|
PLATE LOCKING STRAIGHT, SS, 10H
|
Facility
|
OP
|
$803.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$361.35 |
| Max. Negotiated Rate |
$722.70 |
| Rate for Payer: Aetna of IA Commercial |
$722.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$722.70
|
| Rate for Payer: Aetna of IA Medicare |
$457.71
|
| Rate for Payer: Amerigroup Medicaid |
$463.17
|
| Rate for Payer: Amerigroup Medicare |
$364.96
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$602.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$361.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$458.67
|
| Rate for Payer: Medical Associates Commercial |
$602.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$361.35
|
| Rate for Payer: Midlands Choice Commercial |
$562.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$465.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$415.55
|
| Rate for Payer: United Healthcare Commercial |
$722.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$473.77
|
|
|
PLATE LOCKING STRAIGHT, SS, 12H
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.40 |
| Max. Negotiated Rate |
$829.80 |
| Rate for Payer: Aetna of IA Commercial |
$829.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$829.80
|
| Rate for Payer: Cash Price |
$737.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$691.50
|
| Rate for Payer: Medical Associates Commercial |
$691.50
|
| Rate for Payer: Midlands Choice Commercial |
$645.40
|
| Rate for Payer: United Healthcare Commercial |
$829.80
|
|
|
PLATE LOCKING STRAIGHT, SS, 12H
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.90 |
| Max. Negotiated Rate |
$829.80 |
| Rate for Payer: Aetna of IA Commercial |
$829.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$829.80
|
| Rate for Payer: Aetna of IA Medicare |
$525.54
|
| Rate for Payer: Amerigroup Medicaid |
$531.81
|
| Rate for Payer: Amerigroup Medicare |
$419.05
|
| Rate for Payer: Cash Price |
$737.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$691.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$414.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$526.65
|
| Rate for Payer: Medical Associates Commercial |
$691.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$414.90
|
| Rate for Payer: Midlands Choice Commercial |
$645.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$534.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$477.13
|
| Rate for Payer: United Healthcare Commercial |
$829.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$543.98
|
|
|
PLATE LOCKING STRAIGHT, SS, 4H
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.60 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Aetna of IA Commercial |
$547.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$547.20
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$456.00
|
| Rate for Payer: Medical Associates Commercial |
$456.00
|
| Rate for Payer: Midlands Choice Commercial |
$425.60
|
| Rate for Payer: United Healthcare Commercial |
$547.20
|
|
|
PLATE LOCKING STRAIGHT, SS, 4H
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.60 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Aetna of IA Commercial |
$547.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$547.20
|
| Rate for Payer: Aetna of IA Medicare |
$346.56
|
| Rate for Payer: Amerigroup Medicaid |
$350.69
|
| Rate for Payer: Amerigroup Medicare |
$276.34
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$456.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$273.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$347.29
|
| Rate for Payer: Medical Associates Commercial |
$456.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$273.60
|
| Rate for Payer: Midlands Choice Commercial |
$425.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$352.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$314.64
|
| Rate for Payer: United Healthcare Commercial |
$547.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$358.72
|
|
|
PLATE LOCKING STRAIGHT, SS, 6H
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.70 |
| Max. Negotiated Rate |
$576.90 |
| Rate for Payer: Aetna of IA Commercial |
$576.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$576.90
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$480.75
|
| Rate for Payer: Medical Associates Commercial |
$480.75
|
| Rate for Payer: Midlands Choice Commercial |
$448.70
|
| Rate for Payer: United Healthcare Commercial |
$576.90
|
|
|
PLATE LOCKING STRAIGHT, SS, 6H
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.45 |
| Max. Negotiated Rate |
$576.90 |
| Rate for Payer: Aetna of IA Commercial |
$576.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$576.90
|
| Rate for Payer: Aetna of IA Medicare |
$365.37
|
| Rate for Payer: Amerigroup Medicaid |
$369.73
|
| Rate for Payer: Amerigroup Medicare |
$291.33
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$480.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$288.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$366.14
|
| Rate for Payer: Medical Associates Commercial |
$480.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$288.45
|
| Rate for Payer: Midlands Choice Commercial |
$448.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$371.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$331.72
|
| Rate for Payer: United Healthcare Commercial |
$576.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$378.19
|
|
|
PLATE LOCKING STRAIGHT, SS, 7H
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047162
|
|
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 STRAIGHT, SS, 7H
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047162
|
|
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 STRAIGHT, SS, 8H
|
Facility
|
IP
|
$743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047163
|
|
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 STRAIGHT, SS, 8H
|
Facility
|
OP
|
$743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047163
|
|
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 THIRD TUBULAR, SS, 10H
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.10 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Aetna of IA Commercial |
$340.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$340.20
|
| Rate for Payer: Aetna of IA Medicare |
$215.46
|
| Rate for Payer: Amerigroup Medicaid |
$218.03
|
| Rate for Payer: Amerigroup Medicare |
$171.80
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$283.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$170.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$215.91
|
| Rate for Payer: Medical Associates Commercial |
$283.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$170.10
|
| Rate for Payer: Midlands Choice Commercial |
$264.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$219.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$195.62
|
| Rate for Payer: United Healthcare Commercial |
$340.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$223.02
|
|
|
PLATE LOCKING THIRD TUBULAR, SS, 10H
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Aetna of IA Commercial |
$340.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$340.20
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$283.50
