|
ANESTHESIA MAC I
|
Facility
|
IP
|
$383.00
|
|
| Hospital Charge Code |
8084816
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$268.10 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Aetna of IA Commercial |
$344.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$344.70
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$287.25
|
| Rate for Payer: Medical Associates Commercial |
$287.25
|
| Rate for Payer: Midlands Choice Commercial |
$268.10
|
| Rate for Payer: United Healthcare Commercial |
$344.70
|
|
|
ANESTHESIA-MAC I
|
Facility
|
OP
|
$383.00
|
|
| Hospital Charge Code |
8059071
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$172.35 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Aetna of IA Commercial |
$344.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$344.70
|
| Rate for Payer: Aetna of IA Medicare |
$218.31
|
| Rate for Payer: Amerigroup Medicaid |
$220.91
|
| Rate for Payer: Amerigroup Medicare |
$174.07
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$287.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$172.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$218.77
|
| Rate for Payer: Medical Associates Commercial |
$287.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$172.35
|
| Rate for Payer: Midlands Choice Commercial |
$268.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$221.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$198.20
|
| Rate for Payer: United Healthcare Commercial |
$344.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$225.97
|
|
|
ANESTHESIA-MAC I
|
Facility
|
IP
|
$383.00
|
|
| Hospital Charge Code |
8059071
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$268.10 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Aetna of IA Commercial |
$344.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$344.70
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$287.25
|
| Rate for Payer: Medical Associates Commercial |
$287.25
|
| Rate for Payer: Midlands Choice Commercial |
$268.10
|
| Rate for Payer: United Healthcare Commercial |
$344.70
|
|
|
ANESTHESIA MAC II
|
Facility
|
IP
|
$514.00
|
|
| Hospital Charge Code |
8059072
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$359.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Aetna of IA Commercial |
$462.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$462.60
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$385.50
|
| Rate for Payer: Medical Associates Commercial |
$385.50
|
| Rate for Payer: Midlands Choice Commercial |
$359.80
|
| Rate for Payer: United Healthcare Commercial |
$462.60
|
|
|
ANESTHESIA MAC II
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
8059072
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$231.30 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Aetna of IA Commercial |
$462.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$462.60
|
| Rate for Payer: Aetna of IA Medicare |
$292.98
|
| Rate for Payer: Amerigroup Medicaid |
$296.48
|
| Rate for Payer: Amerigroup Medicare |
$233.61
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$385.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$231.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$293.60
|
| Rate for Payer: Medical Associates Commercial |
$385.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$231.30
|
| Rate for Payer: Midlands Choice Commercial |
$359.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$297.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$266.00
|
| Rate for Payer: United Healthcare Commercial |
$462.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$303.26
|
|
|
ANESTHESIA MINUTES: Per Interval (1 Qty)
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
8059604
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna of IA Commercial |
$5.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.40
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.50
|
| Rate for Payer: Medical Associates Commercial |
$4.50
|
| Rate for Payer: Midlands Choice Commercial |
$4.20
|
| Rate for Payer: United Healthcare Commercial |
$5.40
|
|
|
ANESTHESIA MINUTES: Per Interval (1 Qty)
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
8059604
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna of IA Commercial |
$5.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.40
|
| Rate for Payer: Aetna of IA Medicare |
$3.42
|
| Rate for Payer: Amerigroup Medicaid |
$3.46
|
| Rate for Payer: Amerigroup Medicare |
$2.73
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.43
|
| Rate for Payer: Medical Associates Commercial |
$4.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.70
|
| Rate for Payer: Midlands Choice Commercial |
$4.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.10
|
| Rate for Payer: United Healthcare Commercial |
$5.40
|
|
|
ANESTH-SPECIAL CIRCUMSTANCES
|
Facility
|
OP
|
$86.00
|
|
| Hospital Charge Code |
8059068
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of IA Commercial |
$77.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.40
|
| Rate for Payer: Aetna of IA Medicare |
$49.02
|
| Rate for Payer: Amerigroup Medicaid |
$49.60
|
| Rate for Payer: Amerigroup Medicare |
$39.09
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.12
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.70
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.50
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
|
|
ANESTH-SPECIAL CIRCUMSTANCES
|
Facility
|
IP
|
$86.00
|
|
| Hospital Charge Code |
8059068
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of IA Commercial |
$77.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.40
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.50
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
|
|
ANGINA PECTORIS
|
Facility
|
IP
|
$4,914.89
|
|
|
Service Code
|
MSDRG 311
|
| Min. Negotiated Rate |
$4,843.66 |
| Max. Negotiated Rate |
$4,914.89 |
| Rate for Payer: Amerigroup Medicaid |
$4,891.14
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,843.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,914.89
|
|
|
Angiotensin Converting Enzyme DMCL
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
8037493
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.68 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$80.18
|
| Rate for Payer: Amerigroup Medicare |
$63.18
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$62.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.40
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.55
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.93
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO WHPI |
$61.68
|
| Rate for Payer: Wellmark IA PPO |
$67.95
|
|
|
Angiotensin Converting Enzyme DMCL
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
8037493
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
Ankle Brachial Index Art Study 1-2 LVLS
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
8998331
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$215.10 |
| Rate for Payer: Aetna of IA Commercial |
$215.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$215.10
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
|
|
Ankle Brachial Index Art Study 1-2 LVLS
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
8998331
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$107.55 |
| Max. Negotiated Rate |
$265.54 |
| Rate for Payer: Aetna of IA Commercial |
$215.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$215.10
|
| Rate for Payer: Aetna of IA Medicare |
$136.23
|
| Rate for Payer: Amerigroup Medicaid |
$137.86
|
| Rate for Payer: Amerigroup Medicare |
$108.63
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$107.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$136.52
