|
SUMAtriptan 100 mg Tab
|
Facility
IP
|
$2.96
|
|
|
Service Code
|
CPT J3030
|
| Hospital Charge Code |
43701880
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna of IA Commercial |
$2.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.66
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.22
|
| Rate for Payer: Medical Associates Commercial |
$2.22
|
| Rate for Payer: Midlands Choice Commercial |
$2.07
|
| Rate for Payer: United Healthcare Commercial |
$2.66
|
|
|
SUMAtriptan 100 mg Tab
|
Facility
OP
|
$2.96
|
|
|
Service Code
|
CPT J3030
|
| Hospital Charge Code |
43701880
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna of IA Commercial |
$2.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.66
|
| Rate for Payer: Aetna of IA Medicare |
$1.69
|
| Rate for Payer: Amerigroup Medicaid |
$1.49
|
| Rate for Payer: Amerigroup Medicare |
$1.49
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.48
|
| Rate for Payer: Medical Associates Commercial |
$2.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.48
|
| Rate for Payer: Midlands Choice Commercial |
$2.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.22
|
| Rate for Payer: United Healthcare Commercial |
$2.66
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.75
|
|
|
SUMAtriptan 6 mg/0.5 mL SubQ SDV
|
Facility
IP
|
$38.30
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43789143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.81 |
| Max. Negotiated Rate |
$34.47 |
| Rate for Payer: Aetna of IA Commercial |
$34.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.47
|
| Rate for Payer: Cash Price |
$30.64
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.72
|
| Rate for Payer: Medical Associates Commercial |
$28.72
|
| Rate for Payer: Midlands Choice Commercial |
$26.81
|
| Rate for Payer: United Healthcare Commercial |
$34.47
|
|
|
SUMAtriptan 6 mg/0.5 mL SubQ SDV
|
Facility
OP
|
$38.30
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43789143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$34.47 |
| Rate for Payer: Aetna of IA Commercial |
$34.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.47
|
| Rate for Payer: Aetna of IA Medicare |
$21.83
|
| Rate for Payer: Amerigroup Medicaid |
$19.33
|
| Rate for Payer: Amerigroup Medicare |
$19.34
|
| Rate for Payer: Cash Price |
$30.64
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.72
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$19.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.14
|
| Rate for Payer: Medical Associates Commercial |
$28.72
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.15
|
| Rate for Payer: Midlands Choice Commercial |
$26.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.72
|
| Rate for Payer: United Healthcare Commercial |
$34.47
|
| Rate for Payer: United Healthcare Managed Medicare |
$22.60
|
|
|
SUPPLIES FOR WOUND CARE NON SELECTIVE
|
Facility
IP
|
$374.00
|
|
|
Service Code
|
CPT 99070
|
| Hospital Charge Code |
8013710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Aetna of IA Commercial |
$336.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$336.60
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$280.50
|
| Rate for Payer: Medical Associates Commercial |
$280.50
|
| Rate for Payer: Midlands Choice Commercial |
$261.80
|
| Rate for Payer: United Healthcare Commercial |
$336.60
|
|
|
SUPPLIES FOR WOUND CARE NON SELECTIVE
|
Facility
OP
|
$374.00
|
|
|
Service Code
|
CPT 99070
|
| Hospital Charge Code |
8013710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$186.93 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Aetna of IA Commercial |
$336.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$336.60
|
| Rate for Payer: Aetna of IA Medicare |
$213.18
|
| Rate for Payer: Amerigroup Medicaid |
$188.76
|
| Rate for Payer: Amerigroup Medicare |
$188.87
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$280.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$187.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$186.93
|
| Rate for Payer: Medical Associates Commercial |
$280.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$187.00
|
| Rate for Payer: Midlands Choice Commercial |
$261.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$189.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$280.50
|
| Rate for Payer: United Healthcare Commercial |
$336.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$220.66
|
|
|
SURETAPE 2-0
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8767795
|
|
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
|
|
|
SURETAPE 2-0
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8767795
|
|
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
|
|
|
Surgical treatment of anal fistula (fistulectomy/fistulotomy); subcutaneous
|
Facility
OP
|
$4,960.19
|
|
|
Service Code
|
CPT 46270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,509.26 |
| Max. Negotiated Rate |
$4,960.19 |
| Rate for Payer: Wellmark IA HMO |
$4,509.26
|
| Rate for Payer: Wellmark IA PPO |
$4,960.19
|
|
|
SURGIMESH HERNIA BARRIER MESH VENRAL
|
Facility
IP
|
$2,988.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8046321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,091.60 |
| Max. Negotiated Rate |
$2,689.20 |
| Rate for Payer: Aetna of IA Commercial |
$2,689.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,689.20
|
| Rate for Payer: Cash Price |
$2,390.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,241.00
|
| Rate for Payer: Medical Associates Commercial |
$2,241.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,091.60
|
| Rate for Payer: United Healthcare Commercial |