|
| Rate for Payer: Medical Associates Commercial |
$283.50
|
| Rate for Payer: Midlands Choice Commercial |
$264.60
|
| Rate for Payer: United Healthcare Commercial |
$340.20
|
|
|
PLATE LOCKING THIRD TUBULAR, SS, 12H
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
|
|
PLATE LOCKING THIRD TUBULAR, SS, 12H
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Aetna of IA Medicare |
$230.85
|
| Rate for Payer: Amerigroup Medicaid |
$233.60
|
| Rate for Payer: Amerigroup Medicare |
$184.07
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$182.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$231.34
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$182.25
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$234.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$209.59
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
|
PLATE LOCKING THIRD TUBULAR, SS, 4H
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna of IA Commercial |
$273.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$273.60
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$228.00
|
| Rate for Payer: Medical Associates Commercial |
$228.00
|
| Rate for Payer: Midlands Choice Commercial |
$212.80
|
| Rate for Payer: United Healthcare Commercial |
$273.60
|
|
|
PLATE LOCKING THIRD TUBULAR, SS, 4H
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna of IA Commercial |
$273.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$273.60
|
| Rate for Payer: Aetna of IA Medicare |
$173.28
|
| Rate for Payer: Amerigroup Medicaid |
$175.35
|
| Rate for Payer: Amerigroup Medicare |
$138.17
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$228.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$136.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$173.64
|
| Rate for Payer: Medical Associates Commercial |
$228.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$136.80
|
| Rate for Payer: Midlands Choice Commercial |
$212.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$176.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$157.32
|
| Rate for Payer: United Healthcare Commercial |
$273.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$179.36
|
|
|
PLATE LOCKING THIRD TUBULAR, SS, 5H
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.90 |
| Max. Negotiated Rate |
$285.30 |
| Rate for Payer: Aetna of IA Commercial |
$285.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$285.30
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$237.75
|
| Rate for Payer: Medical Associates Commercial |
$237.75
|
| Rate for Payer: Midlands Choice Commercial |
$221.90
|
| Rate for Payer: United Healthcare Commercial |
$285.30
|
|
|
PLATE LOCKING THIRD TUBULAR, SS, 5H
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.65 |
| Max. Negotiated Rate |
$285.30 |
| Rate for Payer: Aetna of IA Commercial |
$285.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$285.30
|
| Rate for Payer: Aetna of IA Medicare |
$180.69
|
| Rate for Payer: Amerigroup Medicaid |
$182.85
|
| Rate for Payer: Amerigroup Medicare |
$144.08
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$237.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$142.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$181.07
|
| Rate for Payer: Medical Associates Commercial |
$237.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$142.65
|
| Rate for Payer: Midlands Choice Commercial |
$221.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$183.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$164.05
|
| Rate for Payer: United Healthcare Commercial |
$285.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$187.03
|
|
|
PLATE LOCKING THIRD TUBULAR, SS, 6H
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Aetna of IA Commercial |
$291.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$291.60
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$243.00
|
| Rate for Payer: Medical Associates Commercial |
$243.00
|
| Rate for Payer: Midlands Choice Commercial |
$226.80
|
| Rate for Payer: United Healthcare Commercial |
$291.60
|
|
|
PLATE LOCKING THIRD TUBULAR, SS, 6H
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.80 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Aetna of IA Commercial |
$291.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$291.60
|
| Rate for Payer: Aetna of IA Medicare |
$184.68
|
| Rate for Payer: Amerigroup Medicaid |
$186.88
|
| Rate for Payer: Amerigroup Medicare |
$147.26
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$243.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$145.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$185.07
|
| Rate for Payer: Medical Associates Commercial |
$243.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$145.80
|
| Rate for Payer: Midlands Choice Commercial |
$226.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$187.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$167.67
|
| Rate for Payer: United Healthcare Commercial |
$291.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$191.16
|
|
|
PLATE LOCKING THIRD TUBULAR, SS, 7H
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
|
|
PLATE LOCKING THIRD TUBULAR, SS, 7H
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Aetna of IA Medicare |
$196.08
|
| Rate for Payer: Amerigroup Medicaid |
$198.42
|
| Rate for Payer: Amerigroup Medicare |
$156.35
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$154.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$196.49
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$154.80
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$199.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$178.02
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$202.96
|
|
|
PLATE LOCKING THIRD TUBULAR, SS, 8H
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.90 |
| Max. Negotiated Rate |
$429.30 |
| Rate for Payer: Aetna of IA Commercial |
$429.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$429.30
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$357.75
|
| Rate for Payer: Medical Associates Commercial |
$357.75
|
| Rate for Payer: Midlands Choice Commercial |
$333.90
|
| Rate for Payer: United Healthcare Commercial |
$429.30
|
|
|
PLATE LOCKING THIRD TUBULAR, SS, 8H
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.65 |
| Max. Negotiated Rate |
$429.30 |
| Rate for Payer: Aetna of IA Commercial |
$429.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$429.30
|
| Rate for Payer: Aetna of IA Medicare |
$271.89
|
| Rate for Payer: Amerigroup Medicaid |
$275.13
|
| Rate for Payer: Amerigroup Medicare |
$216.80
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$357.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$214.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$272.46
|
| Rate for Payer: Medical Associates Commercial |
$357.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$214.65
|
| Rate for Payer: Midlands Choice Commercial |
$333.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$276.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$246.85
|
| Rate for Payer: United Healthcare Commercial |
$429.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$281.43
|
|
