|
SUTUREETAPE TIGERLINK 1.3MM WH/BLK
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 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
|
|
|
SUTUREETAPE TIGERLINK 1.3MM WH/BLK
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8760623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.00 |
| 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: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$126.90
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| 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 |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.66
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.85
|
| 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 |
$15.30 |
| 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 |
$19.61
|
| Rate for Payer: Amerigroup Medicare |
$15.45
|
| 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 |
$15.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.42
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.30
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$17.60
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.06
|
|
|
SUTURE RW
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 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
|
|
|
SUTURE RW
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8773299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| 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 |
$25.96
|
| Rate for Payer: Amerigroup Medicare |
$20.45
|
| 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 |
$20.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.70
|
| Rate for Payer: Medical Associates Commercial |
$33.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.25
|
| Rate for Payer: Midlands Choice Commercial |
$31.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.29
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.55
|
|
|
SUTURETAK KIT
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 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
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.75 |
| 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 |
$181.69
|
| Rate for Payer: Amerigroup Medicare |
$143.17
|
| 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 |
$141.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$179.93
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$141.75
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$182.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$163.01
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
|
SUTURETAK KIT 2.4
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.75 |
| 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 |
$181.69
|
| Rate for Payer: Amerigroup Medicare |
$143.17
|
| 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 |
$141.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$179.93
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$141.75
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$182.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$163.01
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
|
SUTURETAK KIT 2.4
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 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 3.0
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 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
|
HCPCS L8699
|
| Hospital Charge Code |
8026419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| 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: Aetna of IA Medicare |
$164.16
|
| Rate for Payer: Amerigroup Medicaid |
$166.12
|
| Rate for Payer: Amerigroup Medicare |
$130.90
|
| 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 |
$129.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$164.51
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$129.60
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$166.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$149.04
|
| 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
|
HCPCS 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
|
HCPCS C1713
|
| Hospital Charge Code |
8047065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.95 |
| 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 |
$202.46
|
| Rate for Payer: Amerigroup Medicare |
$159.53
|
| 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 |
$157.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$200.49
|
| Rate for Payer: Medical Associates Commercial |
$263.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.95
|
| Rate for Payer: Midlands Choice Commercial |
$245.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$203.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$181.64
|
| 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
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8771314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.50 |
| 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 |
$51.91
|
| Rate for Payer: Amerigroup Medicare |
$40.90
|
| 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 |
$40.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.41
|
| Rate for Payer: Medical Associates Commercial |
$67.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.50
|
| Rate for Payer: Midlands Choice Commercial |
$63.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$46.58
|
| Rate for Payer: United Healthcare Commercial |
$81.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$53.10
|
|
|
SUTURETAPE, 1.3MM W/NEEDLE WHITE/BLUE
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 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
|
|
|
SWALLOW FUNCTION EVAL
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
8000750
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$228.83 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Aetna of IA Medicare |
$131.10
|
| Rate for Payer: Amerigroup Medicaid |
$132.66
|
| Rate for Payer: Amerigroup Medicare |
$104.54
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$103.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$131.38
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$103.50
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$133.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$119.02
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$135.70
|
| Rate for Payer: Wellmark IA HMO WHPI |
$207.74
|
| Rate for Payer: Wellmark IA PPO |
$228.83
|
|
|
SWALLOW FUNCTION EVAL
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
8000750
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
|
|
SWALLOW /ORAL FUNCT TREATMENT
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
5534782
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$165.57 |
| Rate for Payer: Aetna of IA Commercial |
$153.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$153.00
|
| Rate for Payer: Aetna of IA Medicare |
$96.90
|
| Rate for Payer: Amerigroup Medicaid |
$98.06
|
| Rate for Payer: Amerigroup Medicare |
$77.26
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$127.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$76.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$97.10
|
| Rate for Payer: Medical Associates Commercial |
$127.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$76.50
|
| Rate for Payer: Midlands Choice Commercial |
$119.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$98.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$87.98
|
| Rate for Payer: United Healthcare Commercial |
$153.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$100.30
|
| Rate for Payer: Wellmark IA HMO WHPI |
$150.31
|
| Rate for Payer: Wellmark IA PPO |
$165.57
|
|
|
SWALLOW /ORAL FUNCT TREATMENT
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
5534782
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of IA Commercial |
$153.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$153.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$127.50
|
| Rate for Payer: Medical Associates Commercial |
$127.50
|
| Rate for Payer: Midlands Choice Commercial |
$119.00
|
| Rate for Payer: United Healthcare Commercial |
$153.00
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$7,378.53
|
|
|
Service Code
|
MSDRG 312
|
| Min. Negotiated Rate |
$7,271.59 |
| Max. Negotiated Rate |
$7,378.53 |
| Rate for Payer: Amerigroup Medicaid |
$7,342.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,271.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,378.53
|
|
|
SYNDESMOTIC FIXATION KIT
|
Facility
|
IP
|
$2,457.00
|
|
|
Service Code
|
HCPCS 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
|
|
|
SYNDESMOTIC FIXATION KIT
|
Facility
|
OP
|
$2,457.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8943981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.65 |
| 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 |
$1,417.20
|
| Rate for Payer: Amerigroup Medicare |
$1,116.71
|
| 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 |
$1,105.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,403.44
|
| Rate for Payer: Medical Associates Commercial |
$1,842.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,105.65
|
| Rate for Payer: Midlands Choice Commercial |
$1,719.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,424.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,271.50
|
| Rate for Payer: United Healthcare Commercial |
$2,211.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,449.63
|
|
|
T3 Free DMCL
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
8037804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.63 |
| 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 |
$92.86
|
| Rate for Payer: Amerigroup Medicare |
$73.17
|
| 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 |
$72.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$91.96
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.45
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$93.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$83.32
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.99
|
| Rate for Payer: Wellmark IA HMO WHPI |
$49.63
|
| Rate for Payer: Wellmark IA PPO |
$54.67
|
|
|
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
|
|
