|
SUTUREETAPE TIGERLINK 1.3MM WH/BLK
|
Facility
OP
|
$220.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8760623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.96 |
| 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: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$111.03
|
| Rate for Payer: Amerigroup Medicare |
$111.10
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$110.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$109.96
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$110.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$111.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
|
|
SUTURE FIBERWIRE/NEEDLE
|
Facility
IP
|
$34.00
|
|
| Hospital Charge Code |
8026439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
|
|
SUTURE FIBERWIRE/NEEDLE
|
Facility
OP
|
$34.00
|
|
| Hospital Charge Code |
8026439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Aetna of IA Medicare |
$19.38
|
| Rate for Payer: Amerigroup Medicaid |
$17.16
|
| Rate for Payer: Amerigroup Medicare |
$17.17
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.99
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.00
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$25.50
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.06
|
|
|
SUTURE RW
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8773299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.49 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna of IA Commercial |
$40.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.50
|
| Rate for Payer: Aetna of IA Medicare |
$25.65
|
| Rate for Payer: Amerigroup Medicaid |
$22.71
|
| Rate for Payer: Amerigroup Medicare |
$22.72
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.49
|
| Rate for Payer: Medical Associates Commercial |
$33.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.50
|
| Rate for Payer: Midlands Choice Commercial |
$31.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.75
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.55
|
|
|
SUTURE RW
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8773299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna of IA Commercial |
$40.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.50
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.75
|
| Rate for Payer: Medical Associates Commercial |
$33.75
|
| Rate for Payer: Midlands Choice Commercial |
$31.50
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
|
|
SUTURETAK KIT
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Aetna of IA Medicare |
$179.55
|
| Rate for Payer: Amerigroup Medicaid |
$158.98
|
| Rate for Payer: Amerigroup Medicare |
$159.08
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$157.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$157.44
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$159.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$236.25
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
|
SUTURETAK KIT
|
Facility
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
|
|
SUTURETAK KIT 2.4
|
Facility
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
|
|
SUTURETAK KIT 2.4
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Aetna of IA Medicare |
$179.55
|
| Rate for Payer: Amerigroup Medicaid |
$158.98
|
| Rate for Payer: Amerigroup Medicare |
$159.08
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$157.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$157.44
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$159.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$236.25
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
|
SUTURETAK KIT 3.0
|
Facility
IP
|
$288.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026419
|
|
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
|
|
|
SUTURETAK KIT 3.0
|
Facility
OP
|
$288.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026419
|
|
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: Partners Health Alliance Commercial |
$216.00
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$169.92
|
|
|
SUTURETAK PERCUTA
|
Facility
IP
|
$351.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.70 |
| Max. Negotiated Rate |
$315.90 |
| Rate for Payer: Aetna of IA Commercial |
$315.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.90
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$263.25
|
| Rate for Payer: Medical Associates Commercial |
$263.25
|
| Rate for Payer: Midlands Choice Commercial |
$245.70
|
| Rate for Payer: United Healthcare Commercial |
$315.90
|
|
|
SUTURETAK PERCUTA
|
Facility
OP
|
$351.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.43 |
| Max. Negotiated Rate |
$315.90 |
| Rate for Payer: Aetna of IA Commercial |
$315.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.90
|
| Rate for Payer: Aetna of IA Medicare |
$200.07
|
| Rate for Payer: Amerigroup Medicaid |
$177.15
|
| Rate for Payer: Amerigroup Medicare |
$177.26
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$263.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$175.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$175.43
|
| Rate for Payer: Medical Associates Commercial |
$263.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$175.50
|
| Rate for Payer: Midlands Choice Commercial |
$245.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$178.13
|
| Rate for Payer: Partners Health Alliance Commercial |
$263.25
|
| Rate for Payer: United Healthcare Commercial |
$315.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$207.09
|
|
|
SUTURETAPE, 1.3MM W/NEEDLE WHITE/BLUE
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8771314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of IA Commercial |
$81.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$67.50
|
| Rate for Payer: Medical Associates Commercial |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$63.00
|
| Rate for Payer: United Healthcare Commercial |
$81.00
|
|
|
SUTURETAPE, 1.3MM W/NEEDLE WHITE/BLUE
