|
PLATE LCOKING DELTOID AVULSION, SS, 3H
|
Facility
IP
|
$1,114.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$779.80 |
| Max. Negotiated Rate |
$1,002.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,002.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,002.60
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$835.50
|
| Rate for Payer: Medical Associates Commercial |
$835.50
|
| Rate for Payer: Midlands Choice Commercial |
$779.80
|
| Rate for Payer: United Healthcare Commercial |
$1,002.60
|
|
|
Platelet Antibody Indirect DMCL
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
8037754
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
|
|
Platelet Antibody Indirect DMCL
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
8037754
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Aetna of IA Medicare |
$99.75
|
| Rate for Payer: Amerigroup Medicaid |
$88.32
|
| Rate for Payer: Amerigroup Medicare |
$88.38
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$87.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$87.46
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$87.50
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$88.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$131.25
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.25
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
PLATELET COUNT
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
2182297
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna of IA Commercial |
$43.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$43.20
|
| Rate for Payer: Aetna of IA Medicare |
$27.36
|
| Rate for Payer: Amerigroup Medicaid |
$24.23
|
| Rate for Payer: Amerigroup Medicare |
$24.24
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$24.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.99
|
| Rate for Payer: Medical Associates Commercial |
$36.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$33.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$36.00
|
| Rate for Payer: United Healthcare Commercial |
$43.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$28.32
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
|
PLATELET COUNT
|
Facility
IP
|
$48.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
2182297
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna of IA Commercial |
$43.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$43.20
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.00
|
| Rate for Payer: Medical Associates Commercial |
$36.00
|
| Rate for Payer: Midlands Choice Commercial |
$33.60
|
| Rate for Payer: United Healthcare Commercial |
$43.20
|
|
|
PLATE LOCKING AXSOS RECON 10 HOLE L120
|
Facility
OP
|
$635.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.37 |
| Max. Negotiated Rate |
$571.50 |
| Rate for Payer: Aetna of IA Commercial |
$571.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$571.50
|
| Rate for Payer: Aetna of IA Medicare |
$361.95
|
| Rate for Payer: Amerigroup Medicaid |
$320.48
|
| Rate for Payer: Amerigroup Medicare |
$320.68
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$476.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$317.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$317.37
|
| Rate for Payer: Medical Associates Commercial |
$476.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$317.50
|
| Rate for Payer: Midlands Choice Commercial |
$444.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$322.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$476.25
|
| Rate for Payer: United Healthcare Commercial |
$571.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$374.65
|
|
|
PLATE LOCKING AXSOS RECON 10 HOLE L120
|
Facility
IP
|
$635.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.50 |
| Max. Negotiated Rate |
$571.50 |
| Rate for Payer: Aetna of IA Commercial |
$571.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$571.50
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$476.25
|
| Rate for Payer: Medical Associates Commercial |
$476.25
|
| Rate for Payer: Midlands Choice Commercial |
$444.50
|
| Rate for Payer: United Healthcare Commercial |
$571.50
|
|
|
PLATE LOCKING AXSOS RECON 4 HOLE L48
|
Facility
OP
|
$477.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.40 |
| Max. Negotiated Rate |
$429.30 |
| Rate for Payer: Aetna of IA Commercial |
$429.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$429.30
|
| Rate for Payer: Aetna of IA Medicare |
$271.89
|
| Rate for Payer: Amerigroup Medicaid |
$240.74
|
| Rate for Payer: Amerigroup Medicare |
$240.88
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$357.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$238.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$238.40
|
| Rate for Payer: Medical Associates Commercial |
$357.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$238.50
|
| Rate for Payer: Midlands Choice Commercial |
$333.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$242.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$357.75
|
| Rate for Payer: United Healthcare Commercial |
$429.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$281.43
|
|
|
PLATE LOCKING AXSOS RECON 4 HOLE L48
|
Facility
IP
|
$477.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.90 |
| Max. Negotiated Rate |
$429.30 |
| Rate for Payer: Aetna of IA Commercial |
$429.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$429.30
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$357.75
|
| Rate for Payer: Medical Associates Commercial |
$357.75
|
| Rate for Payer: Midlands Choice Commercial |
$333.90
|
| Rate for Payer: United Healthcare Commercial |
$429.30
|
|
|
PLATE LOCKING AXSOS RECON 6 HOLE L172
|
Facility
OP
|
$561.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.39 |
| Max. Negotiated Rate |
$504.90 |
| Rate for Payer: Aetna of IA Commercial |
$504.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$504.90
|
| Rate for Payer: Aetna of IA Medicare |
$319.77
|
| Rate for Payer: Amerigroup Medicaid |
