|
27792 Open treatment distal fibula fx including internal fixation
|
Professional
|
$2,177.00
|
|
|
Service Code
|
CPT 27792
|
| Hospital Charge Code |
8799130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$587.29 |
| Max. Negotiated Rate |
$1,523.90 |
| Rate for Payer: Aetna of IA Medicare |
$587.29
|
| Rate for Payer: Amerigroup Medicaid |
$607.26
|
| Rate for Payer: Cash Price |
$1,741.60
|
| Rate for Payer: Cash Price |
$1,741.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$704.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$599.04
|
| Rate for Payer: Medical Associates Commercial |
$1,115.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$587.29
|
| Rate for Payer: Midlands Choice Commercial |
$1,523.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$880.94
|
| Rate for Payer: Wellmark IA HMO |
$1,239.00
|
| Rate for Payer: Wellmark IA PPO |
$1,454.00
|
|
|
2.77MM LOCKING SCREW 40MM
|
Facility
OP
|
$211.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8749293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.46 |
| Max. Negotiated Rate |
$189.90 |
| Rate for Payer: Aetna of IA Commercial |
$189.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$189.90
|
| Rate for Payer: Aetna of IA Medicare |
$120.27
|
| Rate for Payer: Amerigroup Medicaid |
$106.49
|
| Rate for Payer: Amerigroup Medicare |
$106.56
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$158.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$105.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$105.46
|
| Rate for Payer: Medical Associates Commercial |
$158.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$105.50
|
| Rate for Payer: Midlands Choice Commercial |
$147.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$107.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$158.25
|
| Rate for Payer: United Healthcare Commercial |
$189.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$124.49
|
|
|
2.77MM LOCKING SCREW 40MM
|
Facility
IP
|
$211.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8749293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.70 |
| Max. Negotiated Rate |
$189.90 |
| Rate for Payer: Aetna of IA Commercial |
$189.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$189.90
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$158.25
|
| Rate for Payer: Medical Associates Commercial |
$158.25
|
| Rate for Payer: Midlands Choice Commercial |
$147.70
|
| Rate for Payer: United Healthcare Commercial |
$189.90
|
|
|
27822 Open treatment trimalleolar ankle fracture medial and/or lateral malleolus
|
Professional
|
$2,914.00
|
|
|
Service Code
|
CPT 27822
|
| Hospital Charge Code |
8799131
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$791.61 |
| Max. Negotiated Rate |
$2,039.80 |
| Rate for Payer: Aetna of IA Medicare |
$791.61
|
| Rate for Payer: Amerigroup Medicaid |
$818.52
|
| Rate for Payer: Cash Price |
$2,331.20
|
| Rate for Payer: Cash Price |
$2,331.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$949.93
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$807.44
|
| Rate for Payer: Medical Associates Commercial |
$1,504.06
|
| Rate for Payer: Medical Associates Managed Medicare |
$791.61
|
| Rate for Payer: Midlands Choice Commercial |
$2,039.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,187.42
|
| Rate for Payer: Wellmark IA HMO |
$1,678.00
|
| Rate for Payer: Wellmark IA PPO |
$1,970.00
|
|
|
27823 Open treatment trimalleolar ankle fracture medial and/or lateral malleolus
|
Professional
|
$3,268.00
|
|
|
Service Code
|
CPT 27823
|
| Hospital Charge Code |
8799132
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$890.75 |
| Max. Negotiated Rate |
$2,287.60 |
| Rate for Payer: Aetna of IA Medicare |
$890.75
|
| Rate for Payer: Amerigroup Medicaid |
$921.04
|
| Rate for Payer: Cash Price |
$2,614.40
|
| Rate for Payer: Cash Price |
$2,614.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,068.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$908.56
|
| Rate for Payer: Medical Associates Commercial |
$1,692.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$890.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,287.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,336.12
|
| Rate for Payer: Wellmark IA HMO |
$1,888.00
|
| Rate for Payer: Wellmark IA PPO |
$2,216.00
|
|
|
2.7MM LOCKING SCREW 38MM
|
Facility
OP
|
$211.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.46 |
| Max. Negotiated Rate |
$189.90 |
| Rate for Payer: Aetna of IA Commercial |
$189.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$189.90
|
| Rate for Payer: Aetna of IA Medicare |
$120.27
|
| Rate for Payer: Amerigroup Medicaid |
$106.49
|
| Rate for Payer: Amerigroup Medicare |
$106.56
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$158.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$105.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$105.46
|
| Rate for Payer: Medical Associates Commercial |
$158.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$105.50
|
| Rate for Payer: Midlands Choice Commercial |
$147.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$107.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$158.25
