|
1.6MM COMPRESSION WIRE X 150MM
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT C1763
|
| Hospital Charge Code |
8748467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.49 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Aetna of IA Medicare |
$40.47
|
| Rate for Payer: Amerigroup Medicaid |
$35.83
|
| Rate for Payer: Amerigroup Medicare |
$35.86
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.49
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.25
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.89
|
|
|
1.6MM KIRSCHNER WIRE X 150MM
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT C1763
|
| Hospital Charge Code |
8748487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.47 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Aetna of IA Medicare |
$90.63
|
| Rate for Payer: Amerigroup Medicaid |
$80.25
|
| Rate for Payer: Amerigroup Medicare |
$80.30
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$79.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.47
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$79.50
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$119.25
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.81
|
|
|
1.6MM KIRSCHNER WIRE X 150MM
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT C1763
|
| Hospital Charge Code |
8748487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
|
|
17110 Destruction of benign lesions up to 14 lesions
|
Professional
|
$366.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
8799108
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$62.83 |
| Max. Negotiated Rate |
$256.20 |
| Rate for Payer: Aetna of IA Medicare |
$62.83
|
| Rate for Payer: Amerigroup Medicaid |
$64.97
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.09
|
| Rate for Payer: Medical Associates Commercial |
$119.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.83
|
| Rate for Payer: Midlands Choice Commercial |
$256.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$94.24
|
| Rate for Payer: Wellmark IA HMO |
$120.00
|
| Rate for Payer: Wellmark IA PPO |
$140.00
|
|
|
18MMX15MMX15MM SNIPER STAPLE
|
Facility
IP
|
$1,629.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8857932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.30 |
| Max. Negotiated Rate |
$1,466.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,466.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,466.10
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,221.75
|
| Rate for Payer: Medical Associates Commercial |
$1,221.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,140.30
|
| Rate for Payer: United Healthcare Commercial |
$1,466.10
|
|
|
18MMX15MMX15MM SNIPER STAPLE
|
Facility
OP
|
$1,629.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8857932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$814.17 |
| Max. Negotiated Rate |
$1,466.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,466.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,466.10
|
| Rate for Payer: Aetna of IA Medicare |
$928.53
|
| Rate for Payer: Amerigroup Medicaid |
$822.16
|
| Rate for Payer: Amerigroup Medicare |
$822.64
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,221.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$814.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$814.17
|
| Rate for Payer: Medical Associates Commercial |
$1,221.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$814.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,140.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$826.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,221.75
|
| Rate for Payer: United Healthcare Commercial |
$1,466.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$961.11
|
|
|
19100 BREAST BIOPSY NEEDLE CORE
|
Professional
|
$499.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
8069039
|
| Min. Negotiated Rate |
$60.57 |
| Max. Negotiated Rate |
$349.30 |
| Rate for Payer: Amerigroup Medicaid |
$62.63
|
| Rate for Payer: Cash Price |
$399.20
|
| Rate for Payer: Cash Price |
$399.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$72.68
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.78
|
| Rate for Payer: Medical Associates Commercial |
$115.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$60.57
|
| Rate for Payer: Midlands Choice Commercial |
$349.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$90.86
|
| Rate for Payer: Wellmark IA HMO |
$131.00
|
| Rate for Payer: Wellmark IA PPO |
$153.00
|
|
|
19120 REMOVAL OF BREAST LESION
|
Professional
|
$1,643.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
8069146
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$373.39 |
| Max. Negotiated Rate |
$1,150.10 |
| Rate for Payer: Aetna of IA Medicare |
$373.39
|
| Rate for Payer: Amerigroup Medicaid |
$386.09
|
| Rate for Payer: Cash Price |
$1,314.40
|
| Rate for Payer: Cash Price |
$1,314.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$448.07
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$380.86
|
| Rate for Payer: Medical Associates Commercial |
$709.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$373.39
|
| Rate for Payer: Midlands Choice Commercial |
$1,150.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$560.08
|
| Rate for Payer: Wellmark IA HMO |
$799.00
|
| Rate for Payer: Wellmark IA PPO |
$938.00
|
|
|
19301 MASTECTOMY PARTIAL
|
Professional
|
$2,189.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
8069176
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$586.45 |
| Max. Negotiated Rate |
$1,532.30 |
