|
Local Excision and Removal of Internal Fixation Devices of Hip and Femur Without CC/MCC
|
Facility
IP
|
$10,628.83
|
|
|
Service Code
|
MS-DRG 499
|
| Hospital Charge Code |
316
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$10,628.83 |
| Rate for Payer: Amerigroup Medicaid |
$10,577.48
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10,474.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,628.83
|
|
|
LOCKING COMPR BROAD 10 HOLE / L 191MM
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.45 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Aetna of IA Commercial |
$225.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$225.90
|
| Rate for Payer: Aetna of IA Medicare |
$143.07
|
| Rate for Payer: Amerigroup Medicaid |
$126.68
|
| Rate for Payer: Amerigroup Medicare |
$126.76
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$188.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$125.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.45
|
| Rate for Payer: Medical Associates Commercial |
$188.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$125.50
|
| Rate for Payer: Midlands Choice Commercial |
$175.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$188.25
|
| Rate for Payer: United Healthcare Commercial |
$225.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$148.09
|
|
|
LOCKING COMPR BROAD 10 HOLE / L 191MM
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Aetna of IA Commercial |
$225.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$225.90
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$188.25
|
| Rate for Payer: Medical Associates Commercial |
$188.25
|
| Rate for Payer: Midlands Choice Commercial |
$175.70
|
| Rate for Payer: United Healthcare Commercial |
$225.90
|
|
|
LOCKING COMPR BROAD 11 HOLE / L 209MM
|
Facility
IP
|
$279.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna of IA Commercial |
$251.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$251.10
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$209.25
|
| Rate for Payer: Medical Associates Commercial |
$209.25
|
| Rate for Payer: Midlands Choice Commercial |
$195.30
|
| Rate for Payer: United Healthcare Commercial |
$251.10
|
|
|
LOCKING COMPR BROAD 11 HOLE / L 209MM
|
Facility
OP
|
$279.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.44 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna of IA Commercial |
$251.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$251.10
|
| Rate for Payer: Aetna of IA Medicare |
$159.03
|
| Rate for Payer: Amerigroup Medicaid |
$140.81
|
| Rate for Payer: Amerigroup Medicare |
$140.90
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$209.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$139.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$139.44
|
| Rate for Payer: Medical Associates Commercial |
$209.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$139.50
|
| Rate for Payer: Midlands Choice Commercial |
$195.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$141.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$209.25
|
| Rate for Payer: United Healthcare Commercial |
$251.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$164.61
|
|
|
LOCKING COMPR BROAD 12 HOLE / L 227MM
|
Facility
IP
|
$279.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna of IA Commercial |
$251.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$251.10
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$209.25
|
| Rate for Payer: Medical Associates Commercial |
$209.25
|
| Rate for Payer: Midlands Choice Commercial |
$195.30
|
| Rate for Payer: United Healthcare Commercial |
$251.10
|
|
|
LOCKING COMPR BROAD 12 HOLE / L 227MM
|
Facility
OP
|
$279.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.44 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna of IA Commercial |
$251.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$251.10
|
| Rate for Payer: Aetna of IA Medicare |
$159.03
|
| Rate for Payer: Amerigroup Medicaid |
$140.81
|
| Rate for Payer: Amerigroup Medicare |
$140.90
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$209.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$139.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$139.44
|
| Rate for Payer: Medical Associates Commercial |
$209.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$139.50
|
| Rate for Payer: Midlands Choice Commercial |
$195.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$141.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$209.25
|
| Rate for Payer: United Healthcare Commercial |
$251.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$164.61
|
|
|
LOCKING COMPR BROAD 13 HOLE / L 245MM
|
Facility
OP
|
$279.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.44 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna of IA Commercial |
$251.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$251.10
|
| Rate for Payer: Aetna of IA Medicare |
$159.03
|
| Rate for Payer: Amerigroup Medicaid |
$140.81
|
| Rate for Payer: Amerigroup Medicare |
$140.90
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$209.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$139.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$139.44
|
| Rate for Payer: Medical Associates Commercial |
$209.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$139.50
|
| Rate for Payer: Midlands Choice Commercial |
$195.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$141.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$209.25
|
