|
PLATE PROXIMAL LATERAL HUMERUS 3 LEFT
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.10 |
| Max. Negotiated Rate |
$1,420.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,420.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,420.20
|
| Rate for Payer: Aetna of IA Medicare |
$899.46
|
| Rate for Payer: Amerigroup Medicaid |
$910.19
|
| Rate for Payer: Amerigroup Medicare |
$717.20
|
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,183.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$710.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$901.35
|
| Rate for Payer: Medical Associates Commercial |
$1,183.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$710.10
|
| Rate for Payer: Midlands Choice Commercial |
$1,104.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$914.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$816.62
|
| Rate for Payer: United Healthcare Commercial |
$1,420.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$931.02
|
|
|
PLATE PROXIMAL LATERAL HUMERUS 3 LEFT
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.60 |
| Max. Negotiated Rate |
$1,420.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,420.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,420.20
|
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,183.50
|
| Rate for Payer: Medical Associates Commercial |
$1,183.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,104.60
|
| Rate for Payer: United Healthcare Commercial |
$1,420.20
|
|
|
PLATE PROXIMAL LATERAL HUMERUS 3 RIGHT
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.60 |
| Max. Negotiated Rate |
$1,420.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,420.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,420.20
|
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,183.50
|
| Rate for Payer: Medical Associates Commercial |
$1,183.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,104.60
|
| Rate for Payer: United Healthcare Commercial |
$1,420.20
|
|
|
PLATE PROXIMAL LATERAL HUMERUS 3 RIGHT
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.10 |
| Max. Negotiated Rate |
$1,420.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,420.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,420.20
|
| Rate for Payer: Aetna of IA Medicare |
$899.46
|
| Rate for Payer: Amerigroup Medicaid |
$910.19
|
| Rate for Payer: Amerigroup Medicare |
$717.20
|
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,183.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$710.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$901.35
|
| Rate for Payer: Medical Associates Commercial |
$1,183.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$710.10
|
| Rate for Payer: Midlands Choice Commercial |
$1,104.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$914.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$816.62
|
| Rate for Payer: United Healthcare Commercial |
$1,420.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$931.02
|
|
|
PLATE SMARTLOCK VOLAR NARROW RIGHT
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.00 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,170.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,170.00
|
| Rate for Payer: Cash Price |
$1,040.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$975.00
|
| Rate for Payer: Medical Associates Commercial |
$975.00
|
| Rate for Payer: Midlands Choice Commercial |
$910.00
|
| Rate for Payer: United Healthcare Commercial |
$1,170.00
|
|
|
PLATE SMARTLOCK VOLAR NARROW RIGHT
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,170.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,170.00
|
| Rate for Payer: Aetna of IA Medicare |
$741.00
|
| Rate for Payer: Amerigroup Medicaid |
$749.84
|
| Rate for Payer: Amerigroup Medicare |
$590.85
|
| Rate for Payer: Cash Price |
$1,040.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$975.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$585.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$742.56
|
| Rate for Payer: Medical Associates Commercial |
$975.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$585.00
|
| Rate for Payer: Midlands Choice Commercial |
$910.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$753.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$672.75
|
| Rate for Payer: United Healthcare Commercial |
$1,170.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$767.00
|
|
|
PLATES TUBULAR SPS 1/3 410 HOLE L129
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS Q4107
|
| Hospital Charge Code |
8046774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
|
|
PLATES TUBULAR SPS 1/3 410 HOLE L129
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS Q4107
|
| Hospital Charge Code |
8046774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Aetna of IA Medicare |
$40.47
|
| Rate for Payer: Amerigroup Medicaid |
$40.95
|
| Rate for Payer: Amerigroup Medicare |
$32.27
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.56
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.95
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$36.74
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.89
|
|
|
PLATES TUBULAR SPS 1/3 4 HOLE L51
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS Q4107
|
| Hospital Charge Code |
8046770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Aetna of IA Medicare |
$36.48
|
| Rate for Payer: Amerigroup Medicaid |
$36.92
|
| Rate for Payer: Amerigroup Medicare |
$29.09
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.56
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.80
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.12
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
|
|
PLATES TUBULAR SPS 1/3 4 HOLE L51
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS Q4107
|
| Hospital Charge Code |
8046770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
|
|
PLATES TUBULAR SPS 1/3 5 HOLE L64
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS Q4107
|
| Hospital Charge Code |
8046771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
|
|
PLATES TUBULAR SPS 1/3 5 HOLE L64
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS Q4107
|
| Hospital Charge Code |
8046771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Aetna of IA Medicare |
$36.48
|
| Rate for Payer: Amerigroup Medicaid |
$36.92
|
| Rate for Payer: Amerigroup Medicare |
$29.09
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.56
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.80
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.12
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
|
|
PLATES TUBULAR SPS 1/3 6 HOLE L77
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS Q4107
|
| Hospital Charge Code |
8046772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.85 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Aetna of IA Commercial |
