|
Knee Procedures With Principal Diagnosis of Infection Without CC/MCC
|
Facility
IP
|
$13,944.73
|
|
|
Service Code
|
MS-DRG 487
|
| Hospital Charge Code |
306
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$13,944.73 |
| Rate for Payer: Amerigroup Medicaid |
$13,877.37
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13,742.63
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,944.73
|
|
|
KOH PREP FUNGUS
|
Facility
OP
|
$41.00
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
4022879
|
|
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
|
|
|
KOH PREP FUNGUS
|
Facility
IP
|
$41.00
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
4022879
|
|
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
|
|
|
Kools Solution Compound
|
Facility
OP
|
$386.60
|
|
|
Service Code
|
CPT A9270GY
|
| Hospital Charge Code |
43702785
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.22 |
| Max. Negotiated Rate |
$347.94 |
| Rate for Payer: Aetna of IA Commercial |
$347.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$347.94
|
| Rate for Payer: Aetna of IA Medicare |
$220.36
|
| Rate for Payer: Amerigroup Medicaid |
$195.12
|
| Rate for Payer: Amerigroup Medicare |
$195.23
|
| Rate for Payer: Cash Price |
$309.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$289.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$193.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$193.22
|
| Rate for Payer: Medical Associates Commercial |
$289.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$193.30
|
| Rate for Payer: Midlands Choice Commercial |
$270.62
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$196.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$289.95
|
| Rate for Payer: United Healthcare Commercial |
$347.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$228.09
|
|
|
Kools Solution Compound
|
Facility
IP
|
$386.60
|
|
|
Service Code
|
CPT A9270GY
|
| Hospital Charge Code |
43702785
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.62 |
| Max. Negotiated Rate |
$347.94 |
| Rate for Payer: Aetna of IA Commercial |
$347.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$347.94
|
| Rate for Payer: Cash Price |
$309.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$289.95
|
| Rate for Payer: Medical Associates Commercial |
$289.95
|
| Rate for Payer: Midlands Choice Commercial |
$270.62
|
| Rate for Payer: United Healthcare Commercial |
$347.94
|
|
|
K-WIRE 0.062X6
|
Facility
IP
|
$16.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8750332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of IA Commercial |
$14.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.40
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.00
|
| Rate for Payer: Medical Associates Commercial |
$12.00
|
| Rate for Payer: Midlands Choice Commercial |
$11.20
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
|
|
K-WIRE 0.062X6
|
Facility
OP
|
$16.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8750332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of IA Commercial |
$14.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.40
|
| Rate for Payer: Aetna of IA Medicare |
$9.12
|
| Rate for Payer: Amerigroup Medicaid |
$8.08
|
| Rate for Payer: Amerigroup Medicare |
$8.08
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.00
|
| Rate for Payer: Medical Associates Commercial |
$12.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.00
|
| Rate for Payer: Midlands Choice Commercial |
$11.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$9.44
|
|
|
K-WIRE 1.0MM
|
Facility
OP
|
$16.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of IA Commercial |
$14.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.40
|
| Rate for Payer: Aetna of IA Medicare |
$9.12
|
| Rate for Payer: Amerigroup Medicaid |
$8.08
|
| Rate for Payer: Amerigroup Medicare |
$8.08
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.00
|
| Rate for Payer: Medical Associates Commercial |
$12.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.00
|
| Rate for Payer: Midlands Choice Commercial |
$11.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$9.44
|
|
|
K-WIRE 1.0MM
|
Facility
IP
|
$16.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of IA Commercial |
$14.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.40
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.00
|
| Rate for Payer: Medical Associates Commercial |
$12.00
|
| Rate for Payer: Midlands Choice Commercial |
$11.20
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
|
|
K-WIRE 1.2MM
|
Facility
OP
|
$37.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna of IA Commercial |
$33.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.30
|
| Rate for Payer: Aetna of IA Medicare |
$21.09
|
| Rate for Payer: Amerigroup Medicaid |
$18.67
|
| Rate for Payer: Amerigroup Medicare |
$18.68
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.49
|
| Rate for Payer: Medical Associates Commercial |
$27.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.50
|
| Rate for Payer: Midlands Choice Commercial |
$25.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.75
|
| Rate for Payer: United Healthcare Commercial |
$33.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.83
|
|
|
K-WIRE 1.2MM
|
Facility
IP
|
$37.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna of IA Commercial |
$33.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.30
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.75
|
| Rate for Payer: Medical Associates Commercial |
$27.75
|
| Rate for Payer: Midlands Choice Commercial |
$25.90
|
| Rate for Payer: United Healthcare Commercial |
$33.30
|
|
|
K-WIRE, 1.35MM, THREADED TROCAR TIP
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.99 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of IA Commercial |
$32.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.40
|
| Rate for Payer: Aetna of IA Medicare |
$20.52
|
| Rate for Payer: Amerigroup Medicaid |
$18.17
|
| Rate for Payer: Amerigroup Medicare |
$18.18
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.99
|
| Rate for Payer: Medical Associates Commercial |
$27.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$25.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.00
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.24
|
|
|
K-WIRE, 1.35MM, THREADED TROCAR TIP
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of IA Commercial |
$32.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.00
|
| Rate for Payer: Medical Associates Commercial |
$27.00
|
| Rate for Payer: Midlands Choice Commercial |
$25.20
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
|
|
K-WIRE, 1.35MM, TROCAR TIP
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of IA Commercial |