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8771314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of IA Commercial |
$81.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.00
|
| Rate for Payer: Aetna of IA Medicare |
$51.30
|
| Rate for Payer: Amerigroup Medicaid |
$45.42
|
| Rate for Payer: Amerigroup Medicare |
$45.45
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$67.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$45.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$44.98
|
| Rate for Payer: Medical Associates Commercial |
$67.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$45.00
|
| Rate for Payer: Midlands Choice Commercial |
$63.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$45.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$67.50
|
| Rate for Payer: United Healthcare Commercial |
$81.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$53.10
|
|
|
SWALLOW FUNCTION EVAL
|
Facility
OP
|
$195.00
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
8000750
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$97.46 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna of IA Commercial |
$175.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$175.50
|
| Rate for Payer: Aetna of IA Medicare |
$111.15
|
| Rate for Payer: Amerigroup Medicaid |
$98.42
|
| Rate for Payer: Amerigroup Medicare |
$98.48
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$146.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$97.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$97.46
|
| Rate for Payer: Medical Associates Commercial |
$146.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$97.50
|
| Rate for Payer: Midlands Choice Commercial |
$136.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$98.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$146.25
|
| Rate for Payer: United Healthcare Commercial |
$175.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$115.05
|
|
|
SWALLOW FUNCTION EVAL
|
Facility
IP
|
$195.00
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
8000750
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna of IA Commercial |
$175.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$175.50
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$146.25
|
| Rate for Payer: Medical Associates Commercial |
$146.25
|
| Rate for Payer: Midlands Choice Commercial |
$136.50
|
| Rate for Payer: United Healthcare Commercial |
$175.50
|
|
|
SWALLOW /ORAL FUNCT TREATMENT
|
Facility
OP
|
$163.00
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
5534782
|
|
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: Partners Health Alliance Commercial |
$122.25
|
| Rate for Payer: United Healthcare Commercial |
$146.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$96.17
|
|
|
SWALLOW /ORAL FUNCT TREATMENT
|
Facility
IP
|
$163.00
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
5534782
|
|
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
|
|
|
Syncope and Collapse
|
Facility
IP
|
$6,449.74
|
|
|
Service Code
|
MS-DRG 312
|
| Hospital Charge Code |
169
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,449.74 |
| Rate for Payer: Amerigroup Medicaid |
$6,418.58
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,356.26
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,449.74
|
|
|
SYNDESMOTIC FIXATION KIT
|
Facility
OP
|
$2,457.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8943981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.01 |
| Max. Negotiated Rate |
$2,211.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,211.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,211.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,400.49
|
| Rate for Payer: Amerigroup Medicaid |
$1,240.05
|
| Rate for Payer: Amerigroup Medicare |
$1,240.78
|
| Rate for Payer: Cash Price |
$1,965.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,842.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,228.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,228.01
|
| Rate for Payer: Medical Associates Commercial |
$1,842.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,228.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,719.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,246.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,842.75
|
| Rate for Payer: United Healthcare Commercial |
$2,211.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,449.63
|
|
|
SYNDESMOTIC FIXATION KIT
|
Facility
IP
|
$2,457.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8943981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.90 |
| Max. Negotiated Rate |
$2,211.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,211.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,211.30
|
| Rate for Payer: Cash Price |
$1,965.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,842.75
|
| Rate for Payer: Medical Associates Commercial |
$1,842.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,719.90
|
| Rate for Payer: United Healthcare Commercial |
$2,211.30
|
|
|
T3 Free DMCL
|
Facility
IP
|
$161.00
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
8037804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
|
|
T3 Free DMCL
|
Facility
OP
|
$161.00
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
8037804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Aetna of IA Medicare |
$91.77
|
| Rate for Payer: Amerigroup Medicaid |
$81.26
|
| Rate for Payer: Amerigroup Medicare |
$81.30
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$80.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.47
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.50
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$120.75
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.99
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
T3 Reverse DMCL
|
Facility
IP
|
$129.00
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
8037805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
|
