|
ANESTH-BASE UNIT VALUE
|
Facility
|
OP
|
$86.00
|
|
| Hospital Charge Code |
8059593
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of IA Commercial |
$77.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.40
|
| Rate for Payer: Aetna of IA Medicare |
$49.02
|
| Rate for Payer: Amerigroup Medicaid |
$43.40
|
| Rate for Payer: Amerigroup Medicare |
$43.43
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$43.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.98
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$43.00
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.64
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$43.62
|
| Rate for Payer: Oscar Health of IA Commercial |
$64.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.50
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.74
|
|
|
ANESTH-BASE UNIT VALUE
|
Facility
|
IP
|
$86.00
|
|
| Hospital Charge Code |
8059593
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of IA Commercial |
$77.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.40
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.50
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
|
|
ANESTHESIA MAC I
|
Facility
|
OP
|
$383.00
|
|
| Hospital Charge Code |
8084816
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$191.42 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Aetna of IA Commercial |
$344.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$344.70
|
| Rate for Payer: Aetna of IA Medicare |
$218.31
|
| Rate for Payer: Amerigroup Medicaid |
$193.30
|
| Rate for Payer: Amerigroup Medicare |
$193.42
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$287.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$191.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$191.42
|
| Rate for Payer: Medical Associates Commercial |
$287.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$191.50
|
| Rate for Payer: Midlands Choice Commercial |
$268.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$194.37
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$194.26
|
| Rate for Payer: Oscar Health of IA Commercial |
$287.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$287.25
|
| Rate for Payer: United Healthcare Commercial |
$344.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$225.97
|
|
|
ANESTHESIA MAC I
|
Facility
|
IP
|
$383.00
|
|
| Hospital Charge Code |
8084816
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$268.10 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Aetna of IA Commercial |
$344.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$344.70
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$287.25
|
| Rate for Payer: Medical Associates Commercial |
$287.25
|
| Rate for Payer: Midlands Choice Commercial |
$268.10
|
| Rate for Payer: United Healthcare Commercial |
$344.70
|
|
|
ANESTHESIA-MAC I
|
Facility
|
OP
|
$383.00
|
|
| Hospital Charge Code |
8059071
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$191.42 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Aetna of IA Commercial |
$344.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$344.70
|
| Rate for Payer: Aetna of IA Medicare |
$218.31
|
| Rate for Payer: Amerigroup Medicaid |
$193.30
|
| Rate for Payer: Amerigroup Medicare |
$193.42
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$287.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$191.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$191.42
|
| Rate for Payer: Medical Associates Commercial |
$287.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$191.50
|
| Rate for Payer: Midlands Choice Commercial |
$268.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$194.37
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$194.26
|
| Rate for Payer: Oscar Health of IA Commercial |
$287.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$287.25
|
| Rate for Payer: United Healthcare Commercial |
$344.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$225.97
|
|
|
ANESTHESIA-MAC I
|
Facility
|
IP
|
$383.00
|
|
| Hospital Charge Code |
8059071
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$268.10 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Aetna of IA Commercial |
$344.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$344.70
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$287.25
|
| Rate for Payer: Medical Associates Commercial |
$287.25
|
| Rate for Payer: Midlands Choice Commercial |
$268.10
|
| Rate for Payer: United Healthcare Commercial |
$344.70
|
|
|
ANESTHESIA MAC II
|
Facility
|
IP
|
$514.00
|
|
| Hospital Charge Code |
8059072
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$359.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Aetna of IA Commercial |
$462.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$462.60
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$385.50
|
| Rate for Payer: Medical Associates Commercial |
$385.50
|
| Rate for Payer: Midlands Choice Commercial |
$359.80
|
| Rate for Payer: United Healthcare Commercial |
$462.60
|
|
|
ANESTHESIA MAC II
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
8059072
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$256.90 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Aetna of IA Commercial |
$462.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$462.60
|
| Rate for Payer: Aetna of IA Medicare |
$292.98
|
| Rate for Payer: Amerigroup Medicaid |
$259.42
|
| Rate for Payer: Amerigroup Medicare |
$259.57
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$385.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$257.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$256.90
|
| Rate for Payer: Medical Associates Commercial |
$385.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$257.00
|
| Rate for Payer: Midlands Choice Commercial |
$359.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$260.86
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$260.70
|
| Rate for Payer: Oscar Health of IA Commercial |
$385.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$385.50
|
| Rate for Payer: United Healthcare Commercial |
$462.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$303.26
|
|
|
ANESTH-SPECIAL CIRCUMSTANCES
|
Facility
|
IP
|
$86.00
|
|
| Hospital Charge Code |
8059068
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of IA Commercial |
$77.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.40
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.50
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
|
|
ANESTH-SPECIAL CIRCUMSTANCES
|
Facility
|
OP
|
$86.00
|
|
| Hospital Charge Code |
8059068
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of IA Commercial |
$77.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.40
|
| Rate for Payer: Aetna of IA Medicare |
$49.02
|
| Rate for Payer: Amerigroup Medicaid |
$43.40
|
| Rate for Payer: Amerigroup Medicare |
$43.43
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$43.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.98
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$43.00
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.64
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$43.62
|
| Rate for Payer: Oscar Health of IA Commercial |
$64.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.50
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.74
|
|
|
Angina Pectoris
|
Facility
|
IP
|
$4,296.21
|
|
|
Service Code
|
MS-DRG 311
|
| Hospital Charge Code |
168
|
| Min. Negotiated Rate |
$4,233.95 |
| Max. Negotiated Rate |
$4,296.21 |
| Rate for Payer: Amerigroup Medicaid |
$4,275.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,233.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,296.21
|
|
|
Angiotensin Converting Enzyme DMCL
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
8037493
