|
PLATE LOCKING RECON 4 HOLE / L 62MM
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.90 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of IA Commercial |
$453.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$453.60
|
| Rate for Payer: Aetna of IA Medicare |
$287.28
|
| Rate for Payer: Amerigroup Medicaid |
$254.37
|
| Rate for Payer: Amerigroup Medicare |
$254.52
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$252.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$251.90
|
| Rate for Payer: Medical Associates Commercial |
$378.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$252.00
|
| Rate for Payer: Midlands Choice Commercial |
$352.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$255.78
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$255.63
|
| Rate for Payer: Oscar Health of IA Commercial |
$378.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$378.00
|
| Rate for Payer: United Healthcare Commercial |
$453.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$297.36
|
|
|
PLATE LOCKING RECON 4 HOLE / L 62MM
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of IA Commercial |
$453.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$453.60
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.00
|
| Rate for Payer: Medical Associates Commercial |
$378.00
|
| Rate for Payer: Midlands Choice Commercial |
$352.80
|
| Rate for Payer: United Healthcare Commercial |
$453.60
|
|
|
PLATE LOCKING RECON 6 HOLE / L 94MM
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.70 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna of IA Commercial |
$459.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$459.90
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$383.25
|
| Rate for Payer: Medical Associates Commercial |
$383.25
|
| Rate for Payer: Midlands Choice Commercial |
$357.70
|
| Rate for Payer: United Healthcare Commercial |
$459.90
|
|
|
PLATE LOCKING RECON 6 HOLE / L 94MM
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.40 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna of IA Commercial |
$459.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$459.90
|
| Rate for Payer: Aetna of IA Medicare |
$291.27
|
| Rate for Payer: Amerigroup Medicaid |
$257.90
|
| Rate for Payer: Amerigroup Medicare |
$258.06
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$383.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$255.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$255.40
|
| Rate for Payer: Medical Associates Commercial |
$383.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$255.50
|
| Rate for Payer: Midlands Choice Commercial |
$357.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$259.33
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$259.18
|
| Rate for Payer: Oscar Health of IA Commercial |
$383.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$383.25
|
| Rate for Payer: United Healthcare Commercial |
$459.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$301.49
|
|
|
PLATE LOCKING RECON 8 HOLE / L 126MM
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$295.38 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Aetna of IA Commercial |
$531.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$531.90
|
| Rate for Payer: Aetna of IA Medicare |
$336.87
|
| Rate for Payer: Amerigroup Medicaid |
$298.28
|
| Rate for Payer: Amerigroup Medicare |
$298.46
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$443.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$295.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$295.38
|
| Rate for Payer: Medical Associates Commercial |
$443.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$295.50
|
| Rate for Payer: Midlands Choice Commercial |
$413.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$299.93
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$299.76
|
| Rate for Payer: Oscar Health of IA Commercial |
$443.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$443.25
|
| Rate for Payer: United Healthcare Commercial |
$531.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$348.69
|
|
|
PLATE LOCKING RECON 8 HOLE / L 126MM
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.70 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Aetna of IA Commercial |
$531.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$531.90
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$443.25
|
| Rate for Payer: Medical Associates Commercial |
$443.25
|
| Rate for Payer: Midlands Choice Commercial |
$413.70
|
| Rate for Payer: United Healthcare Commercial |
$531.90
|
|
|
PLATE LOCKING STRAIGHT, SS, 10H
|
Facility
|
IP
|
$803.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.10 |
| 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: Cash Price |
$642.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$602.25
|
| Rate for Payer: Medical Associates Commercial |
$602.25
|
| Rate for Payer: Midlands Choice Commercial |
$562.10
|
| Rate for Payer: United Healthcare Commercial |
$722.70
|
|
|
PLATE LOCKING STRAIGHT, SS, 10H
|
Facility
|
OP
|
$803.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$401.34 |
| 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 |
$405.27
|
| Rate for Payer: Amerigroup Medicare |
$405.52
|
| 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 |
$401.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$401.34
|
| Rate for Payer: Medical Associates Commercial |
$602.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$401.50
|
| Rate for Payer: Midlands Choice Commercial |
$562.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$407.52
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$407.28
|
| Rate for Payer: Oscar Health of IA Commercial |
$602.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$602.25
|
| Rate for Payer: United Healthcare Commercial |
$722.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$473.77
|
|
|
PLATE LOCKING STRAIGHT, SS, 12H
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.82 |
| 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 |
$465.33
|
| Rate for Payer: Amerigroup Medicare |
$465.61
|
| 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 |
$461.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$460.82
|
| Rate for Payer: Medical Associates Commercial |
$691.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$461.00
|
| Rate for Payer: Midlands Choice Commercial |
$645.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$467.92
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$467.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$691.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$691.50
|
| Rate for Payer: United Healthcare Commercial |
$829.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$543.98
