|
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: Molina Healthcare Managed Medicare |
$86.73
|
| Rate for Payer: Oscar Health of IA Commercial |
$128.25
|
| 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
|
|
|
3.0MMX18MM GL LOCKING SCREW
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463696
|
|
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: Molina Healthcare Managed Medicare |
$173.46
|
| Rate for Payer: Oscar Health of IA Commercial |
$256.50
|
| 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
|
|
|
3.0MMX18MM GL LOCKING SCREW
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463696
|
|
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
|
|
|
3.0MMX24MM GL LOCKING SCREW
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463698
|
|
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
|
|
|
3.0MMX24MM GL LOCKING SCREW
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463698
|
|
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: Molina Healthcare Managed Medicare |
$173.46
|
| Rate for Payer: Oscar Health of IA Commercial |
$256.50
|
| 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
|
|
|
3.0X10MM VAL SCREW TI
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8783212
|
|
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
|
|
|
3.0X10MM VAL SCREW TI
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8783212
|
|
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
|
|
|
3.0X12MM TIGER CANNULATED SCREWS
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8465016
|
|
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
|
|
|
3.0X12MM TIGER CANNULATED SCREWS
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8465016
|
|
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
|
|
|
3.0X18MM VAL SCREW TI
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8783214
|
|
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
|
|
|
3.0X18MM VAL SCREW TI
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8783214
|
|
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
|
|
|
3.0X20MM VAL SCREW TI
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8783216
|
|
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
|
|
|
3.0X20MM VAL SCREW TI
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8783216
|
|
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
|
|
|
3.0X24MM TIGER CANNULATED SCREW
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8465018
|
|
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
|
|
|
3.0X24MM TIGER CANNULATED SCREW
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8465018
|
|
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
|
|
|
31575 Nasopharyngoscopy flexible fiberoptic
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
8799165
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$142.21 |
| Rate for Payer: Aetna of IA Medicare |
$62.17
|
| Rate for Payer: Amerigroup Medicaid |
$64.28
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$63.41
|
| Rate for Payer: Medical Associates Commercial |
$118.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.17
|
| Rate for Payer: Midlands Choice Commercial |
$142.21
|
| Rate for Payer: Oscar Health of IA Commercial |
$107.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.26
|
|
|
32421 THORACENTESIS IN ED
|
Professional
|
Both
|
$302.00
|
|
| Hospital Charge Code |
8069160
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$226.50 |
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Medical Associates Commercial |
$226.50
|
| Rate for Payer: Midlands Choice Commercial |
$211.40
|
|
|
32550 Insertion of indwelling tunnelled pleural catheter w/cuff
|
Professional
|
Both
|
$2,357.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
8799166
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.48 |
| Max. Negotiated Rate |
$1,649.90 |
| Rate for Payer: Aetna of IA Medicare |
$182.48
|
| Rate for Payer: Amerigroup Medicaid |
$188.68
|
| Rate for Payer: Cash Price |
$1,885.60
|
| Rate for Payer: Cash Price |
$1,885.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$218.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$186.13
|
| Rate for Payer: Medical Associates Commercial |
$346.71
|
| Rate for Payer: Medical Associates Managed Medicare |
$182.48
|
| Rate for Payer: Midlands Choice Commercial |
$1,649.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$315.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$273.72
|
|
|
32554 Thoracentesis- diagnostic- PROFEE
|
Professional
|
Both
|
$336.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
8799167
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna of IA Medicare |
$80.08
|
| Rate for Payer: Amerigroup Medicaid |
$82.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$81.68
|
| Rate for Payer: Medical Associates Commercial |
$152.15
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.08
|
| Rate for Payer: Midlands Choice Commercial |
$235.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$138.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$120.12
|
|
|
32555 Thoracentesis aspiration of the pleural space; w/imaging guidance
|
Professional
|
Both
|
$1,032.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
8799168
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$98.85 |
| Max. Negotiated Rate |
$722.40 |
| Rate for Payer: Aetna of IA Medicare |
$98.85
|
| Rate for Payer: Amerigroup Medicaid |
$102.21
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$118.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.83
|
| Rate for Payer: Medical Associates Commercial |
$187.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$98.85
|
| Rate for Payer: Midlands Choice Commercial |
$722.40
|
| Rate for Payer: Oscar Health of IA Commercial |
$171.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.28
|
|
|
3.4MM TWO-STEP HAMMER TOE IMPLANT 3.4X3.0X14
|
Facility
|
OP
|
$2,880.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,439.42 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,592.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,592.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,641.60
|
| Rate for Payer: Amerigroup Medicaid |
$1,453.54
|
| Rate for Payer: Amerigroup Medicare |
$1,454.40
|
| Rate for Payer: Cash Price |
$2,304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,160.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,440.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,439.42
|
| Rate for Payer: Medical Associates Commercial |
$2,160.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,440.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,016.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,461.60
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,460.74
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,160.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,699.20
|
|
|
3.4MM TWO-STEP HAMMER TOE IMPLANT 3.4X3.0X14
|
Facility
|
IP
|
$2,880.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,592.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,160.00
|
| Rate for Payer: Medical Associates Commercial |
$2,160.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare Commercial |
$2,592.00
|
|
|
3.4MMX3.0MMX16MM SPADE TWO-STEP HAMMER TOE IMPLANT
|
Facility
|
OP
|
$2,340.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8749763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,169.53 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,106.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,106.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,333.80
|
| Rate for Payer: Amerigroup Medicaid |
$1,181.00
|
| Rate for Payer: Amerigroup Medicare |
$1,181.70
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,755.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,170.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,169.53
|
| Rate for Payer: Medical Associates Commercial |
$1,755.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,170.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,638.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,187.55
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,186.85
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,755.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,755.00
|
| Rate for Payer: United Healthcare Commercial |
$2,106.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,380.60
|
|
|
3.4MMX3.0MMX16MM SPADE TWO-STEP HAMMER TOE IMPLANT
|
Facility
|
IP
|
$2,340.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8749763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.00 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,106.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,755.00
|
| Rate for Payer: Medical Associates Commercial |
$1,755.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,638.00
|
| Rate for Payer: United Healthcare Commercial |
$2,106.00
|
|
|
3.4MMX3.0MMX8MM SPADE TWO STEP HAMMER
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8470646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$899.64 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,620.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,620.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,026.00
|
| Rate for Payer: Amerigroup Medicaid |
$908.46
|
| Rate for Payer: Amerigroup Medicare |
$909.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,350.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$900.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$899.64
|
| Rate for Payer: Medical Associates Commercial |
$1,350.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$900.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,260.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$913.50
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$912.96
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,350.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,350.00
|
| Rate for Payer: United Healthcare Commercial |
$1,620.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,062.00
|
|