$32.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.00
|
| Rate for Payer: Medical Associates Commercial |
$27.00
|
| Rate for Payer: Midlands Choice Commercial |
$25.20
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
|
|
K-WIRE, 1.35MM, TROCAR TIP
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.99 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of IA Commercial |
$32.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.40
|
| Rate for Payer: Aetna of IA Medicare |
$20.52
|
| Rate for Payer: Amerigroup Medicaid |
$18.17
|
| Rate for Payer: Amerigroup Medicare |
$18.18
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.99
|
| Rate for Payer: Medical Associates Commercial |
$27.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$25.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.00
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.24
|
|
|
K-WIRE 1.5 MM
|
Facility
OP
|
$16.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of IA Commercial |
$14.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.40
|
| Rate for Payer: Aetna of IA Medicare |
$9.12
|
| Rate for Payer: Amerigroup Medicaid |
$8.08
|
| Rate for Payer: Amerigroup Medicare |
$8.08
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.00
|
| Rate for Payer: Medical Associates Commercial |
$12.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.00
|
| Rate for Payer: Midlands Choice Commercial |
$11.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$9.44
|
|
|
K-WIRE 1.5 MM
|
Facility
IP
|
$16.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of IA Commercial |
$14.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.40
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.00
|
| Rate for Payer: Medical Associates Commercial |
$12.00
|
| Rate for Payer: Midlands Choice Commercial |
$11.20
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
|
|
K-WIRE, 1.60MM, TROCAR TIP
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna of IA Commercial |
$11.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.70
|
| Rate for Payer: Aetna of IA Medicare |
$7.41
|
| Rate for Payer: Amerigroup Medicaid |
$6.56
|
| Rate for Payer: Amerigroup Medicare |
$6.56
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.50
|
| Rate for Payer: Medical Associates Commercial |
$9.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.50
|
| Rate for Payer: Midlands Choice Commercial |
$9.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.75
|
| Rate for Payer: United Healthcare Commercial |
$11.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.67
|
|
|
K-WIRE, 1.60MM, TROCAR TIP
|
Facility
IP
|
$13.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna of IA Commercial |
$11.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.70
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.75
|
| Rate for Payer: Medical Associates Commercial |
$9.75
|
| Rate for Payer: Midlands Choice Commercial |
$9.10
|
| Rate for Payer: United Healthcare Commercial |
$11.70
|
|
|
K-WIRE, 1.60MM, TROCAR TIP-1
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of IA Commercial |
$16.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.20
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.50
|
| Rate for Payer: Medical Associates Commercial |
$13.50
|
| Rate for Payer: Midlands Choice Commercial |
$12.60
|
| Rate for Payer: United Healthcare Commercial |
$16.20
|
|
|
K-WIRE, 1.60MM, TROCAR TIP-1
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of IA Commercial |
$16.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.20
|
| Rate for Payer: Aetna of IA Medicare |
$10.26
|
| Rate for Payer: Amerigroup Medicaid |
$9.08
|
| Rate for Payer: Amerigroup Medicare |
$9.09
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9.00
|
| Rate for Payer: Medical Associates Commercial |
$13.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.00
|
| Rate for Payer: Midlands Choice Commercial |
$12.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$13.50
|
| Rate for Payer: United Healthcare Commercial |
$16.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$10.62
|
|
|
K-WIRE 1.6MM
|
Facility
IP
|
$37.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna of IA Commercial |
$33.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.30
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.75
|
| Rate for Payer: Medical Associates Commercial |
$27.75
|
| Rate for Payer: Midlands Choice Commercial |
$25.90
|
| Rate for Payer: United Healthcare Commercial |
$33.30
|
|
|
K-WIRE 1.6MM
|
Facility
OP
|
$37.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna of IA Commercial |
$33.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.30
|
| Rate for Payer: Aetna of IA Medicare |
$21.09
|
| Rate for Payer: Amerigroup Medicaid |
$18.67
|
| Rate for Payer: Amerigroup Medicare |
$18.68
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.49
|
| Rate for Payer: Medical Associates Commercial |
$27.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.50
|
| Rate for Payer: Midlands Choice Commercial |
$25.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.75
|
| Rate for Payer: United Healthcare Commercial |
$33.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.83
|
|
|
K-WIRE 1.8X310MM IMPLANT
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8025848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.94 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Aetna of IA Commercial |
$255.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$255.60
|
| Rate for Payer: Aetna of IA Medicare |
$161.88
|
| Rate for Payer: Amerigroup Medicaid |
$143.33
|
| Rate for Payer: Amerigroup Medicare |
$143.42
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$213.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$142.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$141.94
|
| Rate for Payer: Medical Associates Commercial |
$213.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$142.00
|
| Rate for Payer: Midlands Choice Commercial |
$198.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$144.13
|
| Rate for Payer: Partners Health Alliance Commercial |
$213.00
|
| Rate for Payer: United Healthcare Commercial |
$255.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$167.56
|
|
|
K-WIRE 1.8X310MM IMPLANT
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8025848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Aetna of IA Commercial |
$255.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$255.60
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$213.00
|
| Rate for Payer: Medical Associates Commercial |
$213.00
|
| Rate for Payer: Midlands Choice Commercial |
$198.80
|
| Rate for Payer: United Healthcare Commercial |
$255.60
|
|
