|
21555 EXC NECK LES SUBQ LESS THAN 3 CM
|
Professional
|
Both
|
$1,382.00
|
|
|
Service Code
|
CPT 21555
|
| Hospital Charge Code |
8069117
|
| Min. Negotiated Rate |
$278.41 |
| Max. Negotiated Rate |
$1,036.50 |
| Rate for Payer: Amerigroup Medicaid |
$287.88
|
| Rate for Payer: Cash Price |
$1,105.60
|
| Rate for Payer: Cash Price |
$1,105.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$334.09
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$283.98
|
| Rate for Payer: Medical Associates Commercial |
$1,036.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$278.41
|
| Rate for Payer: Midlands Choice Commercial |
$967.40
|
| Rate for Payer: Oscar Health of IA Commercial |
$481.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$417.62
|
|
|
22902 EXC ABD LES SUBQ LESS THAN 3 CM
|
Professional
|
Both
|
$1,461.00
|
|
|
Service Code
|
CPT 22902
|
| Hospital Charge Code |
8069165
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$300.50 |
| Max. Negotiated Rate |
$1,022.70 |
| Rate for Payer: Aetna of IA Medicare |
$300.50
|
| Rate for Payer: Amerigroup Medicaid |
$310.72
|
| Rate for Payer: Cash Price |
$1,168.80
|
| Rate for Payer: Cash Price |
$1,168.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$360.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$306.51
|
| Rate for Payer: Medical Associates Commercial |
$570.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$300.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,022.70
|
| Rate for Payer: Oscar Health of IA Commercial |
$519.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$450.75
|
|
|
2.2MM X 10MM LOCKING SCREW
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8807705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.43 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Aetna of IA Medicare |
$189.81
|
| Rate for Payer: Amerigroup Medicaid |
$168.07
|
| Rate for Payer: Amerigroup Medicare |
$168.16
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$166.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$166.43
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$166.50
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$169.00
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$168.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$249.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$249.75
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
|
|
2.2MM X 10MM LOCKING SCREW
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8807705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
|
|
2.2MM X 12MM LOCKING SCREW
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8807707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
|
|
2.2MM X 12MM LOCKING SCREW
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8807707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.43 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Aetna of IA Medicare |
$189.81
|
| Rate for Payer: Amerigroup Medicaid |
$168.07
|
| Rate for Payer: Amerigroup Medicare |
$168.16
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$166.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$166.43
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$166.50
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$169.00
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$168.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$249.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$249.75
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
|
|
2.2MM X 12MM NON LOCKING SCREW
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.96 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna of IA Commercial |
$194.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$194.40
|
| Rate for Payer: Aetna of IA Medicare |
$123.12
|
| Rate for Payer: Amerigroup Medicaid |
$109.02
|
| Rate for Payer: Amerigroup Medicare |
$109.08
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$162.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$108.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.96
|
| Rate for Payer: Medical Associates Commercial |
$162.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$108.00
|
| Rate for Payer: Midlands Choice Commercial |
$151.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$109.62
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$109.56
|
| Rate for Payer: Oscar Health of IA Commercial |
$162.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$162.00
|
| Rate for Payer: United Healthcare Commercial |
$194.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$127.44
|
|
|
2.2MM X 12MM NON LOCKING SCREW
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna of IA Commercial |
$194.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$194.40
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$162.00
|
| Rate for Payer: Medical Associates Commercial |
$162.00
|
| Rate for Payer: Midlands Choice Commercial |
$151.20
|
| Rate for Payer: United Healthcare Commercial |
$194.40
|
|
|
2.2MM X 18MM LOCKING SCREW
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956484
|
|
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
|
|
|
2.2MM X 18MM LOCKING SCREW
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956484
|
|
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
|
|
|
2.2MM X 20MM LOCKING SCREW
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956486
|
|
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
|
|
|
2.2MM X 20MM LOCKING SCREW
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956486
|
|
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
|
|
|
2.2MM X 8MM LOCKING SCREW
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8807703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