$2,689.20
|
|
|
SURGIMESH HERNIA BARRIER MESH VENRAL
|
Facility
OP
|
$2,988.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8046321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,493.40 |
| Max. Negotiated Rate |
$2,689.20 |
| Rate for Payer: Aetna of IA Commercial |
$2,689.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,689.20
|
| Rate for Payer: Aetna of IA Medicare |
$1,703.16
|
| Rate for Payer: Amerigroup Medicaid |
$1,508.04
|
| Rate for Payer: Amerigroup Medicare |
$1,508.94
|
| Rate for Payer: Cash Price |
$2,390.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,241.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,494.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,493.40
|
| Rate for Payer: Medical Associates Commercial |
$2,241.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,494.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,091.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,516.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,241.00
|
| Rate for Payer: United Healthcare Commercial |
$2,689.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,762.92
|
|
|
SURGIMESH OPEN/LAP INGUINAL 7 CM
|
Facility
IP
|
$1,440.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8026545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.00 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,296.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,296.00
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,080.00
|
| Rate for Payer: Medical Associates Commercial |
$1,080.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare Commercial |
$1,296.00
|
|
|
SURGIMESH OPEN/LAP INGUINAL 7 CM
|
Facility
OP
|
$1,440.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8026545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$719.71 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,296.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,296.00
|
| Rate for Payer: Aetna of IA Medicare |
$820.80
|
| Rate for Payer: Amerigroup Medicaid |
$726.77
|
| Rate for Payer: Amerigroup Medicare |
$727.20
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,080.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$720.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$719.71
|
| Rate for Payer: Medical Associates Commercial |
$1,080.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$720.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,008.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$730.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$849.60
|
|
|
SURGITIE LIGATING LOOP
|
Facility
IP
|
$1,104.00
|
|
| Hospital Charge Code |
8046978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$772.80 |
| Max. Negotiated Rate |
$993.60 |
| Rate for Payer: Aetna of IA Commercial |
$993.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$993.60
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$828.00
|
| Rate for Payer: Medical Associates Commercial |
$828.00
|
| Rate for Payer: Midlands Choice Commercial |
$772.80
|
| Rate for Payer: United Healthcare Commercial |
$993.60
|
|
|
SURGITIE LIGATING LOOP
|
Facility
OP
|
$1,104.00
|
|
| Hospital Charge Code |
8046978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$551.78 |
| Max. Negotiated Rate |
$993.60 |
| Rate for Payer: Aetna of IA Commercial |
$993.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$993.60
|
| Rate for Payer: Aetna of IA Medicare |
$629.28
|
| Rate for Payer: Amerigroup Medicaid |
$557.19
|
| Rate for Payer: Amerigroup Medicare |
$557.52
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$828.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$552.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$551.78
|
| Rate for Payer: Medical Associates Commercial |
$828.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$552.00
|
| Rate for Payer: Midlands Choice Commercial |
$772.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$560.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$828.00
|
| Rate for Payer: United Healthcare Commercial |
$993.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$651.36
|
|
|
SURG TX MISSED ABORT; 2ND TRIMESTR
|
Professional
|
$1,283.00
|
|
|
Service Code
|
CPT 59821
|
| Hospital Charge Code |
8068908
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$335.00 |
| Max. Negotiated Rate |
$898.10 |
| Rate for Payer: Aetna of IA Medicare |
$335.00
|
| Rate for Payer: Amerigroup Medicaid |
$346.39
|
| Rate for Payer: Cash Price |
$1,026.40
|
| Rate for Payer: Cash Price |
$1,026.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$402.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$341.70
|
| Rate for Payer: Medical Associates Commercial |
$636.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$335.00
|
| Rate for Payer: Midlands Choice Commercial |
$898.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$502.50
|
| Rate for Payer: Wellmark IA HMO |
$727.00
|
| Rate for Payer: Wellmark IA PPO |
$853.00
|
|
|
SUTURE ANCH, BIO-COMPOSITE P-LCK 2.4X11.3
|
Facility
OP
|
$1,030.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8771306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$514.79 |
| Max. Negotiated Rate |
$927.00 |
| Rate for Payer: Aetna of IA Commercial |
$927.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$927.00
|
| Rate for Payer: Aetna of IA Medicare |
$587.10
|
| Rate for Payer: Amerigroup Medicaid |
$519.84
|
| Rate for Payer: Amerigroup Medicare |
$520.15
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$772.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$515.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$514.79
|
