|
WIRE KIT WITH BLADE
|
Facility
|
IP
|
$2,025.00
|
|
| Hospital Charge Code |
8046946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,822.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,822.50
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,518.75
|
| Rate for Payer: Medical Associates Commercial |
$1,518.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,417.50
|
| Rate for Payer: United Healthcare Commercial |
$1,822.50
|
|
|
WIRE KIT WITH BLADE
|
Facility
|
OP
|
$2,025.00
|
|
| Hospital Charge Code |
8046946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.10 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,822.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,822.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,154.25
|
| Rate for Payer: Amerigroup Medicaid |
$1,022.02
|
| Rate for Payer: Amerigroup Medicare |
$1,022.62
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,518.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,012.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,012.10
|
| Rate for Payer: Medical Associates Commercial |
$1,518.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,012.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,417.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,027.69
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,027.08
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,518.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,518.75
|
| Rate for Payer: United Healthcare Commercial |
$1,822.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,194.75
|
|
|
WIRE KIT WITH BLADE-1
|
Facility
|
OP
|
$405.00
|
|
| Hospital Charge Code |
8047062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.42 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Aetna of IA Medicare |
$230.85
|
| Rate for Payer: Amerigroup Medicaid |
$204.40
|
| Rate for Payer: Amerigroup Medicare |
$204.52
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$202.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.42
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$205.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$205.42
|
| Rate for Payer: Oscar Health of IA Commercial |
$303.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$303.75
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
|
WIRE KIT WITH BLADE-1
|
Facility
|
IP
|
$405.00
|
|
| Hospital Charge Code |
8047062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
|
|
WIRES KIRSCHNER 0.6MM
|
Facility
|
OP
|
$140.00
|
|
| Hospital Charge Code |
8046721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.97 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of IA Commercial |
$126.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.00
|
| Rate for Payer: Aetna of IA Medicare |
$79.80
|
| Rate for Payer: Amerigroup Medicaid |
$70.66
|
| Rate for Payer: Amerigroup Medicare |
$70.70
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.97
|
| Rate for Payer: Medical Associates Commercial |
$105.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.00
|
| Rate for Payer: Midlands Choice Commercial |
$98.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.05
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$71.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$105.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$105.00
|
| Rate for Payer: United Healthcare Commercial |
$126.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.60
|
|
|
WIRES KIRSCHNER 0.6MM
|
Facility
|
IP
|
$140.00
|
|
| Hospital Charge Code |
8046721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of IA Commercial |
$126.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.00
|
| Rate for Payer: Medical Associates Commercial |
$105.00
|
| Rate for Payer: Midlands Choice Commercial |
$98.00
|
| Rate for Payer: United Healthcare Commercial |
$126.00
|
|
|
WIRES KIRSCHNER 0.8MM
|
Facility
|
OP
|
$140.00
|
|
| Hospital Charge Code |
8046897
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.97 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of IA Commercial |
$126.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.00
|
| Rate for Payer: Aetna of IA Medicare |
$79.80
|
| Rate for Payer: Amerigroup Medicaid |
$70.66
|
| Rate for Payer: Amerigroup Medicare |
$70.70
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.97
|
| Rate for Payer: Medical Associates Commercial |
$105.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.00
|
| Rate for Payer: Midlands Choice Commercial |
$98.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.05
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$71.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$105.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$105.00
|
| Rate for Payer: United Healthcare Commercial |
$126.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.60
|
|
|
WIRES KIRSCHNER 0.8MM
|
Facility
|
IP
|
$140.00
|
|
| Hospital Charge Code |
8046897
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of IA Commercial |
$126.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.00
|
| Rate for Payer: Medical Associates Commercial |
$105.00
|
| Rate for Payer: Midlands Choice Commercial |
$98.00
|
| Rate for Payer: United Healthcare Commercial |
$126.00
|
|
|
WIRES KIRSCHNER 1.0MM
|
Facility
|
OP
|
$161.00
|
|
| Hospital Charge Code |
8046903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.47 |
