|
GRAFT PASTE BIOSET ALLOGRAFT 10CC SYRNGE
|
Facility
|
OP
|
$2,070.00
|
|
| Hospital Charge Code |
8025836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.50 |
| 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 |
$1,193.98
|
| Rate for Payer: Amerigroup Medicare |
$940.82
|
| 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 |
$931.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,182.38
|
| Rate for Payer: Medical Associates Commercial |
$1,552.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$931.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,449.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,199.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,071.22
|
| Rate for Payer: United Healthcare Commercial |
$1,863.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,221.30
|
|
|
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 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 PASTE BIOSET ALLOGRAFT 5CC SYRINGE
|
Facility
|
OP
|
$1,341.00
|
|
| Hospital Charge Code |
8046247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$603.45 |
| 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 |
$773.49
|
| Rate for Payer: Amerigroup Medicare |
$609.48
|
| 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 |
$603.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$765.98
|
| Rate for Payer: Medical Associates Commercial |
$1,005.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$603.45
|
| Rate for Payer: Midlands Choice Commercial |
$938.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$777.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$693.97
|
| Rate for Payer: United Healthcare Commercial |
$1,206.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$791.19
|
|
|
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 |
$17.10 |
| 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 |
$21.92
|
| Rate for Payer: Amerigroup Medicare |
$17.27
|
| 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 |
$17.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.71
|
| Rate for Payer: Medical Associates Commercial |
$28.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.10
|
| Rate for Payer: Midlands Choice Commercial |
$26.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.66
|
| 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
|
OP
|
$38.00
|
|
| Hospital Charge Code |
8046244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.10 |
| 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 |
$21.92
|
| Rate for Payer: Amerigroup Medicare |
$17.27
|
| 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 |
$17.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.71
|
| Rate for Payer: Medical Associates Commercial |
$28.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.10
|
| Rate for Payer: Midlands Choice Commercial |
$26.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.66
|
| 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 SURGICAL ALLOMAX
|
Facility
|
OP
|
$10,622.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8025924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,779.90 |
| 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 |
$6,126.77
|
| Rate for Payer: Amerigroup Medicare |
$4,827.70
|
| 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 |
$4,779.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,067.29
|
| Rate for Payer: Medical Associates Commercial |
$7,966.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$4,779.90
|
| Rate for Payer: Midlands Choice Commercial |
$7,435.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,156.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$5,496.89
|
| Rate for Payer: United Healthcare Commercial |
$9,559.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$6,266.98
|
|
|
GRAFT SURGICAL ALLOMAX
|
Facility
|
IP
|
$10,622.00
|
|
|
Service Code
|
HCPCS 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 TIBIALIS ANTERIOR TENDON 220MM
|
Facility
|
OP
|
$4,680.00
|
|
| Hospital Charge Code |
8046788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.00 |
| 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: Aetna of IA Medicare |
$2,667.60
|
| Rate for Payer: Amerigroup Medicaid |
$2,699.42
|
| Rate for Payer: Amerigroup Medicare |
$2,127.06
|
| 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 |
$2,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,673.22
|
| Rate for Payer: Medical Associates Commercial |
$3,510.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,276.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,712.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,421.90
|
| 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 |
$2,106.00 |
| 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: Aetna of IA Medicare |
$2,667.60
|
| Rate for Payer: Amerigroup Medicaid |
$2,699.42
|
| Rate for Payer: Amerigroup Medicare |
$2,127.06
|
| 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 |
$2,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,673.22
|
| Rate for Payer: Medical Associates Commercial |
$3,510.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,276.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,712.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,421.90
|
| 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 ANTERIOR TENDON 7MMX225MM
|
Facility
|
OP
|
$4,680.00
|
|
| Hospital Charge Code |
8046783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.00 |
| 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: Aetna of IA Medicare |
$2,667.60
|
| Rate for Payer: Amerigroup Medicaid |
$2,699.42
|
| Rate for Payer: Amerigroup Medicare |
$2,127.06
|
| 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 |
$2,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,673.22
|
| Rate for Payer: Medical Associates Commercial |
$3,510.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,276.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,712.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,421.90
|
| 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
|
|
|
GRAFT TIBIALIS POSTERIOR TENDON 5X 220MM
|
Facility
|
OP
|
$4,680.00
|
|
| Hospital Charge Code |
8046787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.00 |
| 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: Aetna of IA Medicare |
$2,667.60
|
| Rate for Payer: Amerigroup Medicaid |
$2,699.42
|
| Rate for Payer: Amerigroup Medicare |
$2,127.06
|
| 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 |
$2,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,673.22
|
| Rate for Payer: Medical Associates Commercial |
$3,510.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,276.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,712.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,421.90
|
| Rate for Payer: United Healthcare Commercial |
$4,212.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,761.20
|
|
|
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 |
$18.45 |
| 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 |
$23.65
|
| Rate for Payer: Amerigroup Medicare |
$18.63
|
| 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 |
$18.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.42
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.45
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.22
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.19
|
|
|
Greater than 30 minutes 99498
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
8398015
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$65.70 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of IA Commercial |
$131.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
| Rate for Payer: Aetna of IA Medicare |
$83.22
|
| Rate for Payer: Amerigroup Medicaid |
$84.21
|
| Rate for Payer: Amerigroup Medicare |
$66.36
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$65.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$83.40
|
| Rate for Payer: Medical Associates Commercial |
$109.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$65.70
|
| Rate for Payer: Midlands Choice Commercial |
$102.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$84.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.56
|
| Rate for Payer: United Healthcare Commercial |
$131.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.14
|
|
|
Greater than 30 minutes 99498
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
8398015
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$102.20 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of IA Commercial |
$131.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
| Rate for Payer: Medical Associates Commercial |
$109.50
|
| Rate for Payer: Midlands Choice Commercial |
$102.20
|
| Rate for Payer: United Healthcare Commercial |
$131.40
|
|
|
GRIDLOCK ANKLE SCREW 4.0X34MM
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS 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
|
|
|
GRIDLOCK ANKLE SCREW 4.0X34MM
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8852829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.05 |
| 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 |
$109.02
|
| Rate for Payer: Amerigroup Medicare |
$85.90
|
| 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 |
$85.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.96
|
| Rate for Payer: Medical Associates Commercial |
$141.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$85.05
|
| Rate for Payer: Midlands Choice Commercial |
$132.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$109.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$97.81
|
| Rate for Payer: United Healthcare Commercial |
$170.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$111.51
|
|
|
Ground Emergency Medical Transportation
|
Facility
|
OP
|
$1,183.97
|
|
|
Service Code
|
HCPCS A0999 QN
|
| Hospital Charge Code |
8777230
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$532.79 |
| Max. Negotiated Rate |
$1,065.57 |
| Rate for Payer: Aetna of IA Commercial |
$1,065.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,065.57
|
| Rate for Payer: Aetna of IA Medicare |
$674.86
|
| Rate for Payer: Amerigroup Medicaid |
$682.91
|
| Rate for Payer: Amerigroup Medicare |
$538.11
|
| Rate for Payer: Cash Price |
$947.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$887.98
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$532.79
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$676.28
|
| Rate for Payer: Medical Associates Commercial |
$887.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$532.79
|
| Rate for Payer: Midlands Choice Commercial |
$828.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$686.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$612.70
|
| Rate for Payer: United Healthcare Commercial |
$1,065.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,006.37
|
|
