|
piperacillin-tazobactam 3 g-0.375 g IV SDV Inj [VDMC]
|
Facility
|
OP
|
$27.74
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
10413855
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$24.97 |
| Rate for Payer: Aetna of IA Commercial |
$24.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.97
|
| Rate for Payer: Aetna of IA Medicare |
$15.81
|
| Rate for Payer: Amerigroup Medicaid |
$14.00
|
| Rate for Payer: Amerigroup Medicare |
$14.01
|
| Rate for Payer: Cash Price |
$22.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.87
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.86
|
| Rate for Payer: Medical Associates Commercial |
$20.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.87
|
| Rate for Payer: Midlands Choice Commercial |
$19.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.08
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$14.07
|
| Rate for Payer: Oscar Health of IA Commercial |
$20.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.80
|
| Rate for Payer: United Healthcare Commercial |
$24.97
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.37
|
|
|
piperacillin-tazobactam 3 g-0.375 g IV SDV Inj [VDMC]
|
Facility
|
IP
|
$27.74
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
10413855
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.42 |
| Max. Negotiated Rate |
$24.97 |
| Rate for Payer: Aetna of IA Commercial |
$24.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.97
|
| Rate for Payer: Cash Price |
$22.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.80
|
| Rate for Payer: Medical Associates Commercial |
$20.80
|
| Rate for Payer: Midlands Choice Commercial |
$19.42
|
| Rate for Payer: United Healthcare Commercial |
$24.97
|
|
|
piperacillin-tazobactam 4 g-0.5 g IV SDV Inj [VDMC]
|
Facility
|
OP
|
$30.82
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
10413924
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$27.74 |
| Rate for Payer: Aetna of IA Commercial |
$27.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.74
|
| Rate for Payer: Aetna of IA Medicare |
$17.57
|
| Rate for Payer: Amerigroup Medicaid |
$15.55
|
| Rate for Payer: Amerigroup Medicare |
$15.56
|
| Rate for Payer: Cash Price |
$24.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.40
|
| Rate for Payer: Medical Associates Commercial |
$23.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.41
|
| Rate for Payer: Midlands Choice Commercial |
$21.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.64
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$15.63
|
| Rate for Payer: Oscar Health of IA Commercial |
$23.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.12
|
| Rate for Payer: United Healthcare Commercial |
$27.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.18
|
|
|
piperacillin-tazobactam 4 g-0.5 g IV SDV Inj [VDMC]
|
Facility
|
IP
|
$30.82
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
10413924
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$27.74 |
| Rate for Payer: Aetna of IA Commercial |
$27.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.74
|
| Rate for Payer: Cash Price |
$24.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.12
|
| Rate for Payer: Medical Associates Commercial |
$23.12
|
| Rate for Payer: Midlands Choice Commercial |
$21.57
|
| Rate for Payer: United Healthcare Commercial |
$27.74
|
|
|
piroxicam 20 mg Cap [VDMC]
|
Facility
|
IP
|
$3.42
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10413993
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Aetna of IA Commercial |
$3.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.08
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.56
|
| Rate for Payer: Medical Associates Commercial |
$2.56
|
| Rate for Payer: Midlands Choice Commercial |
$2.39
|
| Rate for Payer: United Healthcare Commercial |
$3.08
|
|
|
piroxicam 20 mg Cap [VDMC]
|
Facility
|
OP
|
$3.42
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10413993
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Aetna of IA Commercial |
$3.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.08
|
| Rate for Payer: Aetna of IA Medicare |
$1.95
|
| Rate for Payer: Amerigroup Medicaid |
$1.73
|
| Rate for Payer: Amerigroup Medicare |
$1.73
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.56
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.71
|
| Rate for Payer: Medical Associates Commercial |
$2.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.71
|
| Rate for Payer: Midlands Choice Commercial |
$2.39
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.74
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.73
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.56
|
| Rate for Payer: United Healthcare Commercial |
$3.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.02
|
|
|
PLATE 10 HOLE DYNAMIC COMP
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.44 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna of IA Commercial |
$247.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$247.50
|
| Rate for Payer: Aetna of IA Medicare |
$156.75
|
| Rate for Payer: Amerigroup Medicaid |
$138.79
|
| Rate for Payer: Amerigroup Medicare |
$138.88
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$206.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$137.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$137.44
|
| Rate for Payer: Medical Associates Commercial |
$206.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$137.50
|
| Rate for Payer: Midlands Choice Commercial |
$192.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$139.56
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$139.48
|
| Rate for Payer: Oscar Health of IA Commercial |
$206.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$206.25
|
| Rate for Payer: United Healthcare Commercial |
$247.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$162.25
|
|
|
PLATE 10 HOLE DYNAMIC COMP
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna of IA Commercial |
