|
GRAFT CHIPS STERLING CANCELLOUS 1-4MM 15
|
Facility
OP
|
$405.00
|
|
| Hospital Charge Code |
8026570
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
GRAFT CHIPS STERLING CANCELLOUS 1-4MM 30
|
Facility
IP
|
$630.00
|
|
| Hospital Charge Code |
8026571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna of IA Commercial |
$567.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$567.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$472.50
|
| Rate for Payer: Medical Associates Commercial |
$472.50
|
| Rate for Payer: Midlands Choice Commercial |
$441.00
|
| Rate for Payer: United Healthcare Commercial |
$567.00
|
|
|
GRAFT CHIPS STERLING CANCELLOUS 1-4MM 30
|
Facility
OP
|
$630.00
|
|
| Hospital Charge Code |
8026571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$314.87 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna of IA Commercial |
$567.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$567.00
|
| Rate for Payer: Aetna of IA Medicare |
$359.10
|
| Rate for Payer: Amerigroup Medicaid |
$317.96
|
| Rate for Payer: Amerigroup Medicare |
$318.15
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$472.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$315.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$314.87
|
| Rate for Payer: Medical Associates Commercial |
$472.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$315.00
|
| Rate for Payer: Midlands Choice Commercial |
$441.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$319.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$472.50
|
| Rate for Payer: United Healthcare Commercial |
$567.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$371.70
|
|
|
GRAFT PASTE BIOSET ALLOGRAFT 10CC SYRNGE
|
Facility
IP
|
$2,070.00
|
|
| Hospital Charge Code |
8025836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.00 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,863.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,863.00
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,552.50
|
| Rate for Payer: Medical Associates Commercial |
$1,552.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,449.00
|
| Rate for Payer: United Healthcare Commercial |
$1,863.00
|
|
|
GRAFT PASTE BIOSET ALLOGRAFT 10CC SYRNGE
|
Facility
OP
|
$2,070.00
|
|
| Hospital Charge Code |
8025836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,034.59 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,863.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,863.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,179.90
|
| Rate for Payer: Amerigroup Medicaid |
$1,044.73
|
| Rate for Payer: Amerigroup Medicare |
$1,045.35
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,552.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,035.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,034.59
|
| Rate for Payer: Medical Associates Commercial |
$1,552.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,035.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,449.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,050.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,552.50
|
| Rate for Payer: United Healthcare Commercial |
$1,863.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,221.30
|
|
|
GRAFT PASTE BIOSET ALLOGRAFT 5CC SYRINGE
|
Facility
OP
|
$1,341.00
|
|
| Hospital Charge Code |
8046247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.23 |
| Max. Negotiated Rate |
$1,206.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,206.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,206.90
|
| Rate for Payer: Aetna of IA Medicare |
$764.37
|
| Rate for Payer: Amerigroup Medicaid |
$676.80
|
| Rate for Payer: Amerigroup Medicare |
$677.20
|
| Rate for Payer: Cash Price |
$1,072.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,005.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$670.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$670.23
|
| Rate for Payer: Medical Associates Commercial |
$1,005.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$670.50
|
| Rate for Payer: Midlands Choice Commercial |
$938.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$680.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,005.75
|
| Rate for Payer: United Healthcare Commercial |
$1,206.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$791.19
|
|
|
GRAFT PASTE BIOSET ALLOGRAFT 5CC SYRINGE
|
Facility
IP
|
$1,341.00
|
|
| Hospital Charge Code |
8046247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.70 |
| Max. Negotiated Rate |
$1,206.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,206.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,206.90
|
| Rate for Payer: Cash Price |
$1,072.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,005.75
|
| Rate for Payer: Medical Associates Commercial |
$1,005.75
|
| Rate for Payer: Midlands Choice Commercial |
$938.70
|
| Rate for Payer: United Healthcare Commercial |
$1,206.90
|
|
|
GRAFT SKIN DERMACARRIERS
|
Facility
IP
|
$38.00
|
|
| Hospital Charge Code |
8046248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of IA Commercial |
$34.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.20
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.50
|
| Rate for Payer: Medical Associates Commercial |
$28.50
|
| Rate for Payer: Midlands Choice Commercial |
$26.60
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
|
|
GRAFT SKIN DERMACARRIERS
|
Facility
OP
|
$38.00
|
|
| Hospital Charge Code |
8046248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.99 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of IA Commercial |
$34.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.20
|
| Rate for Payer: Aetna of IA Medicare |
$21.66
|
| Rate for Payer: Amerigroup Medicaid |
$19.18
|
| Rate for Payer: Amerigroup Medicare |
$19.19
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$19.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.99
|
| Rate for Payer: Medical Associates Commercial |
$28.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.00
|
| Rate for Payer: Midlands Choice Commercial |