| Rate for Payer: United Healthcare Commercial |
$251.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$164.61
|
|
|
LOCKING COMPR BROAD 13 HOLE / L 245MM
|
Facility
IP
|
$279.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna of IA Commercial |
$251.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$251.10
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$209.25
|
| Rate for Payer: Medical Associates Commercial |
$209.25
|
| Rate for Payer: Midlands Choice Commercial |
$195.30
|
| Rate for Payer: United Healthcare Commercial |
$251.10
|
|
|
LOCKING COMPR BROAD 14 HOLE / L 263MM
|
Facility
IP
|
$279.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna of IA Commercial |
$251.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$251.10
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$209.25
|
| Rate for Payer: Medical Associates Commercial |
$209.25
|
| Rate for Payer: Midlands Choice Commercial |
$195.30
|
| Rate for Payer: United Healthcare Commercial |
$251.10
|
|
|
LOCKING COMPR BROAD 14 HOLE / L 263MM
|
Facility
OP
|
$279.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.44 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna of IA Commercial |
$251.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$251.10
|
| Rate for Payer: Aetna of IA Medicare |
$159.03
|
| Rate for Payer: Amerigroup Medicaid |
$140.81
|
| Rate for Payer: Amerigroup Medicare |
$140.90
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$209.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$139.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$139.44
|
| Rate for Payer: Medical Associates Commercial |
$209.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$139.50
|
| Rate for Payer: Midlands Choice Commercial |
$195.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$141.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$209.25
|
| Rate for Payer: United Healthcare Commercial |
$251.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$164.61
|
|
|
LOCKING COMPR BROAD 6 HOLE / L 119MM
|
Facility
OP
|
$224.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.96 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna of IA Commercial |
$201.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$201.60
|
| Rate for Payer: Aetna of IA Medicare |
$127.68
|
| Rate for Payer: Amerigroup Medicaid |
$113.05
|
| Rate for Payer: Amerigroup Medicare |
$113.12
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$168.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$112.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$111.96
|
| Rate for Payer: Medical Associates Commercial |
$168.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$112.00
|
| Rate for Payer: Midlands Choice Commercial |
$156.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$113.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$168.00
|
| Rate for Payer: United Healthcare Commercial |
$201.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$132.16
|
|
|
LOCKING COMPR BROAD 6 HOLE / L 119MM
|
Facility
IP
|
$224.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna of IA Commercial |
$201.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$201.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$168.00
|
| Rate for Payer: Medical Associates Commercial |
$168.00
|
| Rate for Payer: Midlands Choice Commercial |
$156.80
|
| Rate for Payer: United Healthcare Commercial |
$201.60
|
|
|
LOCKING COMPR BROAD 7 HOLE / L 137MM
|
Facility
OP
|
$250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of IA Commercial |
$225.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$225.00
|
| Rate for Payer: Aetna of IA Medicare |
$142.50
|
| Rate for Payer: Amerigroup Medicaid |
$126.18
|
| Rate for Payer: Amerigroup Medicare |
$126.25
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$187.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$125.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$124.95
|
| Rate for Payer: Medical Associates Commercial |
$187.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$125.00
|
| Rate for Payer: Midlands Choice Commercial |
$175.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$126.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$187.50
|
| Rate for Payer: United Healthcare Commercial |
$225.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$147.50
|
|
|
LOCKING COMPR BROAD 7 HOLE / L 137MM
|
Facility
IP
|
$250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of IA Commercial |
$225.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$225.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$187.50
|
| Rate for Payer: Medical Associates Commercial |
$187.50
|
| Rate for Payer: Midlands Choice Commercial |
$175.00
|
| Rate for Payer: United Healthcare Commercial |
$225.00
|
|
|
LOCKING COMPR BROAD 8 HOLE / L 155MM
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Aetna of IA Commercial |
$225.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$225.90
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$188.25
|
| Rate for Payer: Medical Associates Commercial |
$188.25
|
| Rate for Payer: Midlands Choice Commercial |
$175.70
|
| Rate for Payer: United Healthcare Commercial |
$225.90
|
|
|
LOCKING COMPR BROAD 8 HOLE / L 155MM
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.45 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Aetna of IA Commercial |
$225.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$225.90
|
| Rate for Payer: Aetna of IA Medicare |
$143.07
|
| Rate for Payer: Amerigroup Medicaid |
