|
IMPLANT TITANIUM LONG NAIL 11X320X125L
|
Facility
OP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.56 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,116.40
|
| Rate for Payer: Amerigroup Medicare |
$1,117.06
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,105.56
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,122.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
|
IMPLANT TITANIUM LONG NAIL 11X320X125 R
|
Facility
IP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.40 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
|
|
IMPLANT TITANIUM LONG NAIL 11X320X125 R
|
Facility
OP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.56 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,116.40
|
| Rate for Payer: Amerigroup Medicare |
$1,117.06
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,105.56
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,122.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
|
IMPLANT TITANIUM LONG NAIL 11X340X125L
|
Facility
IP
|
$2,212.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.40 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
|
|
IMPLANT TITANIUM LONG NAIL 11X340X125L
|
Facility
OP
|
$2,212.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.56 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,116.40
|
| Rate for Payer: Amerigroup Medicare |
$1,117.06
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,105.56
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,122.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
|
IMPLANT TITANIUM LONG NAIL 11X340X125R
|
Facility
OP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.56 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,116.40
|
| Rate for Payer: Amerigroup Medicare |
$1,117.06
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,105.56
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,122.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
|
IMPLANT TITANIUM LONG NAIL 11X340X125R
|
Facility
IP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.40 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
|
|
IMPLANT TITANIUM LONG NAIL 11X360X125L
|
Facility
OP
|
$2,695.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,346.96 |
| Max. Negotiated Rate |
$2,425.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,425.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,425.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,536.15
|
| Rate for Payer: Amerigroup Medicaid |
$1,360.17
|
| Rate for Payer: Amerigroup Medicare |
$1,360.98
|
| Rate for Payer: Cash Price |
$2,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,021.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,347.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,346.96
|
| Rate for Payer: Medical Associates Commercial |
$2,021.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,347.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,886.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,367.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,021.25
|
| Rate for Payer: United Healthcare Commercial |
$2,425.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,590.05
|
|
|
IMPLANT TITANIUM LONG NAIL 11X360X125L
|
Facility
IP
|
$2,695.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,886.50 |
| Max. Negotiated Rate |
$2,425.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,425.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,425.50
|
| Rate for Payer: Cash Price |
$2,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,021.25
|
| Rate for Payer: Medical Associates Commercial |
$2,021.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,886.50
|
| Rate for Payer: United Healthcare Commercial |
$2,425.50
|
|
|
IMPLANT TITANIUM LONG NAIL 11X360X125R
|
Facility
IP
|
$2,212.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.40 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
|
|
IMPLANT TITANIUM LONG NAIL 11X360X125R
|
Facility
OP
|
$2,212.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.56 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,116.40
|
| Rate for Payer: Amerigroup Medicare |
$1,117.06
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,105.56
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,122.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
|
IMPLANT TITANIUM LONG NAIL 11X380X125L
|
Facility
OP
|
$2,212.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.56 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,116.40
|
| Rate for Payer: Amerigroup Medicare |
$1,117.06
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,105.56
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,122.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
|
IMPLANT TITANIUM LONG NAIL 11X380X125L
|
Facility
IP
|
$2,212.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.40 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
|
|
IMPLANT TITANIUM LONG NAIL 11X380X125R
|
Facility
IP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.40 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
|
|
IMPLANT TITANIUM LONG NAIL 11X380X125R
|
Facility
OP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.56 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,116.40
|
| Rate for Payer: Amerigroup Medicare |
$1,117.06
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,105.56
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,122.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
|
IMPLANT TITANIUM LONG NAIL 11X400X125L
|
Facility
IP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.40 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
|
|
IMPLANT TITANIUM LONG NAIL 11X400X125L
|
Facility
OP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.56 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,116.40
|
| Rate for Payer: Amerigroup Medicare |
$1,117.06
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,105.56
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,122.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
|
IMPLANT TITANIUM LONG NAIL 11X400X125R
|
Facility
OP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.56 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,116.40
|
| Rate for Payer: Amerigroup Medicare |
$1,117.06
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,105.56
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,122.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
|
IMPLANT TITANIUM LONG NAIL 11X400X125R
|
Facility
IP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.40 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
|
|
IMPLANT TITANIUM LONG NAIL 11X420X125L
|
Facility
IP
|
$2,212.00
|
|
| Hospital Charge Code |
8046473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.40 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
|
|
IMPLANT TITANIUM LONG NAIL 11X420X125L
|
Facility
OP
|
$2,212.00
|
|
| Hospital Charge Code |
8046473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.56 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,116.40
|
| Rate for Payer: Amerigroup Medicare |
$1,117.06
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,105.56
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,122.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
|
IMPLANT TITANIUM LONG NAIL 11X420X125R
|
Facility
IP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.40 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
|
|
IMPLANT TITANIUM LONG NAIL 11X420X125R
|
Facility
OP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.56 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,116.40
|
| Rate for Payer: Amerigroup Medicare |
$1,117.06
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,105.56
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,122.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
|
IMPLANT TITANIUM LONG NAIL 11X440X125L
|
Facility
IP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.40 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
|
|
IMPLANT TITANIUM LONG NAIL 11X440X125L
|
Facility
OP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.56 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,116.40
|
| Rate for Payer: Amerigroup Medicare |
$1,117.06
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,105.56
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,122.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