$283.14
|
| Rate for Payer: Amerigroup Medicare |
$283.30
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$420.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$280.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$280.39
|
| Rate for Payer: Medical Associates Commercial |
$420.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$280.50
|
| Rate for Payer: Midlands Choice Commercial |
$392.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$284.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$420.75
|
| Rate for Payer: United Healthcare Commercial |
$504.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$330.99
|
|
|
PLATE LOCKING AXSOS RECON 6 HOLE L172
|
Facility
IP
|
$561.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.70 |
| Max. Negotiated Rate |
$504.90 |
| Rate for Payer: Aetna of IA Commercial |
$504.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$504.90
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$420.75
|
| Rate for Payer: Medical Associates Commercial |
$420.75
|
| Rate for Payer: Midlands Choice Commercial |
$392.70
|
| Rate for Payer: United Healthcare Commercial |
$504.90
|
|
|
PLATE LOCKING AXSOS RECON 8 HOLE L96
|
Facility
OP
|
$615.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.38 |
| Max. Negotiated Rate |
$553.50 |
| Rate for Payer: Aetna of IA Commercial |
$553.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$553.50
|
| Rate for Payer: Aetna of IA Medicare |
$350.55
|
| Rate for Payer: Amerigroup Medicaid |
$310.39
|
| Rate for Payer: Amerigroup Medicare |
$310.58
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$461.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$307.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$307.38
|
| Rate for Payer: Medical Associates Commercial |
$461.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$307.50
|
| Rate for Payer: Midlands Choice Commercial |
$430.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$312.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$461.25
|
| Rate for Payer: United Healthcare Commercial |
$553.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$362.85
|
|
|
PLATE LOCKING AXSOS RECON 8 HOLE L96
|
Facility
IP
|
$615.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.50 |
| Max. Negotiated Rate |
$553.50 |
| Rate for Payer: Aetna of IA Commercial |
$553.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$553.50
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$461.25
|
| Rate for Payer: Medical Associates Commercial |
$461.25
|
| Rate for Payer: Midlands Choice Commercial |
$430.50
|
| Rate for Payer: United Healthcare Commercial |
$553.50
|
|
|
PLATE LOCKING DELTOID AVULSION, SS, 5H
|
Facility
OP
|
$1,114.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.78 |
| Max. Negotiated Rate |
$1,002.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,002.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,002.60
|
| Rate for Payer: Aetna of IA Medicare |
$634.98
|
| Rate for Payer: Amerigroup Medicaid |
$562.24
|
| Rate for Payer: Amerigroup Medicare |
$562.57
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$835.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$557.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$556.78
|
| Rate for Payer: Medical Associates Commercial |
$835.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$557.00
|
| Rate for Payer: Midlands Choice Commercial |
$779.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$565.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$835.50
|
| Rate for Payer: United Healthcare Commercial |
$1,002.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$657.26
|
|
|
PLATE LOCKING DELTOID AVULSION, SS, 5H
|
Facility
IP
|
$1,114.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$779.80 |
| Max. Negotiated Rate |
$1,002.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,002.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,002.60
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$835.50
|
| Rate for Payer: Medical Associates Commercial |
$835.50
|
| Rate for Payer: Midlands Choice Commercial |
$779.80
|
| Rate for Payer: United Healthcare Commercial |
$1,002.60
|
|
|
PLATE LOCKING DELTOID AVULSION, SS, 7H
|
Facility
OP
|
$1,215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.26 |
| Max. Negotiated Rate |
$1,093.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,093.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,093.50
|
| Rate for Payer: Aetna of IA Medicare |
$692.55
|
| Rate for Payer: Amerigroup Medicaid |
$613.21
|
| Rate for Payer: Amerigroup Medicare |
$613.58
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$911.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$607.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$607.26
|
| Rate for Payer: Medical Associates Commercial |
$911.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$607.50
|
| Rate for Payer: Midlands Choice Commercial |
$850.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$616.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$911.25
|
| Rate for Payer: United Healthcare Commercial |
$1,093.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$716.85
|
|
|
PLATE LOCKING DELTOID AVULSION, SS, 7H
|
Facility
IP
|
$1,215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$850.50 |
| Max. Negotiated Rate |
$1,093.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,093.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,093.50
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$911.25
|
| Rate for Payer: Medical Associates Commercial |
$911.25
|
| Rate for Payer: Midlands Choice Commercial |
$850.50
|
| Rate for Payer: United Healthcare Commercial |
$1,093.50
|
|
|
PLATE LOCKING DISTAL FIBULA, SS,LEFT, 4H
|
Facility
OP
|
$743.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$371.35 |
| Max. Negotiated Rate |
$668.70 |
| Rate for Payer: Aetna of IA Commercial |
$668.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$668.70
|
