|
PLATE LOCKING THIRD TUBULAR, SS, 5H
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.44 |
| 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 |
$159.99
|
| Rate for Payer: Amerigroup Medicare |
$160.08
|
| 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 |
$158.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$158.44
|
| Rate for Payer: Medical Associates Commercial |
$237.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$158.50
|
| Rate for Payer: Midlands Choice Commercial |
$221.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$160.88
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$160.78
|
| Rate for Payer: Oscar Health of IA Commercial |
$237.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$237.75
|
| 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
|
CPT 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
|
CPT C1713
|
| Hospital Charge Code |
8047171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.94 |
| 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 |
$163.52
|
| Rate for Payer: Amerigroup Medicare |
$163.62
|
| 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 |
$162.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$161.94
|
| Rate for Payer: Medical Associates Commercial |
$243.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$162.00
|
| Rate for Payer: Midlands Choice Commercial |
$226.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$164.43
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$164.33
|
| Rate for Payer: Oscar Health of IA Commercial |
$243.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$243.00
|
| 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
|
CPT 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
|
CPT C1713
|
| Hospital Charge Code |
8047172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.93 |
| 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 |
$173.62
|
| Rate for Payer: Amerigroup Medicare |
$173.72
|
| 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 |
$172.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$171.93
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$172.00
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$174.58
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$174.48
|
| Rate for Payer: Oscar Health of IA Commercial |
$258.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$258.00
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$202.96
|
|
|
PLATE LOCKING THIRD TUBULAR, SS, 8H
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.40 |
| 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 |
$240.74
|
| Rate for Payer: Amerigroup Medicare |
$240.88
|
| 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 |
$238.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$238.40
|
| Rate for Payer: Medical Associates Commercial |
$357.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$238.50
|
| Rate for Payer: Midlands Choice Commercial |
$333.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$242.08
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$241.93
|
| Rate for Payer: Oscar Health of IA Commercial |
$357.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$357.75
|
| Rate for Payer: United Healthcare Commercial |
$429.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$281.43
|
|
|
PLATE LOCKING THIRD TUBULAR, SS, 8H
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT 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 PROXIMAL LATERAL HUMERUS 3 LEFT
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$788.68 |
| Max. Negotiated Rate |
$1,420.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,420.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,420.20
|
| Rate for Payer: Aetna of IA Medicare |
$899.46
|
| Rate for Payer: Amerigroup Medicaid |
$796.42
|
| Rate for Payer: Amerigroup Medicare |
$796.89
|
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,183.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$789.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$788.68
|
| Rate for Payer: Medical Associates Commercial |
$1,183.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$789.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,104.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$800.84
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$800.36
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,183.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,183.50
|
| Rate for Payer: United Healthcare Commercial |
$1,420.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$931.02
|
|
|
PLATE PROXIMAL LATERAL HUMERUS 3 LEFT
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.60 |
| Max. Negotiated Rate |
$1,420.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,420.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,420.20
|
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,183.50
|
| Rate for Payer: Medical Associates Commercial |
$1,183.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,104.60
|
| Rate for Payer: United Healthcare Commercial |
$1,420.20
|
|
|
PLATE PROXIMAL LATERAL HUMERUS 3 RIGHT
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$788.68 |
| Max. Negotiated Rate |
$1,420.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,420.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,420.20
|
| Rate for Payer: Aetna of IA Medicare |
$899.46
|
| Rate for Payer: Amerigroup Medicaid |
$796.42
|
| Rate for Payer: Amerigroup Medicare |
$796.89
|
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,183.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$789.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$788.68
|
| Rate for Payer: Medical Associates Commercial |
$1,183.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$789.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,104.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$800.84
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$800.36
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,183.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,183.50
|
| Rate for Payer: United Healthcare Commercial |
$1,420.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$931.02
|
|
|
PLATE PROXIMAL LATERAL HUMERUS 3 RIGHT
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.60 |
| Max. Negotiated Rate |
$1,420.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,420.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,420.20
|
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,183.50
|
| Rate for Payer: Medical Associates Commercial |
$1,183.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,104.60
|
| Rate for Payer: United Healthcare Commercial |
$1,420.20
|
|
|
PLATE SMARTLOCK VOLAR NARROW RIGHT
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.74 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,170.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,170.00
|
| Rate for Payer: Aetna of IA Medicare |
$741.00
|
| Rate for Payer: Amerigroup Medicaid |
$656.11
|
| Rate for Payer: Amerigroup Medicare |
$656.50
|
