|
PLATE 8 HOLE SM FRAGMENT
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.80 |
| 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: Cash Price |
$107.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.50
|
| Rate for Payer: Medical Associates Commercial |
$100.50
|
| Rate for Payer: Midlands Choice Commercial |
$93.80
|
| Rate for Payer: United Healthcare Commercial |
$120.60
|
|
|
PLATE AXSOS COMPRESSION LOCKING 10HOLE
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.96 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna of IA Commercial |
$189.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$189.00
|
| Rate for Payer: Aetna of IA Medicare |
$119.70
|
| Rate for Payer: Amerigroup Medicaid |
$105.99
|
| Rate for Payer: Amerigroup Medicare |
$106.05
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$157.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$105.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$104.96
|
| Rate for Payer: Medical Associates Commercial |
$157.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$105.00
|
| Rate for Payer: Midlands Choice Commercial |
$147.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$106.58
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$106.51
|
| Rate for Payer: Oscar Health of IA Commercial |
$157.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$157.50
|
| Rate for Payer: United Healthcare Commercial |
$189.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$123.90
|
|
|
PLATE AXSOS COMPRESSION LOCKING 10HOLE
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna of IA Commercial |
$189.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$189.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$157.50
|
| Rate for Payer: Medical Associates Commercial |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$147.00
|
| Rate for Payer: United Healthcare Commercial |
$189.00
|
|
|
PLATE AXSOS COMPRESSION LOCKING 4 HOLE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.47 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Aetna of IA Commercial |
$130.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$130.50
|
| Rate for Payer: Aetna of IA Medicare |
$82.65
|
| Rate for Payer: Amerigroup Medicaid |
$73.18
|
| Rate for Payer: Amerigroup Medicare |
$73.22
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$72.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$72.47
|
| Rate for Payer: Medical Associates Commercial |
$108.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.50
|
| Rate for Payer: Midlands Choice Commercial |
$101.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$73.59
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$73.54
|
| Rate for Payer: Oscar Health of IA Commercial |
$108.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$108.75
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$85.55
|
|
|
PLATE AXSOS COMPRESSION LOCKING 4 HOLE
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Aetna of IA Commercial |
$130.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$130.50
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.75
|
| Rate for Payer: Medical Associates Commercial |
$108.75
|
| Rate for Payer: Midlands Choice Commercial |
$101.50
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
|
|
PLATE AXSOS COMPRESSION LOCKING 6 HOLE
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.90 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of IA Commercial |
$159.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$159.30
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.75
|
| Rate for Payer: Medical Associates Commercial |
$132.75
|
| Rate for Payer: Midlands Choice Commercial |
$123.90
|
| Rate for Payer: United Healthcare Commercial |
$159.30
|
|
|
PLATE AXSOS COMPRESSION LOCKING 6 HOLE
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.46 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of IA Commercial |
$159.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$159.30
|
| Rate for Payer: Aetna of IA Medicare |
$100.89
|
| Rate for Payer: Amerigroup Medicaid |
$89.33
|
| Rate for Payer: Amerigroup Medicare |
$89.38
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$88.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$88.46
|
| Rate for Payer: Medical Associates Commercial |
$132.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.50
|
| Rate for Payer: Midlands Choice Commercial |
$123.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$89.83
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$89.77
|
| Rate for Payer: Oscar Health of IA Commercial |
$132.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$132.75
|
| Rate for Payer: United Healthcare Commercial |
$159.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$104.43
|
|
|
PLATE AXSOS COMPRESSION LOCKING 7 HOLE
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.45 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna of IA Commercial |
$207.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.90
|
| Rate for Payer: Aetna of IA Medicare |
$131.67
|
| Rate for Payer: Amerigroup Medicaid |
$116.59
|
| Rate for Payer: Amerigroup Medicare |
$116.66
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$173.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$115.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$115.45
|
| Rate for Payer: Medical Associates Commercial |
$173.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$115.50
|
| Rate for Payer: Midlands Choice Commercial |
$161.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$117.23
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$117.16
|
| Rate for Payer: Oscar Health of IA Commercial |
$173.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$173.25
|
| Rate for Payer: United Healthcare Commercial |
$207.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$136.29
|
|
|
PLATE AXSOS COMPRESSION LOCKING 7 HOLE
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna of IA Commercial |
$207.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.90
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$173.25
|
| Rate for Payer: Medical Associates Commercial |
$173.25
|
| Rate for Payer: Midlands Choice Commercial |
$161.70
|
| Rate for Payer: United Healthcare Commercial |
$207.90
|
|
|
PLATE AXSOS COMPRESSION LOCKING 8 HOLE
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna of IA Commercial |
$189.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$189.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$157.50
|
