|
IMPLANT TIBIAL BEARING INSERT CR 4X11MM
|
Facility
OP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,519.49 |
| Max. Negotiated Rate |
$4,536.90 |
| Rate for Payer: Aetna of IA Commercial |
$4,536.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,536.90
|
| Rate for Payer: Aetna of IA Medicare |
$2,873.37
|
| Rate for Payer: Amerigroup Medicaid |
$2,544.19
|
| Rate for Payer: Amerigroup Medicare |
$2,545.70
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,780.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,520.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,519.49
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,520.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,558.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,780.75
|
| Rate for Payer: United Healthcare Commercial |
$4,536.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,974.19
|
|
|
IMPLANT TIBIAL BEARING INSERT CR 4X11MM
|
Facility
IP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.70 |
| Max. Negotiated Rate |
$4,536.90 |
| Rate for Payer: Aetna of IA Commercial |
$4,536.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,536.90
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: United Healthcare Commercial |
$4,536.90
|
|
|
IMPLANT TIBIAL NAIL STANDARD 11X315MM
|
Facility
IP
|
$3,449.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,414.30 |
| Max. Negotiated Rate |
$3,104.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,104.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,104.10
|
| Rate for Payer: Cash Price |
$2,759.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,586.75
|
| Rate for Payer: Medical Associates Commercial |
$2,586.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,414.30
|
| Rate for Payer: United Healthcare Commercial |
$3,104.10
|
|
|
IMPLANT TIBIAL NAIL STANDARD 11X315MM
|
Facility
OP
|
$3,449.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,723.81 |
| Max. Negotiated Rate |
$3,104.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,104.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,104.10
|
| Rate for Payer: Aetna of IA Medicare |
$1,965.93
|
| Rate for Payer: Amerigroup Medicaid |
$1,740.71
|
| Rate for Payer: Amerigroup Medicare |
$1,741.74
|
| Rate for Payer: Cash Price |
$2,759.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,586.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,724.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,723.81
|
| Rate for Payer: Medical Associates Commercial |
$2,586.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,724.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,414.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,750.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,586.75
|
| Rate for Payer: United Healthcare Commercial |
$3,104.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,034.91
|
|
|
IMPLANT TIBIAL SIZE #5
|
Facility
IP
|
$4,140.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,898.00 |
| Max. Negotiated Rate |
$3,726.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,726.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,726.00
|
| Rate for Payer: Cash Price |
$3,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,105.00
|
| Rate for Payer: Medical Associates Commercial |
$3,105.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,898.00
|
| Rate for Payer: United Healthcare Commercial |
$3,726.00
|
|
|
IMPLANT TIBIAL SIZE #5
|
Facility
OP
|
$4,140.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,069.17 |
| Max. Negotiated Rate |
$3,726.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,726.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,726.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,359.80
|
| Rate for Payer: Amerigroup Medicaid |
$2,089.46
|
| Rate for Payer: Amerigroup Medicare |
$2,090.70
|
| Rate for Payer: Cash Price |
$3,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,105.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,070.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,069.17
|
| Rate for Payer: Medical Associates Commercial |
$3,105.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,070.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,898.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,101.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,105.00
|
| Rate for Payer: United Healthcare Commercial |
$3,726.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,442.60
|
|
|
IMPLANT TIBIAL SIZE #6
|
Facility
IP
|
$4,140.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,898.00 |
| Max. Negotiated Rate |
$3,726.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,726.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,726.00
|
| Rate for Payer: Cash Price |
$3,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,105.00
|
| Rate for Payer: Medical Associates Commercial |
$3,105.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,898.00
|
| Rate for Payer: United Healthcare Commercial |
$3,726.00
|
|
|
IMPLANT TIBIAL SIZE #6
|
Facility
OP
|
$4,140.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,069.17 |
| Max. Negotiated Rate |
$3,726.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,726.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,726.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,359.80
|
| Rate for Payer: Amerigroup Medicaid |
$2,089.46
|
| Rate for Payer: Amerigroup Medicare |
$2,090.70
|
| Rate for Payer: Cash Price |
$3,312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,105.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,070.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,069.17
|
| Rate for Payer: Medical Associates Commercial |
$3,105.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,070.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,898.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,101.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,105.00
|
| Rate for Payer: United Healthcare Commercial |
$3,726.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,442.60
|
|
|
IMPLANT TIGERSTICK
|
Facility
OP
|
$69.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.49 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna of IA Commercial |
$62.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$62.10
|
| Rate for Payer: Aetna of IA Medicare |
$39.33
|
| Rate for Payer: Amerigroup Medicaid |
$34.82
|
| Rate for Payer: Amerigroup Medicare |
$34.84
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.49
|
| Rate for Payer: Medical Associates Commercial |
$51.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.50
|
| Rate for Payer: Midlands Choice Commercial |
$48.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.75
|
| Rate for Payer: United Healthcare Commercial |
$62.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$40.71
|
|
|
IMPLANT TIGERSTICK
|
Facility
IP
|
$69.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna of IA Commercial |
$62.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$62.10
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.75
|
| Rate for Payer: Medical Associates Commercial |
$51.75
|
| Rate for Payer: Midlands Choice Commercial |
$48.30
|
| Rate for Payer: United Healthcare Commercial |
$62.10
|
|
|
IMPLANT TITANIUM +10 END CAP
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of IA Commercial |
$193.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$193.50
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$161.25
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
|
|
IMPLANT TITANIUM +10 END CAP
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.46 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of IA Commercial |