$26.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.50
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$22.42
|
|
|
GRAFT SKIN DERMACARRIERS II 1.5:1 STERIL
|
Facility
IP
|
$38.00
|
|
| Hospital Charge Code |
8046244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of IA Commercial |
$34.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.20
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.50
|
| Rate for Payer: Medical Associates Commercial |
$28.50
|
| Rate for Payer: Midlands Choice Commercial |
$26.60
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
|
|
GRAFT SKIN DERMACARRIERS II 1.5:1 STERIL
|
Facility
OP
|
$38.00
|
|
| Hospital Charge Code |
8046244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.99 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of IA Commercial |
$34.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.20
|
| Rate for Payer: Aetna of IA Medicare |
$21.66
|
| Rate for Payer: Amerigroup Medicaid |
$19.18
|
| Rate for Payer: Amerigroup Medicare |
$19.19
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$19.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.99
|
| Rate for Payer: Medical Associates Commercial |
$28.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.00
|
| Rate for Payer: Midlands Choice Commercial |
$26.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.50
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$22.42
|
|
|
GRAFT SURGICAL ALLOMAX
|
Facility
IP
|
$10,622.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8025924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,435.40 |
| Max. Negotiated Rate |
$9,559.80 |
| Rate for Payer: Aetna of IA Commercial |
$9,559.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$9,559.80
|
| Rate for Payer: Cash Price |
$8,497.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7,966.50
|
| Rate for Payer: Medical Associates Commercial |
$7,966.50
|
| Rate for Payer: Midlands Choice Commercial |
$7,435.40
|
| Rate for Payer: United Healthcare Commercial |
$9,559.80
|
|
|
GRAFT SURGICAL ALLOMAX
|
Facility
OP
|
$10,622.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8025924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,308.88 |
| Max. Negotiated Rate |
$9,559.80 |
| Rate for Payer: Aetna of IA Commercial |
$9,559.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$9,559.80
|
| Rate for Payer: Aetna of IA Medicare |
$6,054.54
|
| Rate for Payer: Amerigroup Medicaid |
$5,360.92
|
| Rate for Payer: Amerigroup Medicare |
$5,364.11
|
| Rate for Payer: Cash Price |
$8,497.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7,966.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5,311.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5,308.88
|
| Rate for Payer: Medical Associates Commercial |
$7,966.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$5,311.00
|
| Rate for Payer: Midlands Choice Commercial |
$7,435.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,390.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$7,966.50
|
| Rate for Payer: United Healthcare Commercial |
$9,559.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$6,266.98
|
|
|
GRAFT TIBIALIS ANTERIOR TENDON 220MM
|
Facility
OP
|
$4,680.00
|
|
| Hospital Charge Code |
8046788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,339.06 |
| Max. Negotiated Rate |
$4,212.00 |
| Rate for Payer: Aetna of IA Commercial |
$4,212.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,212.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,667.60
|
| Rate for Payer: Amerigroup Medicaid |
$2,362.00
|
| Rate for Payer: Amerigroup Medicare |
$2,363.40
|
| Rate for Payer: Cash Price |
$3,744.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,510.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,340.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,339.06
|
| Rate for Payer: Medical Associates Commercial |
$3,510.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,340.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,276.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,375.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,510.00
|
| Rate for Payer: United Healthcare Commercial |
$4,212.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,761.20
|
|
|
GRAFT TIBIALIS ANTERIOR TENDON 220MM
|
Facility
IP
|
$4,680.00
|
|
| Hospital Charge Code |
8046788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,276.00 |
| Max. Negotiated Rate |
$4,212.00 |
| Rate for Payer: Aetna of IA Commercial |
$4,212.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,212.00
|
| Rate for Payer: Cash Price |
$3,744.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,510.00
|
| Rate for Payer: Medical Associates Commercial |
$3,510.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,276.00
|
| Rate for Payer: United Healthcare Commercial |
$4,212.00
|
|
|
GRAFT TIBIALIS ANTERIOR TENDON 7MMX200MM
|
Facility
IP
|
$4,680.00
|
|
| Hospital Charge Code |
8046789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,276.00 |
| Max. Negotiated Rate |
$4,212.00 |
| Rate for Payer: Aetna of IA Commercial |
$4,212.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,212.00
|
| Rate for Payer: Cash Price |
$3,744.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,510.00
|
| Rate for Payer: Medical Associates Commercial |
$3,510.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,276.00
|
| Rate for Payer: United Healthcare Commercial |
$4,212.00
|
|
|
GRAFT TIBIALIS ANTERIOR TENDON 7MMX200MM
|
Facility
OP
|
$4,680.00
|
|
| Hospital Charge Code |
8046789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,339.06 |
| Max. Negotiated Rate |
$4,212.00 |
| Rate for Payer: Aetna of IA Commercial |
$4,212.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,212.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,667.60
|
| Rate for Payer: Amerigroup Medicaid |
$2,362.00
|
| Rate for Payer: Amerigroup Medicare |
$2,363.40
|
| Rate for Payer: Cash Price |
$3,744.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,510.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,340.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,339.06