| Rate for Payer: Medical Associates Commercial |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$147.00
|
| Rate for Payer: United Healthcare Commercial |
$189.00
|
|
|
PLATE AXSOS COMPRESSION LOCKING 8 HOLE
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.96 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna of IA Commercial |
$189.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$189.00
|
| Rate for Payer: Aetna of IA Medicare |
$119.70
|
| Rate for Payer: Amerigroup Medicaid |
$105.99
|
| Rate for Payer: Amerigroup Medicare |
$106.05
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$157.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$105.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$104.96
|
| Rate for Payer: Medical Associates Commercial |
$157.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$105.00
|
| Rate for Payer: Midlands Choice Commercial |
$147.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$106.58
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$106.51
|
| Rate for Payer: Oscar Health of IA Commercial |
$157.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$157.50
|
| Rate for Payer: United Healthcare Commercial |
$189.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$123.90
|
|
|
PLATE CURVED 4 HOLE
|
Facility
|
OP
|
$1,294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$646.74 |
| Max. Negotiated Rate |
$1,164.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,164.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,164.60
|
| Rate for Payer: Aetna of IA Medicare |
$737.58
|
| Rate for Payer: Amerigroup Medicaid |
$653.08
|
| Rate for Payer: Amerigroup Medicare |
$653.47
|
| Rate for Payer: Cash Price |
$1,035.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$970.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$647.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$646.74
|
| Rate for Payer: Medical Associates Commercial |
$970.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$647.00
|
| Rate for Payer: Midlands Choice Commercial |
$905.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$656.70
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$656.32
|
| Rate for Payer: Oscar Health of IA Commercial |
$970.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$970.50
|
| Rate for Payer: United Healthcare Commercial |
$1,164.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$763.46
|
|
|
PLATE CURVED 4 HOLE
|
Facility
|
IP
|
$1,294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$905.80 |
| Max. Negotiated Rate |
$1,164.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,164.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,164.60
|
| Rate for Payer: Cash Price |
$1,035.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$970.50
|
| Rate for Payer: Medical Associates Commercial |
$970.50
|
| Rate for Payer: Midlands Choice Commercial |
$905.80
|
| Rate for Payer: United Healthcare Commercial |
$1,164.60
|
|
|
PLATE DISTAL VOLAR RADIUS 3 HOLE
|
Facility
|
OP
|
$896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.82 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna of IA Commercial |
$806.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$806.40
|
| Rate for Payer: Aetna of IA Medicare |
$510.72
|
| Rate for Payer: Amerigroup Medicaid |
$452.21
|
| Rate for Payer: Amerigroup Medicare |
$452.48
|
| Rate for Payer: Cash Price |
$716.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$672.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$448.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$447.82
|
| Rate for Payer: Medical Associates Commercial |
$672.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$448.00
|
| Rate for Payer: Midlands Choice Commercial |
$627.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$454.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$454.45
|
| Rate for Payer: Oscar Health of IA Commercial |
$672.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$672.00
|
| Rate for Payer: United Healthcare Commercial |
$806.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$528.64
|
|
|
PLATE DISTAL VOLAR RADIUS 3 HOLE
|
Facility
|
IP
|
$896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.20 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna of IA Commercial |
$806.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$806.40
|
| Rate for Payer: Cash Price |
$716.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$672.00
|
| Rate for Payer: Medical Associates Commercial |
$672.00
|
| Rate for Payer: Midlands Choice Commercial |
$627.20
|
| Rate for Payer: United Healthcare Commercial |
$806.40
|
|
|
PLATE DISTAL VOLAR RADIUS 3 HOLE RIGHT
|
Facility
|
IP
|
$896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.20 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna of IA Commercial |
$806.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$806.40
|
| Rate for Payer: Cash Price |
$716.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$672.00
|
| Rate for Payer: Medical Associates Commercial |
$672.00
|
| Rate for Payer: Midlands Choice Commercial |
$627.20
|
| Rate for Payer: United Healthcare Commercial |
$806.40
|
|
|
PLATE DISTAL VOLAR RADIUS 3 HOLE RIGHT
|
Facility
|
OP
|
$896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.82 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna of IA Commercial |
$806.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$806.40
|
| Rate for Payer: Aetna of IA Medicare |
$510.72
|
| Rate for Payer: Amerigroup Medicaid |
$452.21
|
| Rate for Payer: Amerigroup Medicare |
$452.48
|
| Rate for Payer: Cash Price |
$716.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$672.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$448.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$447.82
|
| Rate for Payer: Medical Associates Commercial |
$672.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$448.00
|
| Rate for Payer: Midlands Choice Commercial |
$627.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$454.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$454.45
|
| Rate for Payer: Oscar Health of IA Commercial |
$672.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$672.00
|
| Rate for Payer: United Healthcare Commercial |
$806.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$528.64
|
|
|
PLATE DISTAL VOLAR RADIUS 4 HOLE
|
Facility
|
OP
|
$896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.82 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna of IA Commercial |
$806.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$806.40
