|
CORKSCREW BIO 3.7MM X 17.9
|
Facility
OP
|
$621.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$310.38 |
| Max. Negotiated Rate |
$558.90 |
| Rate for Payer: Aetna of IA Commercial |
$558.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$558.90
|
| Rate for Payer: Aetna of IA Medicare |
$353.97
|
| Rate for Payer: Amerigroup Medicaid |
$313.42
|
| Rate for Payer: Amerigroup Medicare |
$313.60
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$465.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$310.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$310.38
|
| Rate for Payer: Medical Associates Commercial |
$465.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$310.50
|
| Rate for Payer: Midlands Choice Commercial |
$434.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$315.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$465.75
|
| Rate for Payer: United Healthcare Commercial |
$558.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$366.39
|
|
|
CORKSCREW BIO 4.5
|
Facility
OP
|
$591.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$295.38 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Aetna of IA Commercial |
$531.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$531.90
|
| Rate for Payer: Aetna of IA Medicare |
$336.87
|
| Rate for Payer: Amerigroup Medicaid |
$298.28
|
| Rate for Payer: Amerigroup Medicare |
$298.46
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$443.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$295.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$295.38
|
| Rate for Payer: Medical Associates Commercial |
$443.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$295.50
|
| Rate for Payer: Midlands Choice Commercial |
$413.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$299.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$443.25
|
| Rate for Payer: United Healthcare Commercial |
$531.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$348.69
|
|
|
CORKSCREW BIO 4.5
|
Facility
IP
|
$591.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.70 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Aetna of IA Commercial |
$531.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$531.90
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$443.25
|
| Rate for Payer: Medical Associates Commercial |
$443.25
|
| Rate for Payer: Midlands Choice Commercial |
$413.70
|
| Rate for Payer: United Healthcare Commercial |
$531.90
|
|
|
CORKSCREW BIO 5.5
|
Facility
IP
|
$621.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.70 |
| Max. Negotiated Rate |
$558.90 |
| Rate for Payer: Aetna of IA Commercial |
$558.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$558.90
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$465.75
|
| Rate for Payer: Medical Associates Commercial |
$465.75
|
| Rate for Payer: Midlands Choice Commercial |
$434.70
|
| Rate for Payer: United Healthcare Commercial |
$558.90
|
|
|
CORKSCREW BIO 5.5
|
Facility
OP
|
$621.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$310.38 |
| Max. Negotiated Rate |
$558.90 |
| Rate for Payer: Aetna of IA Commercial |
$558.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$558.90
|
| Rate for Payer: Aetna of IA Medicare |
$353.97
|
| Rate for Payer: Amerigroup Medicaid |
$313.42
|
| Rate for Payer: Amerigroup Medicare |
$313.60
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$465.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$310.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$310.38
|
| Rate for Payer: Medical Associates Commercial |
$465.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$310.50
|
| Rate for Payer: Midlands Choice Commercial |
$434.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$315.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$465.75
|
| Rate for Payer: United Healthcare Commercial |
$558.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$366.39
|
|
|
CORKSCREW BIO 6.5
|
Facility
OP
|
$609.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.38 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: Aetna of IA Commercial |
$548.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$548.10
|
| Rate for Payer: Aetna of IA Medicare |
$347.13
|
| Rate for Payer: Amerigroup Medicaid |
$307.36
|
| Rate for Payer: Amerigroup Medicare |
$307.54
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$456.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$304.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$304.38
|
| Rate for Payer: Medical Associates Commercial |
$456.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$304.50
|
| Rate for Payer: Midlands Choice Commercial |
$426.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$309.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$456.75
|
| Rate for Payer: United Healthcare Commercial |
$548.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$359.31
|
|
|
CORKSCREW BIO 6.5
|
Facility
IP
|
$609.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.30 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: Aetna of IA Commercial |
$548.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$548.10
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$456.75
|
| Rate for Payer: Medical Associates Commercial |
$456.75
|
| Rate for Payer: Midlands Choice Commercial |
$426.30
|
| Rate for Payer: United Healthcare Commercial |
$548.10
|
|
|
Coronary Bypass With Cardiac Catheterization With MCC
|
Facility
IP
|
$53,256.33
|
|
|
Service Code
|
MS-DRG 233
|
| Hospital Charge Code |
97
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$53,256.33 |
| Rate for Payer: Amerigroup Medicaid |
$52,999.05
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$52,484.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$53,256.33
|
|
|
Coronary Bypass With Cardiac Catheterization Without MCC
|
Facility
IP
|
$46,882.37
|
|
|
Service Code
|
MS-DRG 234
|
| Hospital Charge Code |
98
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$46,882.37 |
| Rate for Payer: Amerigroup Medicaid |
$46,655.89
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$46,202.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$46,882.37
|
|
|
Coronary Bypass Without Cardiac Catheterization With MCC
|
Facility
IP
|
$44,024.14
|
|
|
Service Code
|
MS-DRG 235
|
| Hospital Charge Code |
99
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$44,024.14 |
| Rate for Payer: Amerigroup Medicaid |
$43,811.46
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43,386.11
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44,024.14
|
|
|
Coronary Bypass Without Cardiac Catheterization Without MCC
|
Facility
IP
|
$36,385.45
|
|
|
Service Code
|
MS-DRG 236
|
| Hospital Charge Code |
100
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$36,385.45 |
| Rate for Payer: Amerigroup Medicaid |
$36,209.67
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35,858.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36,385.45
|
|
|
Coronary Bypass With PTCA With MCC
|
Facility
IP
|
$62,610.56
|
|
|
Service Code
|
MS-DRG 231
|
| Hospital Charge Code |
95
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$62,610.56 |
