|
PLATE LOCKING DISTAL FIBULA,SS,RIGHT, 4H
|
Facility
IP
|
$743.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047156
|
|
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,RIGHT, 4H
|
Facility
OP
|
$743.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047156
|
|
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,RIGHT, 5H
|
Facility
OP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047157
|
|
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,RIGHT, 5H
|
Facility
IP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047157
|
|
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,RIGHT, 6H
|
Facility
OP
|
$979.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047158
|
|
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,RIGHT, 6H
|
Facility
IP
|
$979.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047158
|
|
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,RIGHT, 8H
|
Facility
OP
|
$1,073.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047159
|
|
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
|
|
|
PLATE LOCKING DISTAL FIBULA,SS,RIGHT, 8H
|
Facility
IP
|
$1,073.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047159
|
|
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 FIBULA AVULSION, SS, 3H
|
Facility
OP
|
$945.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.31 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Aetna of IA Commercial |
$850.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$850.50
|
| Rate for Payer: Aetna of IA Medicare |
$538.65
|
| Rate for Payer: Amerigroup Medicaid |
$476.94
|
| Rate for Payer: Amerigroup Medicare |
$477.22
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$708.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$472.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$472.31
|
| Rate for Payer: Medical Associates Commercial |
$708.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$472.50
|
| Rate for Payer: Midlands Choice Commercial |
$661.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$479.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$708.75
|
| Rate for Payer: United Healthcare Commercial |
$850.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$557.55
|
|
|
PLATE LOCKING FIBULA AVULSION, SS, 3H
|
Facility
IP
|
$945.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.50 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Aetna of IA Commercial |
$850.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$850.50
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$708.75
|
| Rate for Payer: Medical Associates Commercial |
$708.75
|
| Rate for Payer: Midlands Choice Commercial |
$661.50
|
| Rate for Payer: United Healthcare Commercial |
$850.50
|
|
|
PLATE LOCKING FIBULA AVULSION, SS, 5H
|
Facility
OP
|
$945.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.31 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Aetna of IA Commercial |
$850.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$850.50
|
| Rate for Payer: Aetna of IA Medicare |
$538.65
|
| Rate for Payer: Amerigroup Medicaid |
$476.94
|
| Rate for Payer: Amerigroup Medicare |
$477.22
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$708.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$472.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$472.31
|
| Rate for Payer: Medical Associates Commercial |
$708.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$472.50
|
| Rate for Payer: Midlands Choice Commercial |
$661.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$479.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$708.75
|
| Rate for Payer: United Healthcare Commercial |
$850.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$557.55
|
|
|
PLATE LOCKING FIBULA AVULSION, SS, 5H
|
Facility
IP
|
$945.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.50 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Aetna of IA Commercial |
$850.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$850.50
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$708.75
|
| Rate for Payer: Medical Associates Commercial |
$708.75
|
| Rate for Payer: Midlands Choice Commercial |
$661.50
|
| Rate for Payer: United Healthcare Commercial |
$850.50
|
|
|
PLATE LOCKING FIBULA AVULSION, SS, 7H
|
Facility
IP
|
$945.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.50 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Aetna of IA Commercial |
$850.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$850.50
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$708.75
|
| Rate for Payer: Medical Associates Commercial |
$708.75
|
| Rate for Payer: Midlands Choice Commercial |
$661.50
|
| Rate for Payer: United Healthcare Commercial |
$850.50
|
|
|
PLATE LOCKING FIBULA AVULSION, SS, 7H
|
Facility
OP
|
$945.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.31 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Aetna of IA Commercial |
$850.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$850.50
|
| Rate for Payer: Aetna of IA Medicare |
$538.65
|
| Rate for Payer: Amerigroup Medicaid |
$476.94
|
| Rate for Payer: Amerigroup Medicare |
$477.22
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$708.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$472.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$472.31
|
| Rate for Payer: Medical Associates Commercial |
$708.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$472.50
|
| Rate for Payer: Midlands Choice Commercial |
$661.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$479.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$708.75
|
| Rate for Payer: United Healthcare Commercial |
$850.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$557.55
|
|
|
PLATE LOCKING RECON 10 HOLE / L 158MM
|
Facility
OP
|
$622.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$310.88 |
| Max. Negotiated Rate |
$559.80 |
| Rate for Payer: Aetna of IA Commercial |
$559.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$559.80
|
| Rate for Payer: Aetna of IA Medicare |
$354.54
|
| Rate for Payer: Amerigroup Medicaid |
$313.92
|
| Rate for Payer: Amerigroup Medicare |
$314.11
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$466.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$311.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$310.88
|
| Rate for Payer: Medical Associates Commercial |
$466.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$311.00
|
| Rate for Payer: Midlands Choice Commercial |
$435.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$315.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$466.50
|
| Rate for Payer: United Healthcare Commercial |
$559.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$366.98
|
|
|
PLATE LOCKING RECON 10 HOLE / L 158MM
|
Facility
IP
|
$622.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.40 |
| Max. Negotiated Rate |
$559.80 |
| Rate for Payer: Aetna of IA Commercial |
$559.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$559.80
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$466.50
|
