|
28313 Recontruction angular deformity to toe soft tissue procedures only
|
Professional
|
$1,754.00
|
|
|
Service Code
|
CPT 28313
|
| Hospital Charge Code |
8799146
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$332.47 |
| Max. Negotiated Rate |
$1,227.80 |
| Rate for Payer: Aetna of IA Medicare |
$332.47
|
| Rate for Payer: Amerigroup Medicaid |
$343.77
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$398.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$339.12
|
| Rate for Payer: Medical Associates Commercial |
$631.69
|
| Rate for Payer: Medical Associates Managed Medicare |
$332.47
|
| Rate for Payer: Midlands Choice Commercial |
$1,227.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$498.70
|
| Rate for Payer: Wellmark IA HMO |
$687.00
|
| Rate for Payer: Wellmark IA PPO |
$806.00
|
|
|
28415 Open treatment of calcaneal fracture
|
Professional
|
$3,751.00
|
|
|
Service Code
|
CPT 28415
|
| Hospital Charge Code |
8799147
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,018.66 |
| Max. Negotiated Rate |
$2,625.70 |
| Rate for Payer: Aetna of IA Medicare |
$1,018.66
|
| Rate for Payer: Amerigroup Medicaid |
$1,053.29
|
| Rate for Payer: Cash Price |
$3,000.80
|
| Rate for Payer: Cash Price |
$3,000.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,222.39
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,039.03
|
| Rate for Payer: Medical Associates Commercial |
$1,935.45
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,018.66
|
| Rate for Payer: Midlands Choice Commercial |
$2,625.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,527.99
|
| Rate for Payer: Wellmark IA HMO |
$2,150.00
|
| Rate for Payer: Wellmark IA PPO |
$2,523.00
|
|
|
28485 Open treatment of metatarsal fracture; includes internal fixation
|
Professional
|
$1,827.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
8799148
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$518.97 |
| Max. Negotiated Rate |
$1,278.90 |
| Rate for Payer: Aetna of IA Medicare |
$518.97
|
| Rate for Payer: Amerigroup Medicaid |
$536.61
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$622.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$529.35
|
| Rate for Payer: Medical Associates Commercial |
$986.04
|
| Rate for Payer: Medical Associates Managed Medicare |
$518.97
|
| Rate for Payer: Midlands Choice Commercial |
$1,278.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$778.46
|
| Rate for Payer: Wellmark IA HMO |
$1,075.00
|
| Rate for Payer: Wellmark IA PPO |
$1,262.00
|
|
|
28740 Arthrodesis midtarsal or tarsometatarsal single joint
|
Professional
|
$2,823.00
|
|
|
Service Code
|
CPT 28740
|
| Hospital Charge Code |
8799149
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$565.05 |
| Max. Negotiated Rate |
$1,976.10 |
| Rate for Payer: Aetna of IA Medicare |
$565.05
|
| Rate for Payer: Amerigroup Medicaid |
$584.26
|
| Rate for Payer: Cash Price |
$2,258.40
|
| Rate for Payer: Cash Price |
$2,258.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$678.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$576.35
|
| Rate for Payer: Medical Associates Commercial |
$1,073.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$565.05
|
| Rate for Payer: Midlands Choice Commercial |
$1,976.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$847.58
|
| Rate for Payer: Wellmark IA HMO |
$1,176.00
|
| Rate for Payer: Wellmark IA PPO |
$1,380.00
|
|
|
28820 Amputate toe metatarsophalangeal joint
|
Professional
|
$1,887.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
8799150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$162.32 |
| Max. Negotiated Rate |
$1,320.90 |
| Rate for Payer: Aetna of IA Medicare |
$162.32
|
| Rate for Payer: Amerigroup Medicaid |
$167.84
|
| Rate for Payer: Cash Price |
$1,509.60
|
| Rate for Payer: Cash Price |
$1,509.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$194.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$165.57
|
| Rate for Payer: Medical Associates Commercial |
$308.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$162.32
|
| Rate for Payer: Midlands Choice Commercial |
$1,320.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$243.48
|
| Rate for Payer: Wellmark IA HMO |
$336.00
|
| Rate for Payer: Wellmark IA PPO |
$395.00
|
|
|
28825 Amputate toe interphalangeal joint
|
Professional
|
$1,807.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
8799151
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$158.30 |
| Max. Negotiated Rate |
$1,264.90 |
| Rate for Payer: Aetna of IA Medicare |
$158.30
|
| Rate for Payer: Amerigroup Medicaid |
$163.68
|
| Rate for Payer: Cash Price |
$1,445.60
|
| Rate for Payer: Cash Price |
$1,445.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$161.47
|
| Rate for Payer: Medical Associates Commercial |
$300.77
|
| Rate for Payer: Medical Associates Managed Medicare |
$158.30
|
| Rate for Payer: Midlands Choice Commercial |
$1,264.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$237.45
|
| Rate for Payer: Wellmark IA HMO |
$326.00
|
| Rate for Payer: Wellmark IA PPO |
$382.00
|
|
|
29580 APPLICATION OF PASTE BOOT (UNNA)
|
Professional
|