|
|
2.2MM X 8MM LOCKING SCREW
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8807703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.43 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Aetna of IA Medicare |
$189.81
|
| Rate for Payer: Amerigroup Medicaid |
$168.07
|
| Rate for Payer: Amerigroup Medicare |
$168.16
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$166.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$166.43
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$166.50
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$169.00
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$168.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$249.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$249.75
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
|
|
24105 BURSECTOMY ELBOW
|
Professional
|
Both
|
$1,169.00
|
|
|
Service Code
|
CPT 24105
|
| Hospital Charge Code |
8068901
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$332.01 |
| Max. Negotiated Rate |
$818.30 |
| Rate for Payer: Aetna of IA Medicare |
$332.01
|
| Rate for Payer: Amerigroup Medicaid |
$343.30
|
| Rate for Payer: Cash Price |
$935.20
|
| Rate for Payer: Cash Price |
$935.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$398.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$338.65
|
| Rate for Payer: Medical Associates Commercial |
$630.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$332.01
|
| Rate for Payer: Midlands Choice Commercial |
$818.30
|
| Rate for Payer: Oscar Health of IA Commercial |
$574.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$498.02
|
|
|
2.4MMX10MM TIGER CANNULATED SCREW
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8865231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$186.30 |
| Rate for Payer: Aetna of IA Commercial |
$186.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$186.30
|
| Rate for Payer: Aetna of IA Medicare |
$117.99
|
| Rate for Payer: Amerigroup Medicaid |
$104.47
|
| Rate for Payer: Amerigroup Medicare |
$104.54
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$155.25
|
| 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 |
$103.46
|
| Rate for Payer: Medical Associates Commercial |
$155.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$103.50
|
| Rate for Payer: Midlands Choice Commercial |
$144.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$105.05
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$104.99
|
| Rate for Payer: Oscar Health of IA Commercial |
$155.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$155.25
|
| Rate for Payer: United Healthcare Commercial |
$186.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$122.13
|
|
|
2.4MMX10MM TIGER CANNULATED SCREW
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8865231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$186.30 |
| Rate for Payer: Aetna of IA Commercial |
$186.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$186.30
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$155.25
|
| Rate for Payer: Medical Associates Commercial |
$155.25
|
| Rate for Payer: Midlands Choice Commercial |
$144.90
|
| Rate for Payer: United Healthcare Commercial |
$186.30
|
|
|
2.4mm x12mm TIGER CANNULATED SCREW
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463417
|
|
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
|
|
|
2.4mm x12mm TIGER CANNULATED SCREW
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463417
|
|
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
|
|
|
2.4MM X 14 GL SCREW
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8700304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.97 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna of IA Commercial |
$129.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$129.60
|
| Rate for Payer: Aetna of IA Medicare |
$82.08
|
| Rate for Payer: Amerigroup Medicaid |
$72.68
|
| Rate for Payer: Amerigroup Medicare |
$72.72
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$72.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.97
|
| Rate for Payer: Medical Associates Commercial |
$108.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.00
|
| Rate for Payer: Midlands Choice Commercial |
$100.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$73.08
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$73.04
|
| Rate for Payer: Oscar Health of IA Commercial |
$108.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$108.00
|
| Rate for Payer: United Healthcare Commercial |
$129.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.96
|
|
|
2.4MM X 14 GL SCREW
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8700304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna of IA Commercial |
$129.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$129.60
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.00
|
| Rate for Payer: Medical Associates Commercial |
$108.00
|
| Rate for Payer: Midlands Choice Commercial |
$100.80
|
| Rate for Payer: United Healthcare Commercial |
$129.60
|
|
|
2.4MMX14MM TIGER CANNULATED SCREWS
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463419
|
|
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
|
|
|
2.4MMX14MM TIGER CANNULATED SCREWS
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463419
|
|
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
|
|
|
2.4MM X 16MM CANNULATED SCREW
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8470644
|
|
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
|
|
|
2.4MM X 16MM CANNULATED SCREW
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8470644
|
|
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
|
|
