|
PLATE LOCKING DISTAL FIBULA, SS,LEFT, 6H
|
Facility
|
OP
|
$979.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.55 |
| 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 |
$564.69
|
| Rate for Payer: Amerigroup Medicare |
$444.96
|
| 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 |
$440.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$559.20
|
| Rate for Payer: Medical Associates Commercial |
$734.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$440.55
|
| Rate for Payer: Midlands Choice Commercial |
$685.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$567.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$506.63
|
| Rate for Payer: United Healthcare Commercial |
$881.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$577.61
|
|
|
PLATE LOCKING DISTAL FIBULA, SS,LEFT, 8H
|
Facility
|
OP
|
$1,073.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.85 |
| 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 |
$618.91
|
| Rate for Payer: Amerigroup Medicare |
$487.68
|
| 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 |
$482.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$612.90
|
| Rate for Payer: Medical Associates Commercial |
$804.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$482.85
|
| Rate for Payer: Midlands Choice Commercial |
$751.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$621.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$555.28
|
| Rate for Payer: United Healthcare Commercial |
$965.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$633.07
|
|
|
PLATE LOCKING DISTAL FIBULA, SS,LEFT, 8H
|
Facility
|
IP
|
$1,073.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$751.10 |
| Max. Negotiated Rate |
$965.70 |
| Rate for Payer: Aetna of IA Commercial |
$965.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$965.70
|
| Rate for Payer: Cash Price |
$858.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$804.75
|
| Rate for Payer: Medical Associates Commercial |
$804.75
|
| Rate for Payer: Midlands Choice Commercial |
$751.10
|
| Rate for Payer: United Healthcare Commercial |
$965.70
|
|
|
PLATE LOCKING DISTAL FIBULA,SS,RIGHT, 4H
|
Facility
|
OP
|
$743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$334.35 |
| 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 |
$428.56
|
| Rate for Payer: Amerigroup Medicare |
$337.69
|
| 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 |
$334.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$424.40
|
| Rate for Payer: Medical Associates Commercial |
$557.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$334.35
|
| Rate for Payer: Midlands Choice Commercial |
$520.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$430.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$384.50
|
| Rate for Payer: United Healthcare Commercial |
$668.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$438.37
|
|
|
PLATE LOCKING DISTAL FIBULA,SS,RIGHT, 4H
|
Facility
|
IP
|
$743.00
|
|
|
Service Code
|
HCPCS 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, 5H
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$395.10 |
| 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 |
$506.43
|
| Rate for Payer: Amerigroup Medicare |
$399.05
|
| 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 |
$395.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$501.51
|
| Rate for Payer: Medical Associates Commercial |
$658.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$395.10
|
| Rate for Payer: Midlands Choice Commercial |
$614.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$508.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$454.36
|
| 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
|
HCPCS 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
|
HCPCS C1713
|
| Hospital Charge Code |
8047158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.55 |
| 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 |
$564.69
|
| Rate for Payer: Amerigroup Medicare |
$444.96
|
| 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 |
$440.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$559.20
|
| Rate for Payer: Medical Associates Commercial |
$734.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$440.55
|
| Rate for Payer: Midlands Choice Commercial |
$685.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$567.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$506.63
|
| 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
|
HCPCS 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
|
HCPCS C1713
|
| Hospital Charge Code |
8047159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.85 |
| 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 |
$618.91
|
| Rate for Payer: Amerigroup Medicare |
$487.68
|
| 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 |
$482.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$612.90
|
| Rate for Payer: Medical Associates Commercial |
$804.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$482.85
|
| Rate for Payer: Midlands Choice Commercial |
$751.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$621.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$555.28
|
| 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
|
HCPCS 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
|
HCPCS C1713
|
| Hospital Charge Code |
8047176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.25 |
| 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 |
$545.08
|
| Rate for Payer: Amerigroup Medicare |
$429.50
|
| 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 |
$425.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$539.78
|
| Rate for Payer: Medical Associates Commercial |
$708.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$425.25
|
| Rate for Payer: Midlands Choice Commercial |
$661.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$547.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$489.04
|
| 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
|
HCPCS 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
|
HCPCS C1713
|
| Hospital Charge Code |
8047177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.25 |
| 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 |
$545.08
|
| Rate for Payer: Amerigroup Medicare |
$429.50
|
| 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 |
$425.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$539.78
|
| Rate for Payer: Medical Associates Commercial |
$708.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$425.25
|
| Rate for Payer: Midlands Choice Commercial |
$661.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$547.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$489.04
|
| 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
|
HCPCS 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
|
HCPCS 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
|
HCPCS C1713
|
| Hospital Charge Code |
8047178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.25 |
| 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 |
$545.08
|
| Rate for Payer: Amerigroup Medicare |
$429.50
|
| 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 |
$425.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$539.78
|
| Rate for Payer: Medical Associates Commercial |
$708.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$425.25
|
| Rate for Payer: Midlands Choice Commercial |
$661.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$547.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$489.04
|
| 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
|
IP
|
$622.00
|
|
|
Service Code
|
HCPCS 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 10 HOLE / L 158MM
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.90 |
| 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 |
$358.77
|
| Rate for Payer: Amerigroup Medicare |
$282.70
|
| 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 |
$279.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$355.29
|
| Rate for Payer: Medical Associates Commercial |
$466.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$279.90
|
| Rate for Payer: Midlands Choice Commercial |
$435.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$360.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$321.88
|
| Rate for Payer: United Healthcare Commercial |
$559.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$366.98
|
|
|
PLATE LOCKING RECON 12 HOLE / L 190MM
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
HCPCS 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
|
HCPCS C1713
|
| Hospital Charge Code |
8046767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$292.05 |
| 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 |
$374.34
|
| Rate for Payer: Amerigroup Medicare |
$294.97
|
| 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 |
$292.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$370.71
|
| Rate for Payer: Medical Associates Commercial |
$486.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$292.05
|
| Rate for Payer: Midlands Choice Commercial |
$454.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$376.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$335.86
|
| 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
|
HCPCS C1713
|
| Hospital Charge Code |
8046768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.90 |
| 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 |
$381.84
|
| Rate for Payer: Amerigroup Medicare |
$300.88
|
| 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 |
$297.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$378.13
|
| Rate for Payer: Medical Associates Commercial |
$496.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$297.90
|
| Rate for Payer: Midlands Choice Commercial |
$463.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$383.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$342.58
|
| 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
|
HCPCS 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
|
HCPCS 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
|
HCPCS C1713
|
| Hospital Charge Code |
8046769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.05 |
| 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 |
$385.88
|
| Rate for Payer: Amerigroup Medicare |
$304.06
|
| 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 |
$301.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$382.13
|
| Rate for Payer: Medical Associates Commercial |
$501.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$301.05
|
| Rate for Payer: Midlands Choice Commercial |
$468.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$387.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$346.21
|
| Rate for Payer: United Healthcare Commercial |
$602.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$394.71
|
|