|
|
|
PLATE LOCKING STRAIGHT, SS, 12H
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
CPT 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, 4H
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
CPT 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
|
CPT C1713
|
| Hospital Charge Code |
8047160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$303.88 |
| 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 |
$306.86
|
| Rate for Payer: Amerigroup Medicare |
$307.04
|
| 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 |
$304.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$303.88
|
| Rate for Payer: Medical Associates Commercial |
$456.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$304.00
|
| Rate for Payer: Midlands Choice Commercial |
$425.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$308.56
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$308.38
|
| Rate for Payer: Oscar Health of IA Commercial |
$456.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$456.00
|
| 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
|
CPT 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
|
CPT C1713
|
| Hospital Charge Code |
8047161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.37 |
| 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 |
$323.51
|
| Rate for Payer: Amerigroup Medicare |
$323.70
|
| 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 |
$320.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$320.37
|
| Rate for Payer: Medical Associates Commercial |
$480.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$320.50
|
| Rate for Payer: Midlands Choice Commercial |
$448.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$325.31
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$325.12
|
| Rate for Payer: Oscar Health of IA Commercial |
$480.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$480.75
|
| Rate for Payer: United Healthcare Commercial |
$576.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$378.19
|
|
|
PLATE LOCKING STRAIGHT, SS, 7H
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.31 |
| 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 |
$476.94
|
| Rate for Payer: Amerigroup Medicare |
$477.22
|
| 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 |
$472.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$472.31
|
| Rate for Payer: Medical Associates Commercial |
$708.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$472.50
|
| Rate for Payer: Midlands Choice Commercial |
$661.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$479.59
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$479.30
|
| Rate for Payer: Oscar Health of IA Commercial |
$708.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$708.75
|
| Rate for Payer: United Healthcare Commercial |
$850.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$557.55
|
|
|
PLATE LOCKING STRAIGHT, SS, 7H
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
CPT 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, 8H
|
Facility
|
IP
|
$743.00
|
|
|
Service Code
|
CPT 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
|
CPT C1713
|
| Hospital Charge Code |
8047163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$371.35 |
| 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 |
$374.99
|
| Rate for Payer: Amerigroup Medicare |
$375.22
|
| 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 |
$371.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$371.35
|
| Rate for Payer: Medical Associates Commercial |
$557.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$371.50
|
| Rate for Payer: Midlands Choice Commercial |
$520.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$377.07
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$376.85
|
| Rate for Payer: Oscar Health of IA Commercial |
$557.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$557.25
|
| Rate for Payer: United Healthcare Commercial |
$668.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$438.37
|
|
|
PLATE LOCKING THIRD TUBULAR, SS, 10H
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 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, 10H
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.92 |
| 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 |
$190.78
|
| Rate for Payer: Amerigroup Medicare |
$190.89
|
| 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 |
$189.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$188.92
|
| Rate for Payer: Medical Associates Commercial |
$283.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$189.00
|
| Rate for Payer: Midlands Choice Commercial |
$264.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$191.84
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$191.72
|
| Rate for Payer: Oscar Health of IA Commercial |
$283.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$283.50
|
| Rate for Payer: United Healthcare Commercial |
$340.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$223.02
|
|
|
PLATE LOCKING THIRD TUBULAR, SS, 12H
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.42 |
| 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 |
$204.40
|
| Rate for Payer: Amerigroup Medicare |
$204.52
|
| 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 |
$202.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.42
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$205.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$205.42
|
| Rate for Payer: Oscar Health of IA Commercial |
$303.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$303.75
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
|
PLATE LOCKING THIRD TUBULAR, SS, 12H
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 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, 4H
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 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
|
CPT C1713
|
| Hospital Charge Code |
8047169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.94 |
| 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 |
$153.43
|
| Rate for Payer: Amerigroup Medicare |
$153.52
|
| 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 |
$152.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$151.94
|
| Rate for Payer: Medical Associates Commercial |
$228.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$152.00
|
| Rate for Payer: Midlands Choice Commercial |
$212.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$154.28
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$154.19
|
| Rate for Payer: Oscar Health of IA Commercial |
$228.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$228.00
|
| 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
|
CPT 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
|
|