| Rate for Payer: Medical Associates Commercial |
$772.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$515.00
|
| Rate for Payer: Midlands Choice Commercial |
$721.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$522.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$772.50
|
| Rate for Payer: United Healthcare Commercial |
$927.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$607.70
|
|
|
SUTURE ANCH, BIO-COMPOSITE P-LCK 2.4X11.3
|
Facility
IP
|
$1,030.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8771306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.00 |
| Max. Negotiated Rate |
$927.00 |
| Rate for Payer: Aetna of IA Commercial |
$927.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$927.00
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$772.50
|
| Rate for Payer: Medical Associates Commercial |
$772.50
|
| Rate for Payer: Midlands Choice Commercial |
$721.00
|
| Rate for Payer: United Healthcare Commercial |
$927.00
|
|
|
SUTURE ANCHOR BIOCOMPOSITE SWIVELOCK 4.75 X 19.1
|
Facility
OP
|
$720.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.86 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna of IA Commercial |
$648.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$648.00
|
| Rate for Payer: Aetna of IA Medicare |
$410.40
|
| Rate for Payer: Amerigroup Medicaid |
$363.38
|
| Rate for Payer: Amerigroup Medicare |
$363.60
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$540.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$360.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$359.86
|
| Rate for Payer: Medical Associates Commercial |
$540.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$360.00
|
| Rate for Payer: Midlands Choice Commercial |
$504.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$365.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$540.00
|
| Rate for Payer: United Healthcare Commercial |
$648.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$424.80
|
|
|
SUTURE ANCHOR BIOCOMPOSITE SWIVELOCK 4.75 X 19.1
|
Facility
IP
|
$720.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna of IA Commercial |
$648.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$648.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$540.00
|
| Rate for Payer: Medical Associates Commercial |
$540.00
|
| Rate for Payer: Midlands Choice Commercial |
$504.00
|
| Rate for Payer: United Healthcare Commercial |
$648.00
|
|
|
SUTURE ANCHOR BIOCOMPOSITE SWIVELOCK 5.5 X 24.5
|
Facility
IP
|
$720.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8025946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna of IA Commercial |
$648.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$648.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$540.00
|
| Rate for Payer: Medical Associates Commercial |
$540.00
|
| Rate for Payer: Midlands Choice Commercial |
$504.00
|
| Rate for Payer: United Healthcare Commercial |
$648.00
|
|
|
SUTURE ANCHOR BIOCOMPOSITE SWIVELOCK 5.5 X 24.5
|
Facility
OP
|
$720.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8025946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.86 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna of IA Commercial |
$648.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$648.00
|
| Rate for Payer: Aetna of IA Medicare |
$410.40
|
| Rate for Payer: Amerigroup Medicaid |
$363.38
|
| Rate for Payer: Amerigroup Medicare |
$363.60
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$540.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$360.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$359.86
|
| Rate for Payer: Medical Associates Commercial |
$540.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$360.00
|
| Rate for Payer: Midlands Choice Commercial |
$504.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$365.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$540.00
|
| Rate for Payer: United Healthcare Commercial |
$648.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$424.80
|
|
|
SUTURE ANCHOR MINIBIO SUTURETAK 2.4X8.5M
|
Facility
OP
|
$585.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$292.38 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Aetna of IA Commercial |
$526.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$526.50
|
| Rate for Payer: Aetna of IA Medicare |
$333.45
|
| Rate for Payer: Amerigroup Medicaid |
$295.25
|
| Rate for Payer: Amerigroup Medicare |
$295.42
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$438.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$292.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$292.38
|
| Rate for Payer: Medical Associates Commercial |
$438.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$292.50
|
| Rate for Payer: Midlands Choice Commercial |
$409.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$296.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$438.75
|
| Rate for Payer: United Healthcare Commercial |
$526.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$345.15
|
|
|
SUTURE ANCHOR MINIBIO SUTURETAK 2.4X8.5M
|
Facility
IP
|
$585.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Aetna of IA Commercial |
$526.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$526.50
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$438.75
|
| Rate for Payer: Medical Associates Commercial |
$438.75
|
| Rate for Payer: Midlands Choice Commercial |
$409.50
|
| Rate for Payer: United Healthcare Commercial |
$526.50
|
|
|
SUTUREETAPE TIGERLINK 1.3MM WH/BLK
|
Facility
IP
|
$220.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8760623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
|
