|
saxagliptin 5 mg Tab
|
Facility
OP
|
$52.72
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700230
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.35 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Aetna of IA Medicare |
$30.05
|
| Rate for Payer: Aetna of IA Commercial |
$47.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$47.45
|
| Rate for Payer: Amerigroup Medicaid |
$26.61
|
| Rate for Payer: Amerigroup Medicare |
$26.62
|
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.54
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$26.35
|
| Rate for Payer: Medical Associates Commercial |
$39.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.36
|
| Rate for Payer: Midlands Choice Commercial |
$36.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.54
|
| Rate for Payer: United Healthcare Commercial |
$47.45
|
| Rate for Payer: United Healthcare Managed Medicare |
$31.10
|
|
|
saxagliptin 5 mg Tab
|
Facility
IP
|
$52.72
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700230
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Aetna of IA Commercial |
$47.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$47.45
|
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.54
|
| Rate for Payer: Medical Associates Commercial |
$39.54
|
| Rate for Payer: Midlands Choice Commercial |
$36.90
|
| Rate for Payer: United Healthcare Commercial |
$47.45
|
|
|
SCIATIC NERVE BLOCK CHARGE
|
Professional
|
$342.00
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
8059065
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$65.85 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Aetna of IA Medicare |
$65.85
|
| Rate for Payer: Amerigroup Medicaid |
$68.09
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$79.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.17
|
| Rate for Payer: Medical Associates Commercial |
$125.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$65.85
|
| Rate for Payer: Midlands Choice Commercial |
$239.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$98.78
|
| Rate for Payer: Wellmark IA HMO |
$130.00
|
| Rate for Payer: Wellmark IA PPO |
$152.00
|
|
|
SCREW 2.2MMX16MM
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8814832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
SCREW 2.2MMX16MM
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8814832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
SCREW 2.2MMX20MM
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8814834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
SCREW 2.2MMX20MM
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8814834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
SCREW 2.2X14MM
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8814830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
SCREW 2.2X14MM
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8814830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
SCREW 2.2X18MM
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8815108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
SCREW 2.2X18MM
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8815108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
SCREW 4.5MMX22MM STTCS
|
Facility
IP
|
$513.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8897831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of IA Commercial |
$461.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$461.70
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$384.75
|
| Rate for Payer: Medical Associates Commercial |
$384.75
|
| Rate for Payer: Midlands Choice Commercial |
$359.10
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
|
|
SCREW 4.5MMX22MM STTCS
|
Facility
OP
|
$513.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8897831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.40 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of IA Commercial |
$461.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$461.70
|
| Rate for Payer: Aetna of IA Medicare |
$292.41
|
| Rate for Payer: Amerigroup Medicaid |
$258.91
|
| Rate for Payer: Amerigroup Medicare |
$259.06
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$384.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$256.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$256.40
|
| Rate for Payer: Medical Associates Commercial |
$384.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$256.50
|
| Rate for Payer: Midlands Choice Commercial |
$359.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$260.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$384.75
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$302.67
|
|
|
SCREW ANCHOR 5.5 WITH MAXBRAID SUTURE ND
|
Facility
OP
|
$599.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$299.38 |
| Max. Negotiated Rate |
$539.10 |
| Rate for Payer: Aetna of IA Commercial |
$539.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$539.10
|
| Rate for Payer: Aetna of IA Medicare |
$341.43
|
| Rate for Payer: Amerigroup Medicaid |
$302.32
|
| Rate for Payer: Amerigroup Medicare |
$302.50
|
| Rate for Payer: Cash Price |
$479.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$449.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$299.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$299.38
|
| Rate for Payer: Medical Associates Commercial |
$449.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$299.50
|
| Rate for Payer: Midlands Choice Commercial |
$419.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$303.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$449.25
|
| Rate for Payer: United Healthcare Commercial |
$539.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$353.41
|
|
|
SCREW ANCHOR 5.5 WITH MAXBRAID SUTURE ND
|
Facility
IP
|
$599.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.30 |
| Max. Negotiated Rate |
$539.10 |
| Rate for Payer: Aetna of IA Commercial |
$539.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$539.10
|
| Rate for Payer: Cash Price |
$479.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$449.25
|
| Rate for Payer: Medical Associates Commercial |
$449.25
|
| Rate for Payer: Midlands Choice Commercial |
$419.30
|
| Rate for Payer: United Healthcare Commercial |
$539.10
|
|
|
SCREW BONE 6.5MM X 50MM
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.94 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna of IA Commercial |
$261.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$261.00
|
| Rate for Payer: Aetna of IA Medicare |
$165.30
|
| Rate for Payer: Amerigroup Medicaid |
$146.36
|
| Rate for Payer: Amerigroup Medicare |
$146.45
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$217.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$145.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$144.94
|
| Rate for Payer: Medical Associates Commercial |
$217.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$145.00
|
| Rate for Payer: Midlands Choice Commercial |
$203.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$147.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$217.50
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$171.10
|
|
|
SCREW BONE 6.5MM X 50MM
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna of IA Commercial |
$261.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$261.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$217.50
|
| Rate for Payer: Medical Associates Commercial |
$217.50
|
| Rate for Payer: Midlands Choice Commercial |
$203.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
|
|
SCREW BONE T10 3.5X12MM
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Aetna of IA Medicare |
$59.28
|
| Rate for Payer: Amerigroup Medicaid |
$52.49
|
| Rate for Payer: Amerigroup Medicare |
$52.52
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.00
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.36
|
|
|
SCREW BONE T10 3.5X12MM
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
|
|
SCREW BONE T10 3.5X30MM
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Aetna of IA Medicare |
$59.28
|
| Rate for Payer: Amerigroup Medicaid |
$52.49
|
| Rate for Payer: Amerigroup Medicare |
$52.52
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.00
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.36
|
|
|
SCREW BONE T10 3.5X30MM
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
|
|
SCREW BONE T10 3.5X55MM
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Aetna of IA Medicare |
$59.28
|
| Rate for Payer: Amerigroup Medicaid |
$52.49
|
| Rate for Payer: Amerigroup Medicare |
$52.52
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.00
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.36
|
|
|
SCREW BONE T10 3.5X55MM
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
|
|
SCREW BONE T7 2.7X14MM
|
Facility
OP
|
$84.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of IA Commercial |
$75.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$75.60
|
| Rate for Payer: Aetna of IA Medicare |
$47.88
|
| Rate for Payer: Amerigroup Medicaid |
$42.39
|
| Rate for Payer: Amerigroup Medicare |
$42.42
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.98
|
| Rate for Payer: Medical Associates Commercial |
$63.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.00
|
| Rate for Payer: Midlands Choice Commercial |
$58.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$63.00
|
| Rate for Payer: United Healthcare Commercial |
$75.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$49.56
|
|
|
SCREW BONE T7 2.7X14MM
|
Facility
IP
|
$84.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of IA Commercial |
$75.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$75.60
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.00
|
| Rate for Payer: Medical Associates Commercial |
$63.00
|
| Rate for Payer: Midlands Choice Commercial |
$58.80
|
| Rate for Payer: United Healthcare Commercial |
$75.60
|
|