| Rate for Payer: Aetna of IA Medicare |
$586.45
|
| Rate for Payer: Amerigroup Medicaid |
$606.39
|
| Rate for Payer: Cash Price |
$1,751.20
|
| Rate for Payer: Cash Price |
$1,751.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$703.74
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$598.18
|
| Rate for Payer: Medical Associates Commercial |
$1,114.26
|
| Rate for Payer: Medical Associates Managed Medicare |
$586.45
|
| Rate for Payer: Midlands Choice Commercial |
$1,532.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$879.68
|
| Rate for Payer: Wellmark IA HMO |
$1,261.00
|
| Rate for Payer: Wellmark IA PPO |
$1,480.00
|
|
|
19302 MASTECTOMY PART W LYMPHADENECT
|
Professional
|
$3,021.00
|
|
|
Service Code
|
CPT 19302
|
| Hospital Charge Code |
8069192
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$804.94 |
| Max. Negotiated Rate |
$2,114.70 |
| Rate for Payer: Aetna of IA Medicare |
$804.94
|
| Rate for Payer: Amerigroup Medicaid |
$832.31
|
| Rate for Payer: Cash Price |
$2,416.80
|
| Rate for Payer: Cash Price |
$2,416.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$965.93
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$821.04
|
| Rate for Payer: Medical Associates Commercial |
$1,529.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$804.94
|
| Rate for Payer: Midlands Choice Commercial |
$2,114.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,207.41
|
| Rate for Payer: Wellmark IA HMO |
$1,731.00
|
| Rate for Payer: Wellmark IA PPO |
$2,032.00
|
|
|
19303 MASTECTOMY SIMPLE AND COMPLETE
|
Professional
|
$3,393.00
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
8069153
|
| Min. Negotiated Rate |
$849.82 |
| Max. Negotiated Rate |
$2,375.10 |
| Rate for Payer: Amerigroup Medicaid |
$878.71
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,019.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$866.82
|
| Rate for Payer: Medical Associates Commercial |
$1,614.66
|
| Rate for Payer: Medical Associates Managed Medicare |
$849.82
|
| Rate for Payer: Midlands Choice Commercial |
$2,375.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,274.73
|
| Rate for Payer: Wellmark IA HMO |
$1,827.00
|
| Rate for Payer: Wellmark IA PPO |
$2,145.00
|
|
|
19307 MASTECTOMY MODIFIED RADICAL
|
Professional
|
$4,017.00
|
|
|
Service Code
|
CPT 19307
|
| Hospital Charge Code |
8069014
|
| Min. Negotiated Rate |
$1,046.09 |
| Max. Negotiated Rate |
$2,811.90 |
| Rate for Payer: Amerigroup Medicaid |
$1,081.66
|
| Rate for Payer: Cash Price |
$3,213.60
|
| Rate for Payer: Cash Price |
$3,213.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,255.31
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,067.01
|
| Rate for Payer: Medical Associates Commercial |
$1,987.57
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,046.09
|
| Rate for Payer: Midlands Choice Commercial |
$2,811.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,569.14
|
| Rate for Payer: Wellmark IA HMO |
$2,252.00
|
| Rate for Payer: Wellmark IA PPO |
$2,643.00
|
|
|
20240 Biopsy of bone; open superficial
|
Professional
|
$503.00
|
|
|
Service Code
|
CPT 20240
|
| Hospital Charge Code |
8799109
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$127.92 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna of IA Medicare |
$127.92
|
| Rate for Payer: Amerigroup Medicaid |
$132.27
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$153.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$130.48
|
| Rate for Payer: Medical Associates Commercial |
$243.05
|
| Rate for Payer: Medical Associates Managed Medicare |
$127.92
|
| Rate for Payer: Midlands Choice Commercial |
$352.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$191.88
|
| Rate for Payer: Wellmark IA HMO |
$248.00
|
| Rate for Payer: Wellmark IA PPO |
$291.00
|
|
|
20526 Carpal tunnel injection
|
Professional
|
$257.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
8799110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$179.90 |
| Rate for Payer: Aetna of IA Medicare |
$50.96
|
| Rate for Payer: Amerigroup Medicaid |
$52.69
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$96.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.96
|
| Rate for Payer: Midlands Choice Commercial |
$179.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$76.44
|
| Rate for Payer: Wellmark IA HMO |
$102.00
|
| Rate for Payer: Wellmark IA PPO |
$119.00
|
|
|
20600 Arthrocentesis- injection small joint/bursa (fingers/toes)
|
Professional
|
$161.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
8799111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$112.70 |
| Rate for Payer: Aetna of IA Medicare |
$32.52
|
| Rate for Payer: Amerigroup Medicaid |
$33.63
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.17
|
| Rate for Payer: Medical Associates Commercial |
$61.79
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.52
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.78
|
| Rate for Payer: Wellmark IA HMO |
$63.00
|
| Rate for Payer: Wellmark IA PPO |
$74.00
|
|
|
20605 Arthrocentesis- injection intermediate joint/bursa (TMJ wrist elbow ankle)
|
Professional
|
$168.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
8799112
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$117.60 |
| Rate for Payer: Aetna of IA Medicare |
$33.48
|
| Rate for Payer: Amerigroup Medicaid |
$34.62
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$40.18
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.15
|
| Rate for Payer: Medical Associates Commercial |
$63.61