$210.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
8799153
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$23.84 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of IA Medicare |
$23.84
|
| Rate for Payer: Amerigroup Medicaid |
$24.65
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.61
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$24.32
|
| Rate for Payer: Medical Associates Commercial |
$45.30
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.84
|
| Rate for Payer: Midlands Choice Commercial |
$147.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$35.76
|
| Rate for Payer: Wellmark IA HMO |
$50.00
|
| Rate for Payer: Wellmark IA PPO |
$58.00
|
|
|
29581 COMPRESSION MULTILAYER BELOW KNEE
|
Professional
|
$296.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
8799154
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$25.18 |
| Max. Negotiated Rate |
$207.20 |
| Rate for Payer: Aetna of IA Medicare |
$25.18
|
| Rate for Payer: Amerigroup Medicaid |
$26.04
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.68
|
| Rate for Payer: Medical Associates Commercial |
$47.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.18
|
| Rate for Payer: Midlands Choice Commercial |
$207.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$37.77
|
| Rate for Payer: Wellmark IA HMO |
$50.00
|
| Rate for Payer: Wellmark IA PPO |
$59.00
|
|
|
29807 Arthroscopy shoulder surgical repair of SLAP lesion
|
Professional
|
$3,485.00
|
|
|
Service Code
|
CPT 29807
|
| Hospital Charge Code |
8799155
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$932.87 |
| Max. Negotiated Rate |
$2,439.50 |
| Rate for Payer: Aetna of IA Medicare |
$932.87
|
| Rate for Payer: Amerigroup Medicaid |
$964.59
|
| Rate for Payer: Cash Price |
$2,788.00
|
| Rate for Payer: Cash Price |
$2,788.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,119.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$951.53
|
| Rate for Payer: Medical Associates Commercial |
$1,772.45
|
| Rate for Payer: Medical Associates Managed Medicare |
$932.87
|
| Rate for Payer: Midlands Choice Commercial |
$2,439.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,399.30
|
| Rate for Payer: Wellmark IA HMO |
$1,978.00
|
| Rate for Payer: Wellmark IA PPO |
$2,322.00
|
|
|
29826 Arthroscopy shoulder surgical; decompression of subacromial space
|
Professional
|
$591.00
|
|
|
Service Code
|
CPT 29826
|
| Hospital Charge Code |
8799156
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$152.35 |
| Max. Negotiated Rate |
$413.70 |
| Rate for Payer: Aetna of IA Medicare |
$152.35
|
| Rate for Payer: Amerigroup Medicaid |
$157.53
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$182.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$155.40
|
| Rate for Payer: Medical Associates Commercial |
$289.46
|
| Rate for Payer: Medical Associates Managed Medicare |
$152.35
|
| Rate for Payer: Midlands Choice Commercial |
$413.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$228.52
|
| Rate for Payer: Wellmark IA HMO |
$326.00
|
| Rate for Payer: Wellmark IA PPO |
$382.00
|
|
|
29827 Arthroscopy shoulder surgical; with rotator cuff repair
|
Professional
|
$3,542.00
|
|
|
Service Code
|
CPT 29827
|
| Hospital Charge Code |
8799157
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$963.00 |
| Max. Negotiated Rate |
$2,479.40 |
| Rate for Payer: Aetna of IA Medicare |
$963.00
|
| Rate for Payer: Amerigroup Medicaid |
$995.74
|
| Rate for Payer: Cash Price |
$2,833.60
|
| Rate for Payer: Cash Price |
$2,833.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,155.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$982.26
|
| Rate for Payer: Medical Associates Commercial |
$1,829.70
|
| Rate for Payer: Medical Associates Managed Medicare |
$963.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,479.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,444.50
|
| Rate for Payer: Wellmark IA HMO |
$2,042.00
|
| Rate for Payer: Wellmark IA PPO |
$2,397.00
|
|
|
29867 Arthroscopy knee surgical; osteochondral allograft
|
Professional
|
$4,311.00
|
|
|
Service Code
|
CPT 29867
|
| Hospital Charge Code |
8799158
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,150.36 |
| Max. Negotiated Rate |
$3,017.70 |
| Rate for Payer: Aetna of IA Medicare |
$1,150.36
|
| Rate for Payer: Amerigroup Medicaid |
$1,189.47
|
| Rate for Payer: Cash Price |
$3,448.80
|
| Rate for Payer: Cash Price |
$3,448.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,380.43
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,173.37
|
| Rate for Payer: Medical Associates Commercial |
$2,185.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,150.36
|
| Rate for Payer: Midlands Choice Commercial |
$3,017.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,725.54
|
| Rate for Payer: Wellmark IA HMO |
$2,441.00
|
| Rate for Payer: Wellmark IA PPO |
$2,865.00
|
|
|
29874 Arthroscopy; knee with removal of loose/foreign body
|
Professional
|
$1,801.00
|
|
|
Service Code
|
CPT 29874
|
| Hospital Charge Code |
8799159
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$489.12 |
| Max. Negotiated Rate |
$1,260.70 |