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$70.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$104.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Angiotensin Converting Enzyme DMCL
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
8037493
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
ANKLE PLATE 12 HOLE 1/3 TUBULAR PLATE
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8823374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.29 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Aetna of IA Commercial |
$931.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$931.50
|
| Rate for Payer: Aetna of IA Medicare |
$589.95
|
| Rate for Payer: Amerigroup Medicaid |
$522.36
|
| Rate for Payer: Amerigroup Medicare |
$522.68
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$776.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$517.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$517.29
|
| Rate for Payer: Medical Associates Commercial |
$776.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$517.50
|
| Rate for Payer: Midlands Choice Commercial |
$724.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$525.26
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$524.95
|
| Rate for Payer: Oscar Health of IA Commercial |
$776.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$776.25
|
| Rate for Payer: United Healthcare Commercial |
$931.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$610.65
|
|
|
ANKLE PLATE 12 HOLE 1/3 TUBULAR PLATE
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8823374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.50 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Aetna of IA Commercial |
$931.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$931.50
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$776.25
|
| Rate for Payer: Medical Associates Commercial |
$776.25
|
| Rate for Payer: Midlands Choice Commercial |
$724.50
|
| Rate for Payer: United Healthcare Commercial |
$931.50
|
|
|
ANKLE PLATE 7 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
|
OP
|
$2,052.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8823181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,025.59 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,169.64
|
| Rate for Payer: Amerigroup Medicaid |
$1,035.64
|
| Rate for Payer: Amerigroup Medicare |
$1,036.26
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,026.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,025.59
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,026.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,041.39
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,040.77
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,539.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,539.00
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,210.68
|
|
|
ANKLE PLATE 7 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
|
IP
|
$2,052.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8823181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.40 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
|
|
ANKLE PLATE 9 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
|
OP
|
$2,052.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8868039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,025.59 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,169.64
|
| Rate for Payer: Amerigroup Medicaid |
$1,035.64
|
| Rate for Payer: Amerigroup Medicare |
$1,036.26
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,026.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,025.59
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,026.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,041.39
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,040.77
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,539.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,539.00
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,210.68
|
|
|
ANKLE PLATE 9 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
|
IP
|
$2,052.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8868039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.40 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
|
|
ANKLE PLATES 10 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
|
IP
|
$2,160.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,512.00 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,944.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,944.00
|
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,620.00
|
| Rate for Payer: Medical Associates Commercial |
$1,620.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,512.00
|
| Rate for Payer: United Healthcare Commercial |
$1,944.00
|
|
|
ANKLE PLATES 10 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
|
OP
|
$2,160.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,079.57 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,944.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,944.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,231.20
|
| Rate for Payer: Amerigroup Medicaid |
$1,090.15
|
| Rate for Payer: Amerigroup Medicare |
$1,090.80
|
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,620.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,080.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,079.57
|
| Rate for Payer: Medical Associates Commercial |
$1,620.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,080.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,512.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,096.20
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,095.55
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,620.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,620.00
|
| Rate for Payer: United Healthcare Commercial |
$1,944.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,274.40
|
|
|
ANKLE PLATES 12 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
|
IP
|
$2,052.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8831363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.40 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
|
|
ANKLE PLATES 12 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
|
OP
|
$2,052.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8831363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,025.59 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,169.64
|
| Rate for Payer: Amerigroup Medicaid |
$1,035.64
|
| Rate for Payer: Amerigroup Medicare |
$1,036.26
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,026.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,025.59
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,026.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,041.39
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,040.77
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,539.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,539.00
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,210.68
|
|
|
ANTIBODY SCREEN GEL
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
4024782
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Aetna of IA Medicare |
$41.61
|
| Rate for Payer: Amerigroup Medicaid |
$36.84
|
| Rate for Payer: Amerigroup Medicare |
$36.86
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.49
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.50
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.05
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$37.03
|
| Rate for Payer: Oscar Health of IA Commercial |
$54.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.75
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.07
|
| Rate for Payer: Wellmark IA HMO |
$97.34
|
| Rate for Payer: Wellmark IA PPO |
$107.07
|
|
|
ANTIBODY SCREEN GEL
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
4024782
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
|