| Rate for Payer: Medical Associates Commercial |
$466.50
|
| Rate for Payer: Midlands Choice Commercial |
$435.40
|
| Rate for Payer: United Healthcare Commercial |
$559.80
|
|
|
PLATE LOCKING RECON 12 HOLE / L 190MM
|
Facility
IP
|
$649.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$454.30 |
| Max. Negotiated Rate |
$584.10 |
| Rate for Payer: Aetna of IA Commercial |
$584.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$584.10
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$486.75
|
| Rate for Payer: Medical Associates Commercial |
$486.75
|
| Rate for Payer: Midlands Choice Commercial |
$454.30
|
| Rate for Payer: United Healthcare Commercial |
$584.10
|
|
|
PLATE LOCKING RECON 12 HOLE / L 190MM
|
Facility
OP
|
$649.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.37 |
| Max. Negotiated Rate |
$584.10 |
| Rate for Payer: Aetna of IA Commercial |
$584.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$584.10
|
| Rate for Payer: Aetna of IA Medicare |
$369.93
|
| Rate for Payer: Amerigroup Medicaid |
$327.55
|
| Rate for Payer: Amerigroup Medicare |
$327.74
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$486.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$324.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$324.37
|
| Rate for Payer: Medical Associates Commercial |
$486.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$324.50
|
| Rate for Payer: Midlands Choice Commercial |
$454.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$329.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$486.75
|
| Rate for Payer: United Healthcare Commercial |
$584.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$382.91
|
|
|
PLATE LOCKING RECON 14 HOLE / L 222MM
|
Facility
OP
|
$662.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.87 |
| Max. Negotiated Rate |
$595.80 |
| Rate for Payer: Aetna of IA Commercial |
$595.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$595.80
|
| Rate for Payer: Aetna of IA Medicare |
$377.34
|
| Rate for Payer: Amerigroup Medicaid |
$334.11
|
| Rate for Payer: Amerigroup Medicare |
$334.31
|
| Rate for Payer: Cash Price |
$529.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$496.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$331.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$330.87
|
| Rate for Payer: Medical Associates Commercial |
$496.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$331.00
|
| Rate for Payer: Midlands Choice Commercial |
$463.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$335.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$496.50
|
| Rate for Payer: United Healthcare Commercial |
$595.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$390.58
|
|
|
PLATE LOCKING RECON 14 HOLE / L 222MM
|
Facility
IP
|
$662.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$463.40 |
| Max. Negotiated Rate |
$595.80 |
| Rate for Payer: Aetna of IA Commercial |
$595.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$595.80
|
| Rate for Payer: Cash Price |
$529.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$496.50
|
| Rate for Payer: Medical Associates Commercial |
$496.50
|
| Rate for Payer: Midlands Choice Commercial |
$463.40
|
| Rate for Payer: United Healthcare Commercial |
$595.80
|
|
|
PLATE LOCKING RECON 16 HOLE / L 254MM
|
Facility
IP
|
$669.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$602.10 |
| Rate for Payer: Aetna of IA Commercial |
$602.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$602.10
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$501.75
|
| Rate for Payer: Medical Associates Commercial |
$501.75
|
| Rate for Payer: Midlands Choice Commercial |
$468.30
|
| Rate for Payer: United Healthcare Commercial |
$602.10
|
|
|
PLATE LOCKING RECON 16 HOLE / L 254MM
|
Facility
OP
|
$669.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$334.37 |
| Max. Negotiated Rate |
$602.10 |
| Rate for Payer: Aetna of IA Commercial |
$602.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$602.10
|
| Rate for Payer: Aetna of IA Medicare |
$381.33
|
| Rate for Payer: Amerigroup Medicaid |
$337.64
|
| Rate for Payer: Amerigroup Medicare |
$337.84
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$501.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$334.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$334.37
|
| Rate for Payer: Medical Associates Commercial |
$501.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$334.50
|
| Rate for Payer: Midlands Choice Commercial |
$468.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$339.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$501.75
|
| Rate for Payer: United Healthcare Commercial |
$602.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$394.71
|
|
|
PLATE LOCKING RECON 4 HOLE / L 62MM
|
Facility
IP
|
$504.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of IA Commercial |
$453.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$453.60
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.00
|
| Rate for Payer: Medical Associates Commercial |
$378.00
|
| Rate for Payer: Midlands Choice Commercial |
$352.80
|
| Rate for Payer: United Healthcare Commercial |
$453.60
|
|
|
PLATE LOCKING RECON 4 HOLE / L 62MM
|
Facility
OP
|
$504.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.90 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of IA Commercial |
$453.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$453.60
|
| Rate for Payer: Aetna of IA Medicare |
$287.28
|
| Rate for Payer: Amerigroup Medicaid |
$254.37
|
| Rate for Payer: Amerigroup Medicare |
$254.52
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$252.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$251.90
|
| Rate for Payer: Medical Associates Commercial |
$378.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$252.00
|
| Rate for Payer: Midlands Choice Commercial |
$352.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$255.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$378.00
|
| Rate for Payer: United Healthcare Commercial |
$453.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$297.36
|
|
|
PLATE LOCKING RECON 6 HOLE / L 94MM
|
Facility
OP
|
$511.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.40 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna of IA Commercial |
$459.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$459.90
|
| Rate for Payer: Aetna of IA Medicare |
$291.27
|
| Rate for Payer: Amerigroup Medicaid |
$257.90
|
| Rate for Payer: Amerigroup Medicare |
$258.06
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$383.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$255.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$255.40
|
| Rate for Payer: Medical Associates Commercial |
$383.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$255.50
|
| Rate for Payer: Midlands Choice Commercial |
$357.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$259.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$383.25
|
| Rate for Payer: United Healthcare Commercial |
$459.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$301.49
|
|