$247.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$247.50
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$206.25
|
| Rate for Payer: Medical Associates Commercial |
$206.25
|
| Rate for Payer: Midlands Choice Commercial |
$192.50
|
| Rate for Payer: United Healthcare Commercial |
$247.50
|
|
|
PLATE 5 DISTAL LATERAL FIBULA
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$441.82 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: Aetna of IA Commercial |
$795.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$795.60
|
| Rate for Payer: Aetna of IA Medicare |
$503.88
|
| Rate for Payer: Amerigroup Medicaid |
$446.15
|
| Rate for Payer: Amerigroup Medicare |
$446.42
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$663.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$442.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$441.82
|
| Rate for Payer: Medical Associates Commercial |
$663.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$442.00
|
| Rate for Payer: Midlands Choice Commercial |
$618.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$448.63
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$448.36
|
| Rate for Payer: Oscar Health of IA Commercial |
$663.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$663.00
|
| Rate for Payer: United Healthcare Commercial |
$795.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$521.56
|
|
|
PLATE 5 DISTAL LATERAL FIBULA
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.80 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: Aetna of IA Commercial |
$795.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$795.60
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$663.00
|
| Rate for Payer: Medical Associates Commercial |
$663.00
|
| Rate for Payer: Midlands Choice Commercial |
$618.80
|
| Rate for Payer: United Healthcare Commercial |
$795.60
|
|
|
PLATE 5 HOLE SM FRAGMENT
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of IA Commercial |
$117.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$97.50
|
| Rate for Payer: Medical Associates Commercial |
$97.50
|
| Rate for Payer: Midlands Choice Commercial |
$91.00
|
| Rate for Payer: United Healthcare Commercial |
$117.00
|
|
|
PLATE 5 HOLE SM FRAGMENT
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of IA Commercial |
$117.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.00
|
| Rate for Payer: Aetna of IA Medicare |
$74.10
|
| Rate for Payer: Amerigroup Medicaid |
$65.61
|
| Rate for Payer: Amerigroup Medicare |
$65.65
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$97.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$65.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.97
|
| Rate for Payer: Medical Associates Commercial |
$97.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$65.00
|
| Rate for Payer: Midlands Choice Commercial |
$91.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$65.98
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$65.94
|
| Rate for Payer: Oscar Health of IA Commercial |
$97.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$97.50
|
| Rate for Payer: United Healthcare Commercial |
$117.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.70
|
|
|
PLATE 5TH MET HOOK LEFT
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8793247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,034.59 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,863.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,863.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,179.90
|
| Rate for Payer: Amerigroup Medicaid |
$1,044.73
|
| Rate for Payer: Amerigroup Medicare |
$1,045.35
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,552.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,035.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,034.59
|
| Rate for Payer: Medical Associates Commercial |
$1,552.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,035.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,449.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,050.52
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,049.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,552.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,552.50
|
| Rate for Payer: United Healthcare Commercial |
$1,863.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,221.30
|
|
|
PLATE 5TH MET HOOK LEFT
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8793247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.00 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,863.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,863.00
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,552.50
|
| Rate for Payer: Medical Associates Commercial |
$1,552.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,449.00
|
| Rate for Payer: United Healthcare Commercial |
$1,863.00
|
|
|
PLATE 6 HOLE DYNAMIC COMP
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.95 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Aetna of IA Commercial |
$228.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$228.60
|
| Rate for Payer: Aetna of IA Medicare |
$144.78
|
| Rate for Payer: Amerigroup Medicaid |
$128.19
|
| Rate for Payer: Amerigroup Medicare |
$128.27
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$190.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$127.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.95
|
| Rate for Payer: Medical Associates Commercial |
$190.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$127.00
|
| Rate for Payer: Midlands Choice Commercial |
$177.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.90
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$128.83
|
| Rate for Payer: Oscar Health of IA Commercial |
$190.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$190.50
|
| Rate for Payer: United Healthcare Commercial |
$228.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$149.86
|
|
|
PLATE 6 HOLE DYNAMIC COMP