|
| Rate for Payer: Aetna of IA Medicare |
$510.72
|
| Rate for Payer: Amerigroup Medicaid |
$452.21
|
| Rate for Payer: Amerigroup Medicare |
$452.48
|
| Rate for Payer: Cash Price |
$716.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$672.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$448.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$447.82
|
| Rate for Payer: Medical Associates Commercial |
$672.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$448.00
|
| Rate for Payer: Midlands Choice Commercial |
$627.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$454.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$454.45
|
| Rate for Payer: Oscar Health of IA Commercial |
$672.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$672.00
|
| Rate for Payer: United Healthcare Commercial |
$806.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$528.64
|
|
|
PLATE DISTAL VOLAR RADIUS 4 HOLE
|
Facility
|
IP
|
$896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.20 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna of IA Commercial |
$806.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$806.40
|
| Rate for Payer: Cash Price |
$716.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$672.00
|
| Rate for Payer: Medical Associates Commercial |
$672.00
|
| Rate for Payer: Midlands Choice Commercial |
$627.20
|
| Rate for Payer: United Healthcare Commercial |
$806.40
|
|
|
PLATE DISTAL VOLAR RADIUS 4 HOLE RIGHT
|
Facility
|
IP
|
$896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.20 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna of IA Commercial |
$806.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$806.40
|
| Rate for Payer: Cash Price |
$716.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$672.00
|
| Rate for Payer: Medical Associates Commercial |
$672.00
|
| Rate for Payer: Midlands Choice Commercial |
$627.20
|
| Rate for Payer: United Healthcare Commercial |
$806.40
|
|
|
PLATE DISTAL VOLAR RADIUS 4 HOLE RIGHT
|
Facility
|
OP
|
$896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.82 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna of IA Commercial |
$806.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$806.40
|
| Rate for Payer: Aetna of IA Medicare |
$510.72
|
| Rate for Payer: Amerigroup Medicaid |
$452.21
|
| Rate for Payer: Amerigroup Medicare |
$452.48
|
| Rate for Payer: Cash Price |
$716.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$672.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$448.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$447.82
|
| Rate for Payer: Medical Associates Commercial |
$672.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$448.00
|
| Rate for Payer: Midlands Choice Commercial |
$627.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$454.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$454.45
|
| Rate for Payer: Oscar Health of IA Commercial |
$672.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$672.00
|
| Rate for Payer: United Healthcare Commercial |
$806.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$528.64
|
|
|
PLATE GLENOID BASE (ORTHO)
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.00 |
| Max. Negotiated Rate |
$3,663.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,663.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,663.00
|
| Rate for Payer: Cash Price |
$3,256.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,052.50
|
| Rate for Payer: Medical Associates Commercial |
$3,052.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,849.00
|
| Rate for Payer: United Healthcare Commercial |
$3,663.00
|
|
|
PLATE GLENOID BASE (ORTHO)
|
Facility
|
OP
|
$4,070.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,034.19 |
| Max. Negotiated Rate |
$3,663.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,663.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,663.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,319.90
|
| Rate for Payer: Amerigroup Medicaid |
$2,054.13
|
| Rate for Payer: Amerigroup Medicare |
$2,055.35
|
| Rate for Payer: Cash Price |
$3,256.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,052.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,035.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,034.19
|
| Rate for Payer: Medical Associates Commercial |
$3,052.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,035.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,849.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,065.52
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$2,064.30
|
| Rate for Payer: Oscar Health of IA Commercial |
$3,052.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,052.50
|
| Rate for Payer: United Healthcare Commercial |
$3,663.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,401.30
|
|
|
PLATE IMPLANT 5 DEGREE MEDIUM LEFT
|
Facility
|
OP
|
$2,641.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.97 |
| Max. Negotiated Rate |
$2,376.90 |
| Rate for Payer: Aetna of IA Commercial |
$2,376.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,376.90
|
| Rate for Payer: Aetna of IA Medicare |
$1,505.37
|
| Rate for Payer: Amerigroup Medicaid |
$1,332.91
|
| Rate for Payer: Amerigroup Medicare |
$1,333.70
|
| Rate for Payer: Cash Price |
$2,112.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,980.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,320.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,319.97
|
| Rate for Payer: Medical Associates Commercial |
$1,980.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,320.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,848.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,340.31
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,339.52
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,980.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,980.75
|
| Rate for Payer: United Healthcare Commercial |
$2,376.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,558.19
|
|
|
PLATE IMPLANT 5 DEGREE MEDIUM LEFT
|
Facility
|
IP
|
$2,641.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,848.70 |
| Max. Negotiated Rate |
$2,376.90 |
| Rate for Payer: Medical Associates Commercial |
$1,980.75
|
| Rate for Payer: Aetna of IA Commercial |
$2,376.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,376.90
|
| Rate for Payer: Cash Price |
$2,112.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,980.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,848.70
|
| Rate for Payer: United Healthcare Commercial |
$2,376.90
|
|
