MM
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8773171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.90 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of IA Commercial |
$453.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$453.60
|
| Rate for Payer: Aetna of IA Medicare |
$287.28
|
| Rate for Payer: Amerigroup Medicaid |
$254.37
|
| Rate for Payer: Amerigroup Medicare |
$254.52
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$252.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$251.90
|
| Rate for Payer: Medical Associates Commercial |
$378.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$252.00
|
| Rate for Payer: Midlands Choice Commercial |
$352.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$255.78
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$255.63
|
| Rate for Payer: Oscar Health of IA Commercial |
$378.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$378.00
|
| Rate for Payer: United Healthcare Commercial |
$453.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$297.36
|
|
|
GLENOID W/KEEL LARGE
|
Facility
|
OP
|
$2,835.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,416.93 |
| Max. Negotiated Rate |
$2,551.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,551.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,551.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,615.95
|
| Rate for Payer: Amerigroup Medicaid |
$1,430.82
|
| Rate for Payer: Amerigroup Medicare |
$1,431.68
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,126.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,417.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,416.93
|
| Rate for Payer: Medical Associates Commercial |
$2,126.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,417.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,984.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,438.76
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,437.91
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,126.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,126.25
|
| Rate for Payer: United Healthcare Commercial |
$2,551.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,672.65
|
|
|
GLENOID W/KEEL LARGE
|
Facility
|
IP
|
$2,835.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,984.50 |
| Max. Negotiated Rate |
$2,551.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,551.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,551.50
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,126.25
|
| Rate for Payer: Medical Associates Commercial |
$2,126.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,984.50
|
| Rate for Payer: United Healthcare Commercial |
$2,551.50
|
|