|
| Rate for Payer: United Healthcare Commercial |
$189.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$124.49
|
|
|
2.7MM LOCKING SCREW 38MM
|
Facility
IP
|
$211.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.70 |
| Max. Negotiated Rate |
$189.90 |
| Rate for Payer: Aetna of IA Commercial |
$189.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$189.90
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$158.25
|
| Rate for Payer: Medical Associates Commercial |
$158.25
|
| Rate for Payer: Midlands Choice Commercial |
$147.70
|
| Rate for Payer: United Healthcare Commercial |
$189.90
|
|
|
2.7MM LOCKING SCREW X42MM
|
Facility
IP
|
$211.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.70 |
| Max. Negotiated Rate |
$189.90 |
| Rate for Payer: Aetna of IA Commercial |
$189.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$189.90
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$158.25
|
| Rate for Payer: Medical Associates Commercial |
$158.25
|
| Rate for Payer: Midlands Choice Commercial |
$147.70
|
| Rate for Payer: United Healthcare Commercial |
$189.90
|
|
|
2.7MM LOCKING SCREW X42MM
|
Facility
OP
|
$211.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.46 |
| Max. Negotiated Rate |
$189.90 |
| Rate for Payer: Aetna of IA Commercial |
$189.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$189.90
|
| Rate for Payer: Aetna of IA Medicare |
$120.27
|
| Rate for Payer: Amerigroup Medicaid |
$106.49
|
| Rate for Payer: Amerigroup Medicare |
$106.56
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$158.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$105.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$105.46
|
| Rate for Payer: Medical Associates Commercial |
$158.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$105.50
|
| Rate for Payer: Midlands Choice Commercial |
$147.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$107.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$158.25
|
| Rate for Payer: United Healthcare Commercial |
$189.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$124.49
|
|
|
2.7MM METAPHYSEAL SCREW X 30MM
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
|
|
2.7MM METAPHYSEAL SCREW X 30MM
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.49 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Aetna of IA Medicare |
$40.47
|
| Rate for Payer: Amerigroup Medicaid |
$35.83
|
| Rate for Payer: Amerigroup Medicare |
$35.86
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.49
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.25
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.89
|
|
|
2.7MM METAPHYSEAL SCREW X 40MM
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.49 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Aetna of IA Medicare |
$40.47
|
| Rate for Payer: Amerigroup Medicaid |
$35.83
|
| Rate for Payer: Amerigroup Medicare |
$35.86
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.49
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.25
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.89
|
|
|
2.7MM METAPHYSEAL SCREW X 40MM
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
|
|
2.7MM METAPHYSEAL SCREW X 42MM
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.49 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Aetna of IA Medicare |
$40.47
|
| Rate for Payer: Amerigroup Medicaid |
$35.83
|
| Rate for Payer: Amerigroup Medicare |
$35.86
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.49
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.25
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.89
|
|
|
2.7MM METAPHYSEAL SCREW X 42MM
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
|
|
2.7MM METAPHYSEAL SCREW X 44MM
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
|
|
2.7MM METAPHYSEAL SCREW X 44MM
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.49 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Aetna of IA Medicare |
$40.47
|
| Rate for Payer: Amerigroup Medicaid |
$35.83
|
| Rate for Payer: Amerigroup Medicare |
$35.86
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.49
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.25
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.89
|
|
|
2.7MM TI VA LOCKING PLATE SM 58MM RIGHT
|
Facility
IP
|
$1,638.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,146.60 |
| Max. Negotiated Rate |
$1,474.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,474.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,310.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,228.50
|
| Rate for Payer: Medical Associates Commercial |
$1,228.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,146.60
|
| Rate for Payer: United Healthcare Commercial |
$1,474.20
|
|
|
2.7MM TI VA LOCKING PLATE SM 58MM RIGHT
|
Facility
OP
|
$1,638.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$818.67 |
| Max. Negotiated Rate |
$1,474.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,474.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,474.20
|
| Rate for Payer: Aetna of IA Medicare |
$933.66
|
| Rate for Payer: Amerigroup Medicaid |
$826.70
|
| Rate for Payer: Amerigroup Medicare |