| Rate for Payer: Aetna of IA Medicare |
$489.12
|
| Rate for Payer: Amerigroup Medicaid |
$505.75
|
| Rate for Payer: Cash Price |
$1,440.80
|
| Rate for Payer: Cash Price |
$1,440.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$586.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$498.90
|
| Rate for Payer: Medical Associates Commercial |
$929.33
|
| Rate for Payer: Medical Associates Managed Medicare |
$489.12
|
| Rate for Payer: Midlands Choice Commercial |
$1,260.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$733.68
|
| Rate for Payer: Wellmark IA HMO |
$1,030.00
|
| Rate for Payer: Wellmark IA PPO |
$1,208.00
|
|
|
29877 Arthroscopy knee w/debridement/shaving of cartilage (chondroplasty)
|
Professional
|
$2,087.00
|
|
|
Service Code
|
CPT 29877
|
| Hospital Charge Code |
8799160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$563.58 |
| Max. Negotiated Rate |
$1,460.90 |
| Rate for Payer: Aetna of IA Medicare |
$563.58
|
| Rate for Payer: Amerigroup Medicaid |
$582.74
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$676.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$574.85
|
| Rate for Payer: Medical Associates Commercial |
$1,070.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$563.58
|
| Rate for Payer: Midlands Choice Commercial |
$1,460.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$845.37
|
| Rate for Payer: Wellmark IA HMO |
$1,193.00
|
| Rate for Payer: Wellmark IA PPO |
$1,400.00
|
|
|
29879 Arthroscopy knee surgical; abrasion arthroplasty-drilling/microfracture
|
Professional
|
$2,223.00
|
|
|
Service Code
|
CPT 29879
|
| Hospital Charge Code |
8799161
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$600.08 |
| Max. Negotiated Rate |
$1,556.10 |
| Rate for Payer: Aetna of IA Medicare |
$600.08
|
| Rate for Payer: Amerigroup Medicaid |
$620.48
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$720.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$612.08
|
| Rate for Payer: Medical Associates Commercial |
$1,140.15
|
| Rate for Payer: Medical Associates Managed Medicare |
$600.08
|
| Rate for Payer: Midlands Choice Commercial |
$1,556.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$900.12
|
| Rate for Payer: Wellmark IA HMO |
$1,269.00
|
| Rate for Payer: Wellmark IA PPO |
$1,490.00
|
|
|
29880 Arthroscopy; knee with meniscenctomy medial/lateral w/shaving
|
Professional
|
$1,885.00
|
|
|
Service Code
|
CPT 29880
|
| Hospital Charge Code |
8799162
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$510.76 |
| Max. Negotiated Rate |
$1,319.50 |
| Rate for Payer: Aetna of IA Medicare |
$510.76
|
| Rate for Payer: Amerigroup Medicaid |
$528.13
|
| Rate for Payer: Cash Price |
$1,508.00
|
| Rate for Payer: Cash Price |
$1,508.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$612.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$520.98
|
| Rate for Payer: Medical Associates Commercial |
$970.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$510.76
|
| Rate for Payer: Midlands Choice Commercial |
$1,319.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$766.14
|
| Rate for Payer: Wellmark IA HMO |
$1,081.00
|
| Rate for Payer: Wellmark IA PPO |
$1,268.00
|
|
|
29881 Arthroscopy knee surgical; with meniscectomy (medial OR lateral)
|
Professional
|
$1,816.00
|
|
|
Service Code
|
CPT 29881
|
| Hospital Charge Code |
8799163
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$492.40 |
| Max. Negotiated Rate |
$1,271.20 |
| Rate for Payer: Aetna of IA Medicare |
$492.40
|
| Rate for Payer: Amerigroup Medicaid |
$509.14
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$590.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$502.25
|
| Rate for Payer: Medical Associates Commercial |
$935.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$492.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,271.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$738.60
|
| Rate for Payer: Wellmark IA HMO |
$1,040.00
|
| Rate for Payer: Wellmark IA PPO |
$1,221.00
|
|
|
29893 Endoscopic plantar fasciotomy
|
Professional
|
$2,136.00
|
|
|
Service Code
|
CPT 29893
|
| Hospital Charge Code |
8799164
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$407.25 |
| Max. Negotiated Rate |
$1,495.20 |
| Rate for Payer: Aetna of IA Medicare |
$407.25
|
| Rate for Payer: Amerigroup Medicaid |
$421.10
|
| Rate for Payer: Cash Price |
$1,708.80
|
| Rate for Payer: Cash Price |
$1,708.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$488.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$415.40
|
| Rate for Payer: Medical Associates Commercial |
$773.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$407.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,495.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$610.88
|
| Rate for Payer: Wellmark IA HMO |
$828.00
|
| Rate for Payer: Wellmark IA PPO |
$971.00
|
|
|
2cmx3cm THIN GRAFT
|
Facility
OP
|
$2,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8781513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,034.59 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,863.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,863.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,179.90
