|
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: Molina Healthcare Managed Medicare |
$730.37
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,080.00
|
| 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: Molina Healthcare Managed Medicare |
$559.95
|
| Rate for Payer: Oscar Health of IA Commercial |
$828.00
|
| 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
|
Both
|
$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: Oscar Health of IA Commercial |
$579.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$502.50
|
|
|
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 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: Molina Healthcare Managed Medicare |
$522.42
|
| Rate for Payer: Oscar Health of IA Commercial |
$772.50
|
| 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 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: Molina Healthcare Managed Medicare |
$365.18
|
| Rate for Payer: Oscar Health of IA Commercial |
$540.00
|
| 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
|
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: Molina Healthcare Managed Medicare |
$365.18
|
| Rate for Payer: Oscar Health of IA Commercial |
$540.00
|
| 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 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 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: Molina Healthcare Managed Medicare |
$296.71
|
| Rate for Payer: Oscar Health of IA Commercial |
$438.75
|
| 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
|
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: Molina Healthcare Managed Medicare |
$111.58
|
| Rate for Payer: Oscar Health of IA Commercial |
$165.00
|
| 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
|
|
|
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
|
|
|
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: Molina Healthcare Managed Medicare |
$17.24
|
| Rate for Payer: Oscar Health of IA Commercial |
$25.50
|
| 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 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 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: Molina Healthcare Managed Medicare |
$22.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$33.75
|
| 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: Molina Healthcare Managed Medicare |
$159.77
|
| Rate for Payer: Oscar Health of IA Commercial |
$236.25
|
| 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: Molina Healthcare Managed Medicare |
$159.77
|
| Rate for Payer: Oscar Health of IA Commercial |
$236.25
|
| 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: 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
|
|