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.48
|
| Rate for Payer: Midlands Choice Commercial |
$117.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.22
|
| Rate for Payer: Wellmark IA HMO |
$66.00
|
| Rate for Payer: Wellmark IA PPO |
$77.00
|
|
|
20611 Drain/injection major joint/bursa w/ ultrasound guidance
|
Professional
|
$313.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
8799113
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$219.10 |
| Rate for Payer: Aetna of IA Medicare |
$53.51
|
| Rate for Payer: Amerigroup Medicaid |
$55.33
|
| Rate for Payer: Cash Price |
$250.40
|
| Rate for Payer: Cash Price |
$250.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.21
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.58
|
| Rate for Payer: Medical Associates Commercial |
$101.67
|
| Rate for Payer: Medical Associates Managed Medicare |
$53.51
|
| Rate for Payer: Midlands Choice Commercial |
$219.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$80.26
|
| Rate for Payer: Wellmark IA HMO |
$106.00
|
| Rate for Payer: Wellmark IA PPO |
$125.00
|
|
|
20670 Removal implant superficial (separate procedure)
|
Professional
|
$1,228.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
8799114
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.01 |
| Max. Negotiated Rate |
$859.60 |
| Rate for Payer: Aetna of IA Medicare |
$132.01
|
| Rate for Payer: Amerigroup Medicaid |
$136.50
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$158.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$134.65
|
| Rate for Payer: Medical Associates Commercial |
$250.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$132.01
|
| Rate for Payer: Midlands Choice Commercial |
$859.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$198.02
|
| Rate for Payer: Wellmark IA HMO |
$259.00
|
| Rate for Payer: Wellmark IA PPO |
$304.00
|
|
|
20680 Removal implanted device deep
|
Professional
|
$2,055.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
8799115
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$381.12 |
| Max. Negotiated Rate |
$1,438.50 |
| Rate for Payer: Aetna of IA Medicare |
$381.12
|
| Rate for Payer: Amerigroup Medicaid |
$394.08
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$457.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$388.74
|
| Rate for Payer: Medical Associates Commercial |
$724.13
|
| Rate for Payer: Medical Associates Managed Medicare |
$381.12
|
| Rate for Payer: Midlands Choice Commercial |
$1,438.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$571.68
|
| Rate for Payer: Wellmark IA HMO |
$751.00
|
| Rate for Payer: Wellmark IA PPO |
$882.00
|
|
|
20690 APPLY BONE FIXATION DEVICE 1 PLATE
|
Professional
|
$2,009.00
|
|
|
Service Code
|
CPT 20690
|
| Hospital Charge Code |
8799116
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$538.64 |
| Max. Negotiated Rate |
$1,406.30 |
| Rate for Payer: Aetna of IA Medicare |
$538.64
|
| Rate for Payer: Amerigroup Medicaid |
$556.95
|
| Rate for Payer: Cash Price |
$1,607.20
|
| Rate for Payer: Cash Price |
$1,607.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$646.37
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$549.41
|
| Rate for Payer: Medical Associates Commercial |
$1,023.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$538.64
|
| Rate for Payer: Midlands Choice Commercial |
$1,406.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$807.96
|
| Rate for Payer: Wellmark IA HMO |
$1,140.00
|
| Rate for Payer: Wellmark IA PPO |
$1,338.00
|
|
|
2.0MM XBRAID TT 100% UHMWPE VIOLET CO-BRAID
|
Facility
OP
|
$180.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8771318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.96 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Aetna of IA Medicare |
$102.60
|
| Rate for Payer: Amerigroup Medicaid |
$90.85
|
| Rate for Payer: Amerigroup Medicare |
$90.90
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.96
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.20
|
|
|
2.0MM XBRAID TT 100% UHMWPE VIOLET CO-BRAID
|
Facility
IP
|
$180.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8771318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
|
|
2.0MM XBRAID TT 100% UHMWPE VIOLET CO-BRAID 3910900019
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8797132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Aetna of IA Medicare |
$57.00
|
| Rate for Payer: Amerigroup Medicaid |
$50.47
|
| Rate for Payer: Amerigroup Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$50.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.98
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
|
|
2.0MM XBRAID TT 100% UHMWPE VIOLET CO-BRAID 3910900019
|
Facility
IP
|
$100.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8797132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
|
|
21116 Temporomandibular joint injection
|
Professional
|
$656.00
|
|
|
Service Code
|
CPT 21116
|
| Hospital Charge Code |
8799117
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$459.20 |
| Rate for Payer: Aetna of IA Medicare |
$40.57
|
| Rate for Payer: Amerigroup Medicaid |
$41.95
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.68
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.38
|
| Rate for Payer: Medical Associates Commercial |
$77.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.57
|
| Rate for Payer: Midlands Choice Commercial |
$459.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$60.86
|
| Rate for Payer: Wellmark IA HMO |
$83.00
|
| Rate for Payer: Wellmark IA PPO |
$98.00
|
|