$83.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$83.70
|
| Rate for Payer: Aetna of IA Medicare |
$53.01
|
| Rate for Payer: Amerigroup Medicaid |
$53.64
|
| Rate for Payer: Amerigroup Medicare |
$42.27
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$69.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$41.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$53.12
|
| Rate for Payer: Medical Associates Commercial |
$69.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$41.85
|
| Rate for Payer: Midlands Choice Commercial |
$65.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$53.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.13
|
| Rate for Payer: United Healthcare Commercial |
$83.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$54.87
|
|
|
PLATES TUBULAR SPS 1/3 6 HOLE L77
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS Q4107
|
| Hospital Charge Code |
8046772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Aetna of IA Commercial |
$83.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$83.70
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$69.75
|
| Rate for Payer: Medical Associates Commercial |
$69.75
|
| Rate for Payer: Midlands Choice Commercial |
$65.10
|
| Rate for Payer: United Healthcare Commercial |
$83.70
|
|
|
PLATES TUBULAR SPS 1/3 8 HOLE L103
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS Q4107
|
| Hospital Charge Code |
8046773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Aetna of IA Medicare |
$59.28
|
| Rate for Payer: Amerigroup Medicaid |
$59.99
|
| Rate for Payer: Amerigroup Medicare |
$47.27
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$46.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.40
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$46.80
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.82
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.36
|
|
|
PLATES TUBULAR SPS 1/3 8 HOLE L103
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS Q4107
|
| Hospital Charge Code |
8046773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
|
|
PLATE TUBULAR LOCKING 10 HOLE L50MM
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.75 |
| 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 |
$100.94
|
| Rate for Payer: Amerigroup Medicare |
$79.54
|
| 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 |
$78.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$99.96
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$78.75
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$101.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$90.56
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.25
|
|
|
PLATE TUBULAR LOCKING 10 HOLE L50MM
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046742
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
PLATE TUBULAR LOCKING 4 HOLE L50MM
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
|
|
PLATE TUBULAR LOCKING 4 HOLE L50MM
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.45 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Aetna of IA Medicare |
$91.77
|
| Rate for Payer: Amerigroup Medicaid |
$92.86
|
| Rate for Payer: Amerigroup Medicare |
$73.17
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$72.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$91.96
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.45
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$93.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$83.32
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.99
|
|
|
PLATE TUBULAR LOCKING 4 HOLE L50MM-1
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.75 |
| 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 |
$100.94
|
| Rate for Payer: Amerigroup Medicare |
$79.54
|
| 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 |
$78.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$99.96
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$78.75
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$101.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$90.56
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.25
|
|
|
PLATE TUBULAR LOCKING 4 HOLE L50MM-1
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046741
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
PLATE TUBULAR LOCKING 6 HOLE L50MM
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Aetna of IA Commercial |
$243.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.90
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$203.25
|
| Rate for Payer: Medical Associates Commercial |
$203.25
|
| Rate for Payer: Midlands Choice Commercial |
$189.70
|
| Rate for Payer: United Healthcare Commercial |
$243.90
|
|
|
PLATE TUBULAR LOCKING 6 HOLE L50MM
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.95 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Aetna of IA Commercial |
$243.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.90
|
| Rate for Payer: Aetna of IA Medicare |
$154.47
|
| Rate for Payer: Amerigroup Medicaid |
$156.31
|
| Rate for Payer: Amerigroup Medicare |
$123.17
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$203.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$121.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$154.80
|
| Rate for Payer: Medical Associates Commercial |
$203.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.95
|
| Rate for Payer: Midlands Choice Commercial |
$189.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$157.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$140.24
|
| Rate for Payer: United Healthcare Commercial |
$243.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.89
|
|
|
pneumococcal 13-valent vaccine inj Dip CR Syr 0.5ml [VDMC]
|
Facility
|
OP
|
$434.50
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
10429979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$195.52 |
| Max. Negotiated Rate |
$391.05 |
| Rate for Payer: Aetna of IA Commercial |
$391.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$391.05
|
| Rate for Payer: Aetna of IA Medicare |
$247.66
|
| Rate for Payer: Amerigroup Medicaid |
$250.62
|
| Rate for Payer: Amerigroup Medicare |
$197.48
|
| Rate for Payer: Cash Price |
$347.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$325.87
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$195.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$248.18
|
| Rate for Payer: Medical Associates Commercial |
$325.87
|
| Rate for Payer: Medical Associates Managed Medicare |
$195.52
|
| Rate for Payer: Midlands Choice Commercial |
$304.15
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$251.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$224.85
|
| Rate for Payer: United Healthcare Commercial |
$391.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$256.35
|
|