| 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: 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: Molina Healthcare Managed Medicare |
$81.66
|
| Rate for Payer: Oscar Health of IA Commercial |
$120.75
|
| 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
|
|
|
WIRES KIRSCHNER 1.0MM
|
Facility
|
IP
|
$161.00
|
|
| Hospital Charge Code |
8046903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| 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: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
|
|
WIRES KIRSCHNER 1.0MM X 150MM
|
Facility
|
OP
|
$191.00
|
|
| Hospital Charge Code |
8047027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.46 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Aetna of IA Commercial |
$171.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$171.90
|
| Rate for Payer: Aetna of IA Medicare |
$108.87
|
| Rate for Payer: Amerigroup Medicaid |
$96.40
|
| Rate for Payer: Amerigroup Medicare |
$96.46
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$143.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$95.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$95.46
|
| Rate for Payer: Medical Associates Commercial |
$143.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$95.50
|
| Rate for Payer: Midlands Choice Commercial |
$133.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$96.93
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$96.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$143.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$143.25
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$112.69
|
|
|
WIRES KIRSCHNER 1.0MM X 150MM
|
Facility
|
IP
|
$191.00
|
|
| Hospital Charge Code |
8047027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.70 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Aetna of IA Commercial |
$171.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$171.90
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$143.25
|
| Rate for Payer: Medical Associates Commercial |
$143.25
|
| Rate for Payer: Midlands Choice Commercial |
$133.70
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
|
|
WIRES KIRSCHNER 1.25MM
|
Facility
|
OP
|
$191.00
|
|
| Hospital Charge Code |
8046403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.46 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Aetna of IA Commercial |
$171.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$171.90
|
| Rate for Payer: Aetna of IA Medicare |
$108.87
|
| Rate for Payer: Amerigroup Medicaid |
$96.40
|
| Rate for Payer: Amerigroup Medicare |
$96.46
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$143.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$95.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$95.46
|
| Rate for Payer: Medical Associates Commercial |
$143.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$95.50
|
| Rate for Payer: Midlands Choice Commercial |
$133.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$96.93
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$96.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$143.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$143.25
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$112.69
|
|
|
WIRES KIRSCHNER 1.25MM
|
Facility
|
IP
|
$191.00
|
|
| Hospital Charge Code |
8046403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.70 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Aetna of IA Commercial |
$171.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$171.90
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$143.25
|
| Rate for Payer: Medical Associates Commercial |
$143.25
|
| Rate for Payer: Midlands Choice Commercial |
$133.70
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
|
|
WIRES KIRSCHNER 1.25MM-1
|
Facility
|
IP
|
$161.00
|
|
| Hospital Charge Code |
8046902
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
WIRES KIRSCHNER 1.25MM-1
|
Facility
|
OP
|
$161.00
|
|
| Hospital Charge Code |
8046902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.47 |
| 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: 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: Molina Healthcare Managed Medicare |
$81.66
|
| Rate for Payer: Oscar Health of IA Commercial |
$120.75
|
| 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
|
|
|
WIRES KIRSCHNER 1.60MM X 150MM
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
8046972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Aetna of IA Commercial |
$17.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.10
|
| Rate for Payer: Aetna of IA Medicare |
$10.83
|
| Rate for Payer: Amerigroup Medicaid |
$9.59
|
| Rate for Payer: Amerigroup Medicare |
$9.60
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9.50
|
| Rate for Payer: Medical Associates Commercial |
$14.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.50
|
| Rate for Payer: Midlands Choice Commercial |
$13.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9.64
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$9.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$14.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.25
|
| Rate for Payer: United Healthcare Commercial |
$17.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.21
|
|
|
WIRES KIRSCHNER 1.60MM X 150MM
|
Facility
|
IP
|
$19.00
|
|
| Hospital Charge Code |
8046972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Aetna of IA Commercial |