$193.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$193.50
|
| Rate for Payer: Aetna of IA Medicare |
$122.55
|
| Rate for Payer: Amerigroup Medicaid |
$108.51
|
| Rate for Payer: Amerigroup Medicare |
$108.58
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$161.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$107.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.46
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$107.50
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$109.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$161.25
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$126.85
|
|
|
IMPLANT TITANIUM +5 END CAP
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.46 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of IA Commercial |
$193.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$193.50
|
| Rate for Payer: Aetna of IA Medicare |
$122.55
|
| Rate for Payer: Amerigroup Medicaid |
$108.51
|
| Rate for Payer: Amerigroup Medicare |
$108.58
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$161.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$107.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.46
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$107.50
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$109.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$161.25
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$126.85
|
|
|
IMPLANT TITANIUM +5 END CAP
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of IA Commercial |
$193.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$193.50
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$161.25
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
|
|
IMPLANT TITANIUM END CAP STANDARD
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of IA Commercial |
$193.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$193.50
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$161.25
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
|
|
IMPLANT TITANIUM END CAP STANDARD
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.46 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of IA Commercial |
$193.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$193.50
|
| Rate for Payer: Aetna of IA Medicare |
$122.55
|
| Rate for Payer: Amerigroup Medicaid |
$108.51
|
| Rate for Payer: Amerigroup Medicare |
$108.58
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$161.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$107.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.46
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$107.50
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$109.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$161.25
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$126.85
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X100MM
|
Facility
IP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.30 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X100MM
|
Facility
OP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.38 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Aetna of IA Medicare |
$352.83
|
| Rate for Payer: Amerigroup Medicaid |
$312.41
|
| Rate for Payer: Amerigroup Medicare |
$312.60
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$309.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$309.38
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$309.50
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$314.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$464.25
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$365.21
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X105MM
|
Facility
IP
|
$816.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.20 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna of IA Commercial |
$734.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$734.40
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$612.00
|
| Rate for Payer: Medical Associates Commercial |
$612.00
|
| Rate for Payer: Midlands Choice Commercial |
$571.20
|
| Rate for Payer: United Healthcare Commercial |
$734.40
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X105MM
|
Facility
OP
|
$816.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$407.84 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna of IA Commercial |
$734.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$734.40
|
| Rate for Payer: Aetna of IA Medicare |
$465.12
|
| Rate for Payer: Amerigroup Medicaid |
$411.84
|
| Rate for Payer: Amerigroup Medicare |
$412.08
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$612.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$408.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$407.84
|
| Rate for Payer: Medical Associates Commercial |
$612.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$408.00
|
| Rate for Payer: Midlands Choice Commercial |
$571.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$414.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$612.00
|
| Rate for Payer: United Healthcare Commercial |
$734.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$481.44
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X110MM
|
Facility
OP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.38 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Aetna of IA Medicare |
$352.83
|
| Rate for Payer: Amerigroup Medicaid |
$312.41
|
| Rate for Payer: Amerigroup Medicare |
$312.60
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$309.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$309.38
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$309.50
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$314.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$464.25
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$365.21
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X110MM
|
Facility
IP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.30 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X115MM
|
Facility
OP
|
$867.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.33 |
| Max. Negotiated Rate |
$780.30 |
| Rate for Payer: Aetna of IA Commercial |
$780.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$780.30
|
| Rate for Payer: Aetna of IA Medicare |
$494.19
|
| Rate for Payer: Amerigroup Medicaid |
$437.57
|
| Rate for Payer: Amerigroup Medicare |
$437.84
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$650.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$433.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$433.33
|
| Rate for Payer: Medical Associates Commercial |
$650.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$433.50
|
| Rate for Payer: Midlands Choice Commercial |
$606.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$440.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$650.25
|
| Rate for Payer: United Healthcare Commercial |
$780.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$511.53
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X115MM
|
Facility
IP
|
$867.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.90 |
| Max. Negotiated Rate |
$780.30 |
| Rate for Payer: Aetna of IA Commercial |
$780.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$780.30
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$650.25
|
| Rate for Payer: Medical Associates Commercial |
$650.25
|
| Rate for Payer: Midlands Choice Commercial |
$606.90
|
| Rate for Payer: United Healthcare Commercial |
$780.30
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X120MM
|
Facility
IP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.30 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
|