| Rate for Payer: Cash Price |
$1,040.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$975.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$650.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$649.74
|
| Rate for Payer: Medical Associates Commercial |
$975.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$650.00
|
| Rate for Payer: Midlands Choice Commercial |
$910.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$659.75
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$659.36
|
| Rate for Payer: Oscar Health of IA Commercial |
$975.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$975.00
|
| Rate for Payer: United Healthcare Commercial |
$1,170.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$767.00
|
|
|
PLATE SMARTLOCK VOLAR NARROW RIGHT
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.00 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,170.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,170.00
|
| Rate for Payer: Cash Price |
$1,040.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$975.00
|
| Rate for Payer: Medical Associates Commercial |
$975.00
|
| Rate for Payer: Midlands Choice Commercial |
$910.00
|
| Rate for Payer: United Healthcare Commercial |
$1,170.00
|
|
|
PLATES TUBULAR SPS 1/3 410 HOLE L129
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
8046774
|
|
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
|
|
|
PLATES TUBULAR SPS 1/3 410 HOLE L129
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
8046774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.49 |
| Max. Negotiated Rate |
$2,069.19 |
| 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: 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: Molina Healthcare Managed Medicare |
$36.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$53.25
|
| 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
|
| Rate for Payer: Wellmark IA HMO |
$1,881.08
|
| Rate for Payer: Wellmark IA PPO |
$2,069.19
|
|
|
PLATES TUBULAR SPS 1/3 4 HOLE L51
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
8046770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.99 |
| Max. Negotiated Rate |
$2,069.19 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Aetna of IA Medicare |
$36.48
|
| Rate for Payer: Amerigroup Medicaid |
$32.30
|
| Rate for Payer: Amerigroup Medicare |
$32.32
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.99
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$32.46
|
| Rate for Payer: Oscar Health of IA Commercial |
$48.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
| Rate for Payer: Wellmark IA HMO |
$1,881.08
|
| Rate for Payer: Wellmark IA PPO |
$2,069.19
|
|
|
PLATES TUBULAR SPS 1/3 4 HOLE L51
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
8046770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
|
|
PLATES TUBULAR SPS 1/3 5 HOLE L64
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
8046771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.99 |
| Max. Negotiated Rate |
$2,069.19 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Aetna of IA Medicare |
$36.48
|
| Rate for Payer: Amerigroup Medicaid |
$32.30
|
| Rate for Payer: Amerigroup Medicare |
$32.32
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.99
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$32.46
|
| Rate for Payer: Oscar Health of IA Commercial |
$48.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
| Rate for Payer: Wellmark IA HMO |
$1,881.08
|
| Rate for Payer: Wellmark IA PPO |
$2,069.19
|
|
|
PLATES TUBULAR SPS 1/3 5 HOLE L64
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
8046771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
|
|
PLATES TUBULAR SPS 1/3 6 HOLE L77
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
8046772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Aetna of IA Commercial |
$83.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$83.70
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$69.75
|
| Rate for Payer: Medical Associates Commercial |
$69.75
|
| Rate for Payer: Midlands Choice Commercial |
$65.10
|
| Rate for Payer: United Healthcare Commercial |
$83.70
|
|
|
PLATES TUBULAR SPS 1/3 6 HOLE L77
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
8046772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$2,069.19 |
| Rate for Payer: Aetna of IA Commercial |
$83.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$83.70
|
| Rate for Payer: Aetna of IA Medicare |
$53.01
|
| Rate for Payer: Amerigroup Medicaid |
$46.94
|
| Rate for Payer: Amerigroup Medicare |
$46.96
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$69.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$46.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$46.48
|
| Rate for Payer: Medical Associates Commercial |
$69.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$46.50
|
| Rate for Payer: Midlands Choice Commercial |
$65.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$47.20
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$47.17
|
| Rate for Payer: Oscar Health of IA Commercial |
$69.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$69.75
|
| Rate for Payer: United Healthcare Commercial |
$83.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$54.87
|
| Rate for Payer: Wellmark IA HMO |
$1,881.08
|
| Rate for Payer: Wellmark IA PPO |
$2,069.19
|
|
|
PLATES TUBULAR SPS 1/3 8 HOLE L103
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
8046773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
|
|
PLATES TUBULAR SPS 1/3 8 HOLE L103
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
8046773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$2,069.19 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Aetna of IA Medicare |
$59.28
|
| Rate for Payer: Amerigroup Medicaid |
$52.49
|
| Rate for Payer: Amerigroup Medicare |
$52.52
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.78
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$52.75
|
| Rate for Payer: Oscar Health of IA Commercial |
$78.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.00
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.36
|
| Rate for Payer: Wellmark IA HMO |
$1,881.08
|
| Rate for Payer: Wellmark IA PPO |
$2,069.19
|
|
|
PLATE TUBULAR LOCKING 10 HOLE L50MM
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
|
|
PLATE TUBULAR LOCKING 10 HOLE L50MM
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.46 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Aetna of IA Medicare |
$99.75
|
| Rate for Payer: Amerigroup Medicaid |
$88.32
|
| Rate for Payer: Amerigroup Medicare |
$88.38
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$87.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$87.46
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$87.50
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$88.81
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$88.76
|
| Rate for Payer: Oscar Health of IA Commercial |
$131.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$131.25
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.25
|
|