$17.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.10
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.25
|
| Rate for Payer: Medical Associates Commercial |
$14.25
|
| Rate for Payer: Midlands Choice Commercial |
$13.30
|
| Rate for Payer: United Healthcare Commercial |
$17.10
|
|
|
WIRES KIRSCHNER 1.6MM
|
Facility
|
OP
|
$161.00
|
|
| Hospital Charge Code |
8046901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.47 |
| 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: 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: Molina Healthcare Managed Medicare |
$81.66
|
| Rate for Payer: Oscar Health of IA Commercial |
$120.75
|
| 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
|
|
|
WIRES KIRSCHNER 1.6MM
|
Facility
|
IP
|
$161.00
|
|
| Hospital Charge Code |
8046901
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
WIRES KIRSCHNER 20MM 150L
|
Facility
|
OP
|
$191.00
|
|
| Hospital Charge Code |
8046404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.46 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Aetna of IA Commercial |
$171.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$171.90
|
| Rate for Payer: Aetna of IA Medicare |
$108.87
|
| Rate for Payer: Amerigroup Medicaid |
$96.40
|
| Rate for Payer: Amerigroup Medicare |
$96.46
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$143.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$95.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$95.46
|
| Rate for Payer: Medical Associates Commercial |
$143.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$95.50
|
| Rate for Payer: Midlands Choice Commercial |
$133.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$96.93
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$96.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$143.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$143.25
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$112.69
|
|
|
WIRES KIRSCHNER 20MM 150L
|
Facility
|
IP
|
$191.00
|
|
| Hospital Charge Code |
8046404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.70 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Aetna of IA Commercial |
$171.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$171.90
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$143.25
|
| Rate for Payer: Medical Associates Commercial |
$143.25
|
| Rate for Payer: Midlands Choice Commercial |
$133.70
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
|
|
WOUND CARE NON-SELECTIVE
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 97602 GP
|
| Hospital Charge Code |
5520785
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$131.45 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Medical Associates Managed Medicare |
$131.50
|
| Rate for Payer: Aetna of IA Commercial |
$236.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$236.70
|
| Rate for Payer: Aetna of IA Medicare |
$149.91
|
| Rate for Payer: Amerigroup Medicaid |
$132.74
|
| Rate for Payer: Amerigroup Medicare |
$132.82
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$197.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$131.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$131.45
|
| Rate for Payer: Medical Associates Commercial |
$197.25
|
| Rate for Payer: Midlands Choice Commercial |
$184.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$133.47
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$133.39
|
| Rate for Payer: Oscar Health of IA Commercial |
$197.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$197.25
|
| Rate for Payer: United Healthcare Commercial |
$236.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$155.17
|
|
|
WOUND CARE NON-SELECTIVE
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
7438786
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.96 |
| Max. Negotiated Rate |
$598.11 |
| Rate for Payer: Aetna of IA Commercial |
$185.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$185.40
|
| Rate for Payer: Aetna of IA Medicare |
$117.42
|
| Rate for Payer: Amerigroup Medicaid |
$103.97
|
| Rate for Payer: Amerigroup Medicare |
$104.03
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$154.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$103.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$102.96
|
| Rate for Payer: Medical Associates Commercial |
$154.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$103.00
|
| Rate for Payer: Midlands Choice Commercial |
$144.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$104.48
|
| Rate for Payer: Oscar Health of IA Commercial |
$154.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$154.50
|
| Rate for Payer: United Healthcare Commercial |
$185.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$121.54
|
| Rate for Payer: Wellmark IA HMO |
$543.74
|
| Rate for Payer: Wellmark IA PPO |
$598.11
|
|
|
WOUND CARE NON-SELECTIVE
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 97602 GP
|
| Hospital Charge Code |
5520785
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$184.10 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Aetna of IA Commercial |
$236.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$236.70
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$197.25
|
| Rate for Payer: Medical Associates Commercial |
$197.25
|
| Rate for Payer: Midlands Choice Commercial |
$184.10
|
| Rate for Payer: United Healthcare Commercial |
$236.70
|
|