|
| Rate for Payer: Amerigroup Medicaid |
$1,044.73
|
| Rate for Payer: Amerigroup Medicare |
$1,045.35
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,552.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,035.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,034.59
|
| Rate for Payer: Medical Associates Commercial |
$1,552.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,035.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,449.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,050.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,552.50
|
| Rate for Payer: United Healthcare Commercial |
$1,863.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,221.30
|
|
|
2cmx3cm THIN GRAFT
|
Facility
IP
|
$2,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8781513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.00 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,863.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,863.00
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,552.50
|
| Rate for Payer: Medical Associates Commercial |
$1,552.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,449.00
|
| Rate for Payer: United Healthcare Commercial |
$1,863.00
|
|
|
3.0MMX12MM GL LOCKING SCREW
|
Facility
OP
|
$342.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.93 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna of IA Commercial |
$307.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$307.80
|
| Rate for Payer: Aetna of IA Medicare |
$194.94
|
| Rate for Payer: Amerigroup Medicaid |
$172.61
|
| Rate for Payer: Amerigroup Medicare |
$172.71
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$256.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$171.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$170.93
|
| Rate for Payer: Medical Associates Commercial |
$256.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$171.00
|
| Rate for Payer: Midlands Choice Commercial |
$239.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$173.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$256.50
|
| Rate for Payer: United Healthcare Commercial |
$307.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$201.78
|
|
|
3.0MMX12MM GL LOCKING SCREW
|
Facility
IP
|
$342.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.40 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna of IA Commercial |
$307.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$307.80
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$256.50
|
| Rate for Payer: Medical Associates Commercial |
$256.50
|
| Rate for Payer: Midlands Choice Commercial |
$239.40
|
| Rate for Payer: United Healthcare Commercial |
$307.80
|
|
|
3.0MMX16MM GL LOCKING SCREW
|
Facility
OP
|
$342.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.93 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna of IA Commercial |
$307.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$307.80
|
| Rate for Payer: Aetna of IA Medicare |
$194.94
|
| Rate for Payer: Amerigroup Medicaid |
$172.61
|
| Rate for Payer: Amerigroup Medicare |
$172.71
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$256.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$171.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$170.93
|
| Rate for Payer: Medical Associates Commercial |
$256.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$171.00
|
| Rate for Payer: Midlands Choice Commercial |
$239.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$173.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$256.50
|
| Rate for Payer: United Healthcare Commercial |
$307.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$201.78
|
|
|
3.0MMX16MM GL LOCKING SCREW
|
Facility
IP
|
$342.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.40 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna of IA Commercial |
$307.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$307.80
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$256.50
|
| Rate for Payer: Medical Associates Commercial |
$256.50
|
| Rate for Payer: Midlands Choice Commercial |
$239.40
|
| Rate for Payer: United Healthcare Commercial |
$307.80
|
|
|
3.0MM X 16MM GL SCREW
|
Facility
OP
|
$171.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.47 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna of IA Commercial |
$153.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$153.90
|
| Rate for Payer: Aetna of IA Medicare |
$97.47
|
| Rate for Payer: Amerigroup Medicaid |
$86.30
|
| Rate for Payer: Amerigroup Medicare |
$86.36
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$128.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$85.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$85.47
|
| Rate for Payer: Medical Associates Commercial |
$128.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$119.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$86.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$128.25
|
| Rate for Payer: United Healthcare Commercial |
$153.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$100.89
|
|