| Rate for Payer: Aetna of IA Medicare |
$423.51
|
| Rate for Payer: Amerigroup Medicaid |
$374.99
|
| Rate for Payer: Amerigroup Medicare |
$375.22
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$557.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$371.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$371.35
|
| Rate for Payer: Medical Associates Commercial |
$557.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$371.50
|
| Rate for Payer: Midlands Choice Commercial |
$520.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$377.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$557.25
|
| Rate for Payer: United Healthcare Commercial |
$668.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$438.37
|
|
|
PLATE LOCKING DISTAL FIBULA, SS,LEFT, 4H
|
Facility
IP
|
$743.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.10 |
| Max. Negotiated Rate |
$668.70 |
| Rate for Payer: Aetna of IA Commercial |
$668.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$668.70
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$557.25
|
| Rate for Payer: Medical Associates Commercial |
$557.25
|
| Rate for Payer: Midlands Choice Commercial |
$520.10
|
| Rate for Payer: United Healthcare Commercial |
$668.70
|
|
|
PLATE LOCKING DISTAL FIBULA, SS,LEFT, 5H
|
Facility
IP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.60 |
| Max. Negotiated Rate |
$790.20 |
| Rate for Payer: Aetna of IA Commercial |
$790.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$790.20
|
| Rate for Payer: Cash Price |
$702.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$658.50
|
| Rate for Payer: Medical Associates Commercial |
$658.50
|
| Rate for Payer: Midlands Choice Commercial |
$614.60
|
| Rate for Payer: United Healthcare Commercial |
$790.20
|
|
|
PLATE LOCKING DISTAL FIBULA, SS,LEFT, 5H
|
Facility
OP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.82 |
| Max. Negotiated Rate |
$790.20 |
| Rate for Payer: Aetna of IA Commercial |
$790.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$790.20
|
| Rate for Payer: Aetna of IA Medicare |
$500.46
|
| Rate for Payer: Amerigroup Medicaid |
$443.13
|
| Rate for Payer: Amerigroup Medicare |
$443.39
|
| Rate for Payer: Cash Price |
$702.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$658.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$439.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$438.82
|
| Rate for Payer: Medical Associates Commercial |
$658.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$439.00
|
| Rate for Payer: Midlands Choice Commercial |
$614.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$445.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$658.50
|
| Rate for Payer: United Healthcare Commercial |
$790.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$518.02
|
|
|
PLATE LOCKING DISTAL FIBULA, SS,LEFT, 6H
|
Facility
OP
|
$979.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.30 |
| Max. Negotiated Rate |
$881.10 |
| Rate for Payer: Aetna of IA Commercial |
$881.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$881.10
|
| Rate for Payer: Aetna of IA Medicare |
$558.03
|
| Rate for Payer: Amerigroup Medicaid |
$494.10
|
| Rate for Payer: Amerigroup Medicare |
$494.40
|
| Rate for Payer: Cash Price |
$783.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$734.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$489.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$489.30
|
| Rate for Payer: Medical Associates Commercial |
$734.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$489.50
|
| Rate for Payer: Midlands Choice Commercial |
$685.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$496.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$734.25
|
| Rate for Payer: United Healthcare Commercial |
$881.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$577.61
|
|
|
PLATE LOCKING DISTAL FIBULA, SS,LEFT, 6H
|
Facility
IP
|
$979.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$685.30 |
| Max. Negotiated Rate |
$881.10 |
| Rate for Payer: Aetna of IA Commercial |
$881.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$881.10
|
| Rate for Payer: Cash Price |
$783.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$734.25
|
| Rate for Payer: Medical Associates Commercial |
$734.25
|
| Rate for Payer: Midlands Choice Commercial |
$685.30
|
| Rate for Payer: United Healthcare Commercial |
$881.10
|
|
|
PLATE LOCKING DISTAL FIBULA, SS,LEFT, 8H
|
Facility
IP
|
$1,073.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$751.10 |
| Max. Negotiated Rate |
$965.70 |
| Rate for Payer: Aetna of IA Commercial |
$965.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$965.70
|
| Rate for Payer: Cash Price |
$858.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$804.75
|
| Rate for Payer: Medical Associates Commercial |
$804.75
|
| Rate for Payer: Midlands Choice Commercial |
$751.10
|
| Rate for Payer: United Healthcare Commercial |
$965.70
|
|
|
PLATE LOCKING DISTAL FIBULA, SS,LEFT, 8H
|
Facility
OP
|
$1,073.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.29 |
| Max. Negotiated Rate |
$965.70 |
| Rate for Payer: Aetna of IA Commercial |
$965.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$965.70
|
| Rate for Payer: Aetna of IA Medicare |
$611.61
|
| Rate for Payer: Amerigroup Medicaid |
$541.54
|
| Rate for Payer: Amerigroup Medicare |
$541.86
|
| Rate for Payer: Cash Price |
$858.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$804.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$536.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$536.29
|
| Rate for Payer: Medical Associates Commercial |
$804.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$536.50
|
| Rate for Payer: Midlands Choice Commercial |
$751.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$544.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$804.75
|
| Rate for Payer: United Healthcare Commercial |
$965.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$633.07
|
|
