|
sotalol 80 mg Tab [VDMC]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10421958
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna of IA Commercial |
$1.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.08
|
| Rate for Payer: Aetna of IA Medicare |
$0.68
|
| Rate for Payer: Amerigroup Medicaid |
$0.61
|
| Rate for Payer: Amerigroup Medicare |
$0.61
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.90
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.60
|
| Rate for Payer: Medical Associates Commercial |
$0.90
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.60
|
| Rate for Payer: Midlands Choice Commercial |
$0.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.61
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.61
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.71
|
|
|
SPADE TWO-STEP HAMMER TOE IMPLANT 34.5MMX3.0MMX14MM
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8868035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,111.06 |
| Max. Negotiated Rate |
$2,000.70 |
| Rate for Payer: Aetna of IA Commercial |
$2,000.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,000.70
|
| Rate for Payer: Aetna of IA Medicare |
$1,267.11
|
| Rate for Payer: Amerigroup Medicaid |
$1,121.95
|
| Rate for Payer: Amerigroup Medicare |
$1,122.62
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,667.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,111.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,111.06
|
| Rate for Payer: Medical Associates Commercial |
$1,667.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,111.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,556.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,128.17
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,127.51
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,667.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,667.25
|
| Rate for Payer: United Healthcare Commercial |
$2,000.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,311.57
|
|
|
SPADE TWO-STEP HAMMER TOE IMPLANT 34.5MMX3.0MMX14MM
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8868035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.10 |
| Max. Negotiated Rate |
$2,000.70 |
| Rate for Payer: Aetna of IA Commercial |
$2,000.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,000.70
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,667.25
|
| Rate for Payer: Medical Associates Commercial |
$1,667.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,556.10
|
| Rate for Payer: United Healthcare Commercial |
$2,000.70
|
|
|
SPADE TWO-STEP HAMMER TOE IMPLANT 3.4MMX3.0MMX18MM
|
Facility
|
OP
|
$2,223.00
|
|
| Hospital Charge Code |
8810198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,111.06 |
| Max. Negotiated Rate |
$2,000.70 |
| Rate for Payer: Aetna of IA Commercial |
$2,000.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,000.70
|
| Rate for Payer: Aetna of IA Medicare |
$1,267.11
|
| Rate for Payer: Amerigroup Medicaid |
$1,121.95
|
| Rate for Payer: Amerigroup Medicare |
$1,122.62
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,667.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,111.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,111.06
|
| Rate for Payer: Medical Associates Commercial |
$1,667.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,111.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,556.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,128.17
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,127.51
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,667.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,667.25
|
| Rate for Payer: United Healthcare Commercial |
$2,000.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,311.57
|
|
|
SPADE TWO-STEP HAMMER TOE IMPLANT 3.4MMX3.0MMX18MM
|
Facility
|
IP
|
$2,223.00
|
|
| Hospital Charge Code |
8810198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.10 |
| Max. Negotiated Rate |
$2,000.70 |
| Rate for Payer: Aetna of IA Commercial |
$2,000.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,000.70
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,667.25
|
| Rate for Payer: Medical Associates Commercial |
$1,667.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,556.10
|
| Rate for Payer: United Healthcare Commercial |
$2,000.70
|
|
|
SPADE TWO-STEP HAMMER TOE IMPLANT - 3.4MMX3.0MMX6MM
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8788811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,260.00 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,620.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,350.00
|
| Rate for Payer: Medical Associates Commercial |
$1,350.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,260.00
|
| Rate for Payer: United Healthcare Commercial |
$1,620.00
|
|
|
SPADE TWO-STEP HAMMER TOE IMPLANT - 3.4MMX3.0MMX6MM
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8788811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$899.64 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,620.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,620.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,026.00
|
| Rate for Payer: Amerigroup Medicaid |
$908.46
|
| Rate for Payer: Amerigroup Medicare |
$909.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,350.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$900.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$899.64
|
| Rate for Payer: Medical Associates Commercial |
$1,350.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$900.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,260.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$913.50
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$912.96
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,350.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,350.00
|
