|
K-WIRE 6X.045 TROCAR POINTS STERILE
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of IA Commercial |
$29.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.70
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.75
|
| Rate for Payer: Medical Associates Commercial |
$24.75
|
| Rate for Payer: Midlands Choice Commercial |
$23.10
|
| Rate for Payer: United Healthcare Commercial |
$29.70
|
|
|
K-WIRE 6X.054 TROCAR POINTS STERILE
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046249
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of IA Commercial |
$31.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.50
|
| Rate for Payer: Aetna of IA Medicare |
$19.95
|
| Rate for Payer: Amerigroup Medicaid |
$17.66
|
| Rate for Payer: Amerigroup Medicare |
$17.68
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.49
|
| Rate for Payer: Medical Associates Commercial |
$26.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.50
|
| Rate for Payer: Midlands Choice Commercial |
$24.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.76
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$17.75
|
| Rate for Payer: Oscar Health of IA Commercial |
$26.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.25
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.65
|
|
|
K-WIRE 6X.054 TROCAR POINTS STERILE
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046249
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of IA Commercial |
$31.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.50
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.25
|
| Rate for Payer: Medical Associates Commercial |
$26.25
|
| Rate for Payer: Midlands Choice Commercial |
$24.50
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
|
|
K-WIRE 6X.062 TROCAR POINTS STERILE
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of IA Commercial |
$31.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.50
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.25
|
| Rate for Payer: Medical Associates Commercial |
$26.25
|
| Rate for Payer: Midlands Choice Commercial |
$24.50
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
|
|
K-WIRE 6X.062 TROCAR POINTS STERILE
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of IA Commercial |
$31.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.50
|
| Rate for Payer: Aetna of IA Medicare |
$19.95
|
| Rate for Payer: Amerigroup Medicaid |
$17.66
|
| Rate for Payer: Amerigroup Medicare |
$17.68
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.49
|
| Rate for Payer: Medical Associates Commercial |
$26.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.50
|
| Rate for Payer: Midlands Choice Commercial |
$24.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.76
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$17.75
|
| Rate for Payer: Oscar Health of IA Commercial |
$26.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.25
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.65
|
|
|
K-WIRE 9X.028 TROCAR POINTS
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$16.23
|
| Rate for Payer: Oscar Health of IA Commercial |
$24.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
K-WIRE 9X.028 TROCAR POINTS
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
K-WIRE 9X.035 TROCAR POINTS
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
K-WIRE 9X.035 TROCAR POINTS
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$16.23
|
| Rate for Payer: Oscar Health of IA Commercial |
$24.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
K-WIRE 9X.045 TROCAR POINTS
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
K-WIRE 9X.045 TROCAR POINTS
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$16.23
|
| Rate for Payer: Oscar Health of IA Commercial |
$24.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
K-WIRE 9X.054 TROCAR POINTS
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
K-WIRE 9X.054 TROCAR POINTS
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$16.23
|
| Rate for Payer: Oscar Health of IA Commercial |
$24.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
K-WIRE 9X.062 TROCAR POINTS
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
K-WIRE 9X.062 TROCAR POINTS
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$16.23
|
| Rate for Payer: Oscar Health of IA Commercial |
$24.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
K-WIRE GAMMA 3.2X450
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of IA Commercial |
$124.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$124.20
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.50
|
| Rate for Payer: Medical Associates Commercial |
$103.50
|
| Rate for Payer: Midlands Choice Commercial |
$96.60
|
| Rate for Payer: United Healthcare Commercial |
$124.20
|
|
|
K-WIRE GAMMA 3.2X450
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of IA Commercial |
$124.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$124.20
|
| Rate for Payer: Aetna of IA Medicare |
$78.66
|
| Rate for Payer: Amerigroup Medicaid |
$69.65
|
| Rate for Payer: Amerigroup Medicare |
$69.69
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$68.97
|
| Rate for Payer: Medical Associates Commercial |
$103.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.00
|
| Rate for Payer: Midlands Choice Commercial |
$96.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.04
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$69.99
|
| Rate for Payer: Oscar Health of IA Commercial |
$103.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$103.50
|
| Rate for Payer: United Healthcare Commercial |
$124.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$81.42
|
|
|
K-WIRE STANDARD 0.035
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna of IA Commercial |
$22.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.50
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.75
|
| Rate for Payer: Medical Associates Commercial |
$18.75
|
| Rate for Payer: Midlands Choice Commercial |
$17.50
|
| Rate for Payer: United Healthcare Commercial |
$22.50
|
|
|
K-WIRE STANDARD 0.035
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna of IA Commercial |
$22.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.50
|
| Rate for Payer: Aetna of IA Medicare |
$14.25
|
| Rate for Payer: Amerigroup Medicaid |
$12.62
|
| Rate for Payer: Amerigroup Medicare |
$12.62
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.50
|
| Rate for Payer: Medical Associates Commercial |
$18.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.50
|
| Rate for Payer: Midlands Choice Commercial |
$17.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.69
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$12.68
|
| Rate for Payer: Oscar Health of IA Commercial |
$18.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.75
|
| Rate for Payer: United Healthcare Commercial |
$22.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.75
|
|
|
K-WIRE W/17MM STOP
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Aetna of IA Medicare |
$22.80
|
| Rate for Payer: Amerigroup Medicaid |
$20.19
|
| Rate for Payer: Amerigroup Medicare |
$20.20
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.99
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.30
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$20.29
|
| Rate for Payer: Oscar Health of IA Commercial |
$30.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.60
|
|
|
K-WIRE W/17MM STOP
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
|
|
K-WIRE W/LENGTH MARKINGS .045IN (1.143MM
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Aetna of IA Medicare |
$22.80
|
| Rate for Payer: Amerigroup Medicaid |
$20.19
|
| Rate for Payer: Amerigroup Medicare |
$20.20
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.99
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.30
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$20.29
|
| Rate for Payer: Oscar Health of IA Commercial |
$30.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.60
|
|
|
K-WIRE W/LENGTH MARKINGS .045IN (1.143MM
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
|
|
L15 FRAME PLATE
|
Facility
|
IP
|
$2,006.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8955187
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,404.20 |
| Max. Negotiated Rate |
$1,805.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,805.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,805.40
|
| Rate for Payer: Cash Price |
$1,604.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,504.50
|
| Rate for Payer: Medical Associates Commercial |
$1,504.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,404.20
|
| Rate for Payer: United Healthcare Commercial |
$1,805.40
|
|
|
L15 FRAME PLATE
|
Facility
|
OP
|
$2,006.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8955187
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,002.60 |
| Max. Negotiated Rate |
$1,805.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,805.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,805.40
|
| Rate for Payer: Aetna of IA Medicare |
$1,143.42
|
| Rate for Payer: Amerigroup Medicaid |
$1,012.43
|
| Rate for Payer: Amerigroup Medicare |
$1,013.03
|
| Rate for Payer: Cash Price |
$1,604.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,504.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,003.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,002.60
|
| Rate for Payer: Medical Associates Commercial |
$1,504.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,003.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,404.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,018.04
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,017.44
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,504.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,504.50
|
| Rate for Payer: United Healthcare Commercial |
$1,805.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,183.54
|
|