$827.19
|
| Rate for Payer: Cash Price |
$1,310.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,228.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$819.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$818.67
|
| Rate for Payer: Medical Associates Commercial |
$1,228.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$819.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,146.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$831.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,228.50
|
| Rate for Payer: United Healthcare Commercial |
$1,474.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$966.42
|
|
|
2.7MM TI VA-LOCKING PLATE SMALL
|
Facility
IP
|
$1,638.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,146.60 |
| Max. Negotiated Rate |
$1,474.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,474.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,310.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,228.50
|
| Rate for Payer: Medical Associates Commercial |
$1,228.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,146.60
|
| Rate for Payer: United Healthcare Commercial |
$1,474.20
|
|
|
2.7MM TI VA-LOCKING PLATE SMALL
|
Facility
OP
|
$1,638.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$818.67 |
| Max. Negotiated Rate |
$1,474.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,474.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,474.20
|
| Rate for Payer: Aetna of IA Medicare |
$933.66
|
| Rate for Payer: Amerigroup Medicaid |
$826.70
|
| Rate for Payer: Amerigroup Medicare |
$827.19
|
| Rate for Payer: Cash Price |
$1,310.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,228.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$819.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$818.67
|
| Rate for Payer: Medical Associates Commercial |
$1,228.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$819.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,146.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$831.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,228.50
|
| Rate for Payer: United Healthcare Commercial |
$1,474.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$966.42
|
|
|
2.7MM TI VA LOCKING SCREW 32MM
|
Facility
OP
|
$211.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.46 |
| Max. Negotiated Rate |
$189.90 |
| Rate for Payer: Aetna of IA Commercial |
$189.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$189.90
|
| Rate for Payer: Aetna of IA Medicare |
$120.27
|
| Rate for Payer: Amerigroup Medicaid |
$106.49
|
| Rate for Payer: Amerigroup Medicare |
$106.56
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$158.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$105.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$105.46
|
| Rate for Payer: Medical Associates Commercial |
$158.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$105.50
|
| Rate for Payer: Midlands Choice Commercial |
$147.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$107.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$158.25
|
| Rate for Payer: United Healthcare Commercial |
$189.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$124.49
|
|
|
2.7MM TI VA LOCKING SCREW 32MM
|
Facility
IP
|
$211.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.70 |
| Max. Negotiated Rate |
$189.90 |
| Rate for Payer: Aetna of IA Commercial |
$189.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$189.90
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$158.25
|
| Rate for Payer: Medical Associates Commercial |
$158.25
|
| Rate for Payer: Midlands Choice Commercial |
$147.70
|
| Rate for Payer: United Healthcare Commercial |
$189.90
|
|
|
2.7MM TI VA LOCKING SCREW 36MM
|
Facility
IP
|
$211.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.70 |
| Max. Negotiated Rate |
$189.90 |
| Rate for Payer: Aetna of IA Commercial |
$189.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$189.90
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$158.25
|
| Rate for Payer: Medical Associates Commercial |
$158.25
|
| Rate for Payer: Midlands Choice Commercial |
$147.70
|
| Rate for Payer: United Healthcare Commercial |
$189.90
|
|
|
2.7MM TI VA LOCKING SCREW 36MM
|
Facility
OP
|
$211.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.46 |
| Max. Negotiated Rate |
$189.90 |
| Rate for Payer: Aetna of IA Commercial |
$189.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$189.90
|
| Rate for Payer: Aetna of IA Medicare |
$120.27
|
| Rate for Payer: Amerigroup Medicaid |
$106.49
|
| Rate for Payer: Amerigroup Medicare |
$106.56
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$158.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$105.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$105.46
|
| Rate for Payer: Medical Associates Commercial |
$158.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$105.50
|
| Rate for Payer: Midlands Choice Commercial |
$147.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$107.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$158.25
|
| Rate for Payer: United Healthcare Commercial |
$189.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$124.49
|
|