$126.68
|
| Rate for Payer: Amerigroup Medicare |
$126.76
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$188.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$125.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.45
|
| Rate for Payer: Medical Associates Commercial |
$188.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$125.50
|
| Rate for Payer: Midlands Choice Commercial |
$175.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$188.25
|
| Rate for Payer: United Healthcare Commercial |
$225.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$148.09
|
|
|
LOCKING COMPR BROAD 9 HOLE / L 173MM
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.45 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Aetna of IA Commercial |
$225.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$225.90
|
| Rate for Payer: Aetna of IA Medicare |
$143.07
|
| Rate for Payer: Amerigroup Medicaid |
$126.68
|
| Rate for Payer: Amerigroup Medicare |
$126.76
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$188.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$125.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.45
|
| Rate for Payer: Medical Associates Commercial |
$188.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$125.50
|
| Rate for Payer: Midlands Choice Commercial |
$175.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$188.25
|
| Rate for Payer: United Healthcare Commercial |
$225.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$148.09
|
|
|
LOCKING COMPR BROAD 9 HOLE / L 173MM
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Aetna of IA Commercial |
$225.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$225.90
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$188.25
|
| Rate for Payer: Medical Associates Commercial |
$188.25
|
| Rate for Payer: Midlands Choice Commercial |
$175.70
|
| Rate for Payer: United Healthcare Commercial |
$225.90
|
|
|
LOCKING COMPR NARROW 10 HOLE / L 187MM
|
Facility
IP
|
$188.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.60 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna of IA Commercial |
$169.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$169.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$141.00
|
| Rate for Payer: Medical Associates Commercial |
$141.00
|
| Rate for Payer: Midlands Choice Commercial |
$131.60
|
| Rate for Payer: United Healthcare Commercial |
$169.20
|
|
|
LOCKING COMPR NARROW 10 HOLE / L 187MM
|
Facility
OP
|
$188.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.96 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna of IA Commercial |
$169.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$169.20
|
| Rate for Payer: Aetna of IA Medicare |
$107.16
|
| Rate for Payer: Amerigroup Medicaid |
$94.88
|
| Rate for Payer: Amerigroup Medicare |
$94.94
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$141.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$94.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$93.96
|
| Rate for Payer: Medical Associates Commercial |
$141.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$94.00
|
| Rate for Payer: Midlands Choice Commercial |
$131.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$95.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$141.00
|
| Rate for Payer: United Healthcare Commercial |
$169.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$110.92
|
|
|
LOCKING COMPR NARROW 12 HOLE / L 223MM
|
Facility
OP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$119.45 |
| Max. Negotiated Rate |
$215.10 |
| Rate for Payer: Aetna of IA Commercial |
$215.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$215.10
|
| Rate for Payer: Aetna of IA Medicare |
$136.23
|
| Rate for Payer: Amerigroup Medicaid |
$120.62
|
| Rate for Payer: Amerigroup Medicare |
$120.70
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$119.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$119.45
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$119.50
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$121.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$179.25
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$141.01
|
|
|
LOCKING COMPR NARROW 12 HOLE / L 223MM
|
Facility
IP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$215.10 |
| Rate for Payer: Aetna of IA Commercial |
$215.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$215.10
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
|
|
LOCKING COMPR NARROW 14 HOLE / L 259MM
|
Facility
OP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$119.45 |
| Max. Negotiated Rate |
$215.10 |
| Rate for Payer: Aetna of IA Commercial |
$215.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$215.10
|
| Rate for Payer: Aetna of IA Medicare |
$136.23
|
| Rate for Payer: Amerigroup Medicaid |
$120.62
|
| Rate for Payer: Amerigroup Medicare |
$120.70
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$119.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$119.45
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$119.50
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$121.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$179.25
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$141.01
|
|
|
LOCKING COMPR NARROW 14 HOLE / L 259MM
|
Facility
IP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$215.10 |
| Rate for Payer: Aetna of IA Commercial |
$215.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$215.10
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
|