|
| Rate for Payer: Medical Associates Commercial |
$3,510.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,340.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,276.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,375.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,510.00
|
| Rate for Payer: United Healthcare Commercial |
$4,212.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,761.20
|
|
|
GRAFT TIBIALIS ANTERIOR TENDON 7MMX225MM
|
Facility
OP
|
$4,680.00
|
|
| Hospital Charge Code |
8046783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,339.06 |
| Max. Negotiated Rate |
$4,212.00 |
| Rate for Payer: Aetna of IA Commercial |
$4,212.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,212.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,667.60
|
| Rate for Payer: Amerigroup Medicaid |
$2,362.00
|
| Rate for Payer: Amerigroup Medicare |
$2,363.40
|
| Rate for Payer: Cash Price |
$3,744.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,510.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,340.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,339.06
|
| Rate for Payer: Medical Associates Commercial |
$3,510.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,340.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,276.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,375.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,510.00
|
| Rate for Payer: United Healthcare Commercial |
$4,212.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,761.20
|
|
|
GRAFT TIBIALIS ANTERIOR TENDON 7MMX225MM
|
Facility
IP
|
$4,680.00
|
|
| Hospital Charge Code |
8046783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,276.00 |
| Max. Negotiated Rate |
$4,212.00 |
| Rate for Payer: Aetna of IA Commercial |
$4,212.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,212.00
|
| Rate for Payer: Cash Price |
$3,744.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,510.00
|
| Rate for Payer: Medical Associates Commercial |
$3,510.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,276.00
|
| Rate for Payer: United Healthcare Commercial |
$4,212.00
|
|
|
GRAFT TIBIALIS POSTERIOR TENDON 5X 220MM
|
Facility
OP
|
$4,680.00
|
|
| Hospital Charge Code |
8046787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,339.06 |
| Max. Negotiated Rate |
$4,212.00 |
| Rate for Payer: Aetna of IA Commercial |
$4,212.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,212.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,667.60
|
| Rate for Payer: Amerigroup Medicaid |
$2,362.00
|
| Rate for Payer: Amerigroup Medicare |
$2,363.40
|
| Rate for Payer: Cash Price |
$3,744.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,510.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,340.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,339.06
|
| Rate for Payer: Medical Associates Commercial |
$3,510.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,340.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,276.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,375.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,510.00
|
| Rate for Payer: United Healthcare Commercial |
$4,212.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,761.20
|
|
|
GRAFT TIBIALIS POSTERIOR TENDON 5X 220MM
|
Facility
IP
|
$4,680.00
|
|
| Hospital Charge Code |
8046787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,276.00 |
| Max. Negotiated Rate |
$4,212.00 |
| Rate for Payer: Aetna of IA Commercial |
$4,212.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,212.00
|
| Rate for Payer: Cash Price |
$3,744.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,510.00
|
| Rate for Payer: Medical Associates Commercial |
$3,510.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,276.00
|
| Rate for Payer: United Healthcare Commercial |
$4,212.00
|
|
|
GRAM STAIN
|
Facility
IP
|
$41.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
634217
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
|
|
GRAM STAIN
|
Facility
OP
|
$41.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
634217
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.49 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Aetna of IA Medicare |
$23.37
|
| Rate for Payer: Amerigroup Medicaid |
$20.69
|
| Rate for Payer: Amerigroup Medicare |
$20.70
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.49
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.50
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.75
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.19
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
GRIDLOCK ANKLE SCREW 4.0X34MM
|
Facility
OP
|
$189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8852829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna of IA Commercial |
$170.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$170.10
|
| Rate for Payer: Aetna of IA Medicare |
$107.73
|
| Rate for Payer: Amerigroup Medicaid |
$95.39
|
| Rate for Payer: Amerigroup Medicare |
$95.44
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$141.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$94.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$94.46
|
| Rate for Payer: Medical Associates Commercial |
$141.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$94.50
|
| Rate for Payer: Midlands Choice Commercial |
$132.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$95.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$141.75
|
| Rate for Payer: United Healthcare Commercial |
$170.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$111.51
|
|
|
GRIDLOCK ANKLE SCREW 4.0X34MM
|
Facility
IP
|
$189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8852829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna of IA Commercial |
$170.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$170.10
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$141.75
|
| Rate for Payer: Medical Associates Commercial |
$141.75
|
| Rate for Payer: Midlands Choice Commercial |
$132.30
|
| Rate for Payer: United Healthcare Commercial |
$170.10
|
|
