|
IMPLANT TITANIUM LOCK SCREW 5X75 FULL TH
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.75 |
| 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 |
$124.01
|
| Rate for Payer: Amerigroup Medicare |
$97.72
|
| 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 |
$96.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$122.81
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$96.75
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$124.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.26
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$126.85
|
|
|
IMPLANT TITANIUM LOCK SCREW 5X80 FULL TH
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.75 |
| 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 |
$124.01
|
| Rate for Payer: Amerigroup Medicare |
$97.72
|
| 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 |
$96.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$122.81
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$96.75
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$124.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.26
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$126.85
|
|
|
IMPLANT TITANIUM LOCK SCREW 5X80 FULL TH
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046349
|
|
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 LOCK SCREW 5X85 FULL TH
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.75 |
| 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 |
$124.01
|
| Rate for Payer: Amerigroup Medicare |
$97.72
|
| 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 |
$96.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$122.81
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$96.75
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$124.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.26
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$126.85
|
|
|
IMPLANT TITANIUM LOCK SCREW 5X85 FULL TH
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046350
|
|
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 LOCK SCREW 5X90 FULL TH
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046351
|
|
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 LOCK SCREW 5X90 FULL TH
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.75 |
| 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 |
$124.01
|
| Rate for Payer: Amerigroup Medicare |
$97.72
|
| 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 |
$96.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$122.81
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$96.75
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$124.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.26
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$126.85
|
|
|
IMPLANT TITANIUM LONG NAIL 11X300X125L
|
Facility
|
OP
|
$2,212.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.40 |
| 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: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,275.88
|
| Rate for Payer: Amerigroup Medicare |
$1,005.35
|
| 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 |
$995.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,263.49
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$995.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,282.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,144.71
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
|
IMPLANT TITANIUM LONG NAIL 11X300X125L
|
Facility
|
IP
|
$2,212.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046467
|
|
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 11X300X125R
|
Facility
|
OP
|
$2,212.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.40 |
| 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: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,275.88
|
| Rate for Payer: Amerigroup Medicare |
$1,005.35
|
| 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 |
$995.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,263.49
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$995.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,282.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,144.71
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
|
IMPLANT TITANIUM LONG NAIL 11X300X125R
|
Facility
|
IP
|
$2,212.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046432
|
|
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 11X320X125L
|
Facility
|
OP
|
$2,212.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.40 |
| 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: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,275.88
|
| Rate for Payer: Amerigroup Medicare |
$1,005.35
|
| 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 |
$995.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,263.49
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$995.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,282.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,144.71
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
|
IMPLANT TITANIUM LONG NAIL 11X320X125L
|
Facility
|
IP
|
$2,212.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046468
|
|
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
|
HCPCS C1713
|
| Hospital Charge Code |
8046433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.40 |
| 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: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,275.88
|
| Rate for Payer: Amerigroup Medicare |
$1,005.35
|
| 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 |
$995.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,263.49
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$995.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,282.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,144.71
|
| 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
|
HCPCS 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 11X340X125L
|
Facility
|
OP
|
$2,212.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.40 |
| 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: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,275.88
|
| Rate for Payer: Amerigroup Medicare |
$1,005.35
|
| 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 |
$995.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,263.49
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$995.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,282.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,144.71
|
| 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
|
HCPCS 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 11X340X125R
|
Facility
|
OP
|
$2,212.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.40 |
| 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: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,275.88
|
| Rate for Payer: Amerigroup Medicare |
$1,005.35
|
| 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 |
$995.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,263.49
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$995.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,282.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,144.71
|
| 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
|
HCPCS 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
|
HCPCS L8699
|
| Hospital Charge Code |
8046470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,212.75 |
| 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 |
$1,554.48
|
| Rate for Payer: Amerigroup Medicare |
$1,224.88
|
| 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 |
$1,212.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,539.38
|
| Rate for Payer: Medical Associates Commercial |
$2,021.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,212.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,886.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,562.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,394.66
|
| 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
|
HCPCS 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
|
OP
|
$2,212.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.40 |
| 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: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,275.88
|
| Rate for Payer: Amerigroup Medicare |
$1,005.35
|
| 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 |
$995.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,263.49
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$995.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,282.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,144.71
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
|
IMPLANT TITANIUM LONG NAIL 11X360X125R
|
Facility
|
IP
|
$2,212.00
|
|
|
Service Code
|
HCPCS 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 11X380X125L
|
Facility
|
OP
|
$2,212.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.40 |
| 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: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,275.88
|
| Rate for Payer: Amerigroup Medicare |
$1,005.35
|
| 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 |
$995.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,263.49
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$995.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,282.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,144.71
|
| 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
|
HCPCS 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
|
|