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$107.55
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$138.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$123.68
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$141.01
|
| Rate for Payer: Wellmark IA HMO WHPI |
$241.06
|
| Rate for Payer: Wellmark IA PPO |
$265.54
|
|
|
ANKLE BRACHIAL INDEX UPR/LXTR ART STUDY 3+ LVLS
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
8395249
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$215.10 |
| Rate for Payer: Aetna of IA Commercial |
$215.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$215.10
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
|
|
ANKLE BRACHIAL INDEX UPR/LXTR ART STUDY 3+ LVLS
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
8395249
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$107.55 |
| Max. Negotiated Rate |
$406.12 |
| Rate for Payer: Aetna of IA Commercial |
$215.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$215.10
|
| Rate for Payer: Aetna of IA Medicare |
$136.23
|
| Rate for Payer: Amerigroup Medicaid |
$137.86
|
| Rate for Payer: Amerigroup Medicare |
$108.63
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$107.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$136.52
|
| Rate for Payer: Medical Associates Commercial |
$179.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$107.55
|
| Rate for Payer: Midlands Choice Commercial |
$167.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$138.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$123.68
|
| Rate for Payer: United Healthcare Commercial |
$215.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$141.01
|
| Rate for Payer: Wellmark IA HMO WHPI |
$368.68
|
| Rate for Payer: Wellmark IA PPO |
$406.12
|
|
|
ANKLE PLATE 12 HOLE 1/3 TUBULAR PLATE
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8823374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.50 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Aetna of IA Commercial |
$931.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$931.50
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$776.25
|
| Rate for Payer: Medical Associates Commercial |
$776.25
|
| Rate for Payer: Midlands Choice Commercial |
$724.50
|
| Rate for Payer: United Healthcare Commercial |
$931.50
|
|
|
ANKLE PLATE 12 HOLE 1/3 TUBULAR PLATE
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8823374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.75 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Aetna of IA Commercial |
$931.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$931.50
|
| Rate for Payer: Aetna of IA Medicare |
$589.95
|
| Rate for Payer: Amerigroup Medicaid |
$596.99
|
| Rate for Payer: Amerigroup Medicare |
$470.41
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$776.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$465.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$591.19
|
| Rate for Payer: Medical Associates Commercial |
$776.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$465.75
|
| Rate for Payer: Midlands Choice Commercial |
$724.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$599.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$535.61
|
| Rate for Payer: United Healthcare Commercial |
$931.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$610.65
|
|
|
ANKLE PLATE 7 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
|
OP
|
$2,052.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8823181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.40 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,169.64
|
| Rate for Payer: Amerigroup Medicaid |
$1,183.59
|
| Rate for Payer: Amerigroup Medicare |
$932.63
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$923.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,172.10
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$923.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,189.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,061.91
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,210.68
|
|
|
ANKLE PLATE 7 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
|
IP
|
$2,052.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8823181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.40 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
|
|
ANKLE PLATE 9 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
|
IP
|
$2,052.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8868039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.40 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
|
|
ANKLE PLATE 9 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
|
OP
|
$2,052.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8868039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.40 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,169.64
|
| Rate for Payer: Amerigroup Medicaid |
$1,183.59
|
| Rate for Payer: Amerigroup Medicare |
$932.63
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$923.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,172.10
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$923.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,189.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,061.91
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,210.68
|
|
|
ANKLE PLATES 10 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
|
IP
|
$2,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8758428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,512.00 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,944.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,944.00
|
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,620.00
|
| Rate for Payer: Medical Associates Commercial |
$1,620.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,512.00
|
| Rate for Payer: United Healthcare Commercial |
$1,944.00
|
|
|
ANKLE PLATES 10 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
|
OP
|
$2,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8758428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.00 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,944.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,944.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,231.20
|
| Rate for Payer: Amerigroup Medicaid |
$1,245.89
|
| Rate for Payer: Amerigroup Medicare |
$981.72
|
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,620.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$972.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,233.79
|
| Rate for Payer: Medical Associates Commercial |
$1,620.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$972.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,512.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,251.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,117.80
|
| Rate for Payer: United Healthcare Commercial |
$1,944.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,274.40
|
|
|
ANKLE PLATES 12 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
|
OP
|
$2,052.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8831363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.40 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,169.64
|
| Rate for Payer: Amerigroup Medicaid |
$1,183.59
|
| Rate for Payer: Amerigroup Medicare |
$932.63
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$923.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,172.10
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$923.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,189.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,061.91
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,210.68
|
|