| Rate for Payer: Amerigroup Medicaid |
$62,308.09
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61,703.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62,610.56
|
|
|
Coronary Bypass With PTCA Without MCC
|
Facility
IP
|
$61,019.04
|
|
|
Service Code
|
MS-DRG 232
|
| Hospital Charge Code |
96
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$61,019.04 |
| Rate for Payer: Amerigroup Medicaid |
$60,724.26
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$60,134.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$61,019.04
|
|
|
Coronavirus 2019 Novel (SARS-CoV-2) DMCL
|
Facility
OP
|
$338.00
|
|
|
Service Code
|
CPT U0002
|
| Hospital Charge Code |
8944439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna of IA Commercial |
$304.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$304.20
|
| Rate for Payer: Aetna of IA Medicare |
$192.66
|
| Rate for Payer: Amerigroup Medicaid |
$170.59
|
| Rate for Payer: Amerigroup Medicare |
$170.69
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$253.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$169.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$168.93
|
| Rate for Payer: Medical Associates Commercial |
$253.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$169.00
|
| Rate for Payer: Midlands Choice Commercial |
$236.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$171.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$253.50
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$199.42
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
Coronavirus 2019 Novel (SARS-CoV-2) DMCL
|
Facility
IP
|
$338.00
|
|
|
Service Code
|
CPT U0002
|
| Hospital Charge Code |
8944439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna of IA Commercial |
$304.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$304.20
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$253.50
|
| Rate for Payer: Medical Associates Commercial |
$253.50
|
| Rate for Payer: Midlands Choice Commercial |
$236.60
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
|
|
Coronavirus 2019 Novel (SARS-CoV-2) IgG Ab DMCL
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
8788720
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of IA Commercial |
$135.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.00
|
| Rate for Payer: Aetna of IA Medicare |
$85.50
|
| Rate for Payer: Amerigroup Medicaid |
$75.70
|
| Rate for Payer: Amerigroup Medicare |
$75.75
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$112.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$75.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.97
|
| Rate for Payer: Medical Associates Commercial |
$112.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$105.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$76.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$112.50
|
| Rate for Payer: United Healthcare Commercial |
$135.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$88.50
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Coronavirus 2019 Novel (SARS-CoV-2) IgG Ab DMCL
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
8788720
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of IA Commercial |
$135.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$112.50
|
| Rate for Payer: Medical Associates Commercial |
$112.50
|
| Rate for Payer: Midlands Choice Commercial |
$105.00
|
| Rate for Payer: United Healthcare Commercial |
$135.00
|
|
|
Coronavirus 2019 Novel Screening PCR
|
Facility
OP
|
$338.00
|
|
|
Service Code
|
CPT 87635 CS
|
| Hospital Charge Code |
8783451
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$168.93 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna of IA Commercial |
$304.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$304.20
|
| Rate for Payer: Aetna of IA Medicare |
$192.66
|
| Rate for Payer: Amerigroup Medicaid |
$170.59
|
| Rate for Payer: Amerigroup Medicare |
$170.69
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$253.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$169.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$168.93
|
| Rate for Payer: Medical Associates Commercial |
$253.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$169.00
|
| Rate for Payer: Midlands Choice Commercial |
$236.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$171.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$253.50
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$199.42
|
|
|
Coronavirus 2019 Novel Screening PCR
|
Facility
IP
|
$338.00
|
|
|
Service Code
|
CPT 87635 CS
|
| Hospital Charge Code |
8783451
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna of IA Commercial |
$304.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$304.20
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$253.50
|
| Rate for Payer: Medical Associates Commercial |
$253.50
|
| Rate for Payer: Midlands Choice Commercial |
$236.60
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
|
|
Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with double osteotomy, any method
|
Facility
OP
|
$9,738.28
|
|
|
Service Code
|
CPT 28299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,852.98 |
| Max. Negotiated Rate |
$9,738.28 |
| Rate for Payer: Wellmark IA HMO |
$8,852.98
|
| Rate for Payer: Wellmark IA PPO |
$9,738.28
|
|
|
Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)
|
Facility
OP
|
$4,658.74
|
|
|
Service Code
|
CPT 28285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,235.22 |
| Max. Negotiated Rate |
$4,658.74 |
| Rate for Payer: Wellmark IA HMO |
$4,235.22
|
| Rate for Payer: Wellmark IA PPO |
$4,658.74
|
|
|
CORTICAL LOCKING SCREW 3.5MM X 12MM
|
Facility
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8895433
|
|
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
|
|
|
CORTICAL LOCKING SCREW 3.5MM X 12MM
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8895433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Aetna of IA Medicare |
$179.55
|
| Rate for Payer: Amerigroup Medicaid |
$158.98
|
| Rate for Payer: Amerigroup Medicare |
$159.08
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$157.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$157.44
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$159.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$236.25
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
|
CORTICAL LOCKING SCREW 3.5MM X 18MM
|
Facility
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8908717
|
|
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
|
|
|
CORTICAL LOCKING SCREW 3.5MM X 18MM
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8908717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Aetna of IA Medicare |
$179.55
|
| Rate for Payer: Amerigroup Medicaid |
$158.98
|
| Rate for Payer: Amerigroup Medicare |
$159.08
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$157.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$157.44
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$159.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$236.25
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