| Rate for Payer: United Healthcare Commercial |
$1,620.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,062.00
|
|
|
SPECIALTY CARE TRANSPORT
|
Facility
|
IP
|
$1,334.00
|
|
|
Service Code
|
CPT A0434 QN
|
| Hospital Charge Code |
7932763
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$933.80 |
| Max. Negotiated Rate |
$1,200.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,200.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,200.60
|
| Rate for Payer: Cash Price |
$1,067.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,000.50
|
| Rate for Payer: Medical Associates Commercial |
$1,000.50
|
| Rate for Payer: Midlands Choice Commercial |
$933.80
|
| Rate for Payer: United Healthcare Commercial |
$1,200.60
|
|
|
SPECIALTY CARE TRANSPORT
|
Facility
|
OP
|
$1,334.00
|
|
|
Service Code
|
CPT A0434 QN
|
| Hospital Charge Code |
7932763
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$666.73 |
| Max. Negotiated Rate |
$1,200.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,200.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,200.60
|
| Rate for Payer: Aetna of IA Medicare |
$760.38
|
| Rate for Payer: Amerigroup Medicaid |
$673.27
|
| Rate for Payer: Amerigroup Medicare |
$673.67
|
| Rate for Payer: Cash Price |
$1,067.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,000.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$667.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$666.73
|
| Rate for Payer: Medical Associates Commercial |
$1,000.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$667.00
|
| Rate for Payer: Midlands Choice Commercial |
$933.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$677.00
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$676.60
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,000.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,000.50
|
| Rate for Payer: United Healthcare Commercial |
$1,200.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,133.90
|
|
|
Speech Language Pathology Video Swallow
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
985772
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.56 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Aetna of IA Commercial |
$350.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$350.10
|
| Rate for Payer: Aetna of IA Medicare |
$221.73
|
| Rate for Payer: Amerigroup Medicaid |
$196.33
|
| Rate for Payer: Amerigroup Medicare |
$196.44
|
| Rate for Payer: Cash Price |
$311.20
|
| Rate for Payer: Cash Price |
$311.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$291.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$194.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$194.42
|
| Rate for Payer: Medical Associates Commercial |
$291.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$194.50
|
| Rate for Payer: Midlands Choice Commercial |
$272.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$197.42
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$197.30
|
| Rate for Payer: Oscar Health of IA Commercial |
$291.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$291.75
|
| Rate for Payer: United Healthcare Commercial |
$350.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$229.51
|
| Rate for Payer: Wellmark IA HMO |
$178.56
|
| Rate for Payer: Wellmark IA PPO |
$196.42
|
|
|
Speech Language Pathology Video Swallow
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
985772
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.30 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Aetna of IA Commercial |
$350.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$350.10
|
| Rate for Payer: Cash Price |
$311.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$291.75
|
| Rate for Payer: Medical Associates Commercial |
$291.75
|
| Rate for Payer: Midlands Choice Commercial |
$272.30
|
| Rate for Payer: United Healthcare Commercial |
$350.10
|
|
|
SPEECH/OTHR COMMUNCATE INDIVIDUAL TX
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
5526782
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$81.47 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna of IA Commercial |
$146.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.70
|
| Rate for Payer: Aetna of IA Medicare |
$92.91
|
| Rate for Payer: Amerigroup Medicaid |
$82.27
|
| Rate for Payer: Amerigroup Medicare |
$82.32
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$122.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$81.47
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.50
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$82.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$82.67
|
| Rate for Payer: Oscar Health of IA Commercial |
$122.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$122.25
|
| Rate for Payer: United Healthcare Commercial |
$146.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$96.17
|
|
|
SPEECH/OTHR COMMUNCATE INDIVIDUAL TX
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
5526782
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$114.10 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna of IA Commercial |
$146.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.70
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$122.25
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: United Healthcare Commercial |
$146.70
|
|
|
SPHINCTEROTOMY ER CHARGE
|
Professional
|
Both
|
$530.00
|
|
| Hospital Charge Code |
8069012
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$371.00 |
| Max. Negotiated Rate |
$397.50 |
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Medical Associates Commercial |
$397.50
|
| Rate for Payer: Midlands Choice Commercial |
$371.00
|
|
|
SPIKED GRIDLOCK ANKLE WASHER
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8780887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.94 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Iowa Total Care Managed Medicaid |