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.80 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Aetna of IA Commercial |
$228.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$228.60
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$190.50
|
| Rate for Payer: Medical Associates Commercial |
$190.50
|
| Rate for Payer: Midlands Choice Commercial |
$177.80
|
| Rate for Payer: United Healthcare Commercial |
$228.60
|
|
|
PLATE 6 HOLE SM FRAGMENT
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.47 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Aetna of IA Medicare |
$73.53
|
| Rate for Payer: Amerigroup Medicaid |
$65.11
|
| Rate for Payer: Amerigroup Medicare |
$65.14
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.47
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$65.47
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$65.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$96.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$96.75
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.11
|
|
|
PLATE 6 HOLE SM FRAGMENT
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
|
|
PLATE 7 HOLE DYNAMIC COMP
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.44 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna of IA Commercial |
$247.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$247.50
|
| Rate for Payer: Aetna of IA Medicare |
$156.75
|
| Rate for Payer: Amerigroup Medicaid |
$138.79
|
| Rate for Payer: Amerigroup Medicare |
$138.88
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$206.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$137.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$137.44
|
| Rate for Payer: Medical Associates Commercial |
$206.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$137.50
|
| Rate for Payer: Midlands Choice Commercial |
$192.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$139.56
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$139.48
|
| Rate for Payer: Oscar Health of IA Commercial |
$206.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$206.25
|
| Rate for Payer: United Healthcare Commercial |
$247.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$162.25
|
|
|
PLATE 7 HOLE DYNAMIC COMP
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Medical Associates Commercial |
$206.25
|
| Rate for Payer: Aetna of IA Commercial |
$247.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$247.50
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$206.25
|
| Rate for Payer: Midlands Choice Commercial |
$192.50
|
| Rate for Payer: United Healthcare Commercial |
$247.50
|
|
|
PLATE 7 HOLE SM FRAGMENT
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
8046723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
|
|
PLATE 7 HOLE SM FRAGMENT
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
8046723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.47 |
| Max. Negotiated Rate |
$2,069.19 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Aetna of IA Medicare |
$73.53
|
| Rate for Payer: Amerigroup Medicaid |
$65.11
|
| Rate for Payer: Amerigroup Medicare |
$65.14
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.47
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$65.47
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$65.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$96.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$96.75
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.11
|
| Rate for Payer: Wellmark IA HMO |
$1,881.08
|
| Rate for Payer: Wellmark IA PPO |
$2,069.19
|
|
|
PLATE 8 HOLE DYNAMIC COMP
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.44 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna of IA Commercial |
$247.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$247.50
|
| Rate for Payer: Aetna of IA Medicare |
$156.75
|
| Rate for Payer: Amerigroup Medicaid |
$138.79
|
| Rate for Payer: Amerigroup Medicare |
$138.88
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$206.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$137.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$137.44
|
| Rate for Payer: Medical Associates Commercial |
$206.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$137.50
|
| Rate for Payer: Midlands Choice Commercial |
$192.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$139.56
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$139.48
|
| Rate for Payer: Oscar Health of IA Commercial |
$206.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$206.25
|
| Rate for Payer: United Healthcare Commercial |
$247.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$162.25
|
|
|
PLATE 8 HOLE DYNAMIC COMP
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna of IA Commercial |
$247.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$247.50
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$206.25
|
| Rate for Payer: Medical Associates Commercial |
$206.25
|
| Rate for Payer: Midlands Choice Commercial |
$192.50
|
| Rate for Payer: United Healthcare Commercial |
$247.50
|
|
|
PLATE 8 HOLE SM FRAGMENT
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna of IA Commercial |
$120.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.60
|
| Rate for Payer: Aetna of IA Medicare |
$76.38
|
| Rate for Payer: Amerigroup Medicaid |
$67.63
|
| Rate for Payer: Amerigroup Medicare |
$67.67
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$66.97
|
| Rate for Payer: Medical Associates Commercial |
$100.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.00
|
| Rate for Payer: Midlands Choice Commercial |
$93.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.00
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$67.96
|
| Rate for Payer: Oscar Health of IA Commercial |
$100.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$100.50
|
| Rate for Payer: United Healthcare Commercial |
$120.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.06
|
|