$143.94
|
| Rate for Payer: Aetna of IA Commercial |
$259.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$259.20
|
| Rate for Payer: Aetna of IA Medicare |
$164.16
|
| Rate for Payer: Amerigroup Medicaid |
$145.35
|
| Rate for Payer: Amerigroup Medicare |
$145.44
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$216.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$144.00
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$144.00
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$146.16
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$146.07
|
| Rate for Payer: Oscar Health of IA Commercial |
$216.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$216.00
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$169.92
|
|
|
SPIKED GRIDLOCK ANKLE WASHER
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8780887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna of IA Commercial |
$259.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$259.20
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$216.00
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
|
|
SPIKED GRIDLOCK SCREW WASHER LARGE
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8740441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna of IA Commercial |
$259.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$259.20
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$216.00
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
|
|
SPIKED GRIDLOCK SCREW WASHER LARGE
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8740441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.94 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna of IA Commercial |
$259.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$259.20
|
| Rate for Payer: Aetna of IA Medicare |
$164.16
|
| Rate for Payer: Amerigroup Medicaid |
$145.35
|
| Rate for Payer: Amerigroup Medicare |
$145.44
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$216.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$144.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$143.94
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$144.00
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$146.16
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$146.07
|
| Rate for Payer: Oscar Health of IA Commercial |
$216.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$216.00
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$169.92
|
|
|
SPIKED WASHER 4.5MM
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8897829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
|
|
SPIKED WASHER 4.5MM
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8897829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Aetna of IA Medicare |
$76.95
|
| Rate for Payer: Amerigroup Medicaid |
$68.13
|
| Rate for Payer: Amerigroup Medicare |
$68.18
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.47
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.51
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$68.47
|
| Rate for Payer: Oscar Health of IA Commercial |
$101.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.25
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.65
|
|
|
SPIKED WASHER FOR 4.5 SCREW
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047046
|
|
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: Molina Healthcare Managed Medicare |
$91.30
|
| Rate for Payer: Oscar Health of IA Commercial |
$135.00
|
| 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
|
|
|
SPIKED WASHER FOR 4.5 SCREW
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047046
|
|
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
|
|
|
SPINAL ANESTHESIA I
|
Facility
|
OP
|
$789.00
|
|
| Hospital Charge Code |
8059078
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$394.34 |
| Max. Negotiated Rate |
$710.10 |
| Rate for Payer: Aetna of IA Commercial |
$710.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$710.10
|
| Rate for Payer: Aetna of IA Medicare |
$449.73
|
| Rate for Payer: Amerigroup Medicaid |
$398.21
|
| Rate for Payer: Amerigroup Medicare |
$398.44
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$591.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$394.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$394.34
|
| Rate for Payer: Medical Associates Commercial |
$591.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$394.50
|
| Rate for Payer: Midlands Choice Commercial |
$552.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$400.42
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$400.18
|
| Rate for Payer: Oscar Health of IA Commercial |
$591.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$591.75
|
| Rate for Payer: United Healthcare Commercial |
$710.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$465.51
|
|
|
SPINAL ANESTHESIA I
|
Facility
|
IP
|
$789.00
|
|
| Hospital Charge Code |
8059078
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$552.30 |
| Max. Negotiated Rate |
$710.10 |
| Rate for Payer: Aetna of IA Commercial |
$710.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$710.10
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$591.75
|
| Rate for Payer: Medical Associates Commercial |
$591.75
|
| Rate for Payer: Midlands Choice Commercial |
$552.30
|
| Rate for Payer: United Healthcare Commercial |
$710.10
|
|
|
SPINAL ANESTHESIA II
|
Facility
|
IP
|
$958.00
|
|
| Hospital Charge Code |
8059590
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$670.60 |
| Max. Negotiated Rate |
$862.20 |
| Rate for Payer: Aetna of IA Commercial |
$862.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$862.20
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$718.50
|
| Rate for Payer: Medical Associates Commercial |
$718.50
|
| Rate for Payer: Midlands Choice Commercial |
$670.60
|
| Rate for Payer: United Healthcare Commercial |
$862.20
|
|
