|
3.4MMX3.0MMX8MM SPADE TWO STEP HAMMER
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8470646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,260.00 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,620.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,350.00
|
| Rate for Payer: Medical Associates Commercial |
$1,350.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,260.00
|
| Rate for Payer: United Healthcare Commercial |
$1,620.00
|
|
|
3.55MM X 10MM LOCKING SCREW
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8812772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
|
|
3.55MM X 10MM LOCKING SCREW
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8812772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.43 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Aetna of IA Medicare |
$189.81
|
| Rate for Payer: Amerigroup Medicaid |
$168.07
|
| Rate for Payer: Amerigroup Medicare |
$168.16
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$166.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$166.43
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$166.50
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$169.00
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$168.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$249.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$249.75
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
|
|
3.5MMX10MM GL ANKLE LOCKING SCREW
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8760631
|
|
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
|
|
|
3.5MMX10MM GL ANKLE LOCKING SCREW
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8760631
|
|
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
|
|
|
3.5MMX12MM GL ANKLE SCREW
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.95 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna of IA Commercial |
$226.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$226.80
|
| Rate for Payer: Aetna of IA Medicare |
$143.64
|
| Rate for Payer: Amerigroup Medicaid |
$127.18
|
| Rate for Payer: Amerigroup Medicare |
$127.26
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$126.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.95
|
| Rate for Payer: Medical Associates Commercial |
$189.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$126.00
|
| Rate for Payer: Midlands Choice Commercial |
$176.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.89
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$127.81
|
| Rate for Payer: Oscar Health of IA Commercial |
$189.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$226.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$148.68
|
|
|
3.5MMX12MM GL ANKLE SCREW
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8759027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$100.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$148.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
3.5MMX12MM GL ANKLE SCREW
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
3.5MMX12MM GL ANKLE SCREW
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna of IA Commercial |
$226.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$226.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.00
|
| Rate for Payer: Medical Associates Commercial |
$189.00
|
| Rate for Payer: Midlands Choice Commercial |
$176.40
|
| Rate for Payer: United Healthcare Commercial |
$226.80
|
|
|
3.5MMX12MM GL ANKLE SCREW
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8759027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
3.5MMX12MM GL ANKLE SCREW
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$100.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$148.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
3.5MMX12MM GL LOCKING SCREW
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8759029
|
|
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
|
|
|
3.5MMX12MM GL LOCKING SCREW
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8759029
|
|
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
|
|
|
3.5MMX14MM GL ANKLE LOCKING SCREW
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8760633
|
|
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
|
|
|
3.5MMX14MM GL ANKLE LOCKING SCREW
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8760633
|
|
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
|
|
|
3.5MM X 14MM LOCKING SCREW
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8812774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
|
|
3.5MM X 14MM LOCKING SCREW
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8812774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.43 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Aetna of IA Medicare |
$189.81
|
| Rate for Payer: Amerigroup Medicaid |
$168.07
|
| Rate for Payer: Amerigroup Medicare |
$168.16
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$166.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$166.43
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$166.50
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$169.00
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$168.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$249.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$249.75
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
|
|
3.5MMX15MM GL ANKLE LOCKING SCREW
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758434
|
|
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
|
|
|
3.5MMX15MM GL ANKLE LOCKING SCREW
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758434
|
|
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
|
|
|
3.5MM X 16MM LOCKING SCREW
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8812776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
|
|
3.5MM X 16MM LOCKING SCREW
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8812776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.43 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Aetna of IA Medicare |
$189.81
|
| Rate for Payer: Amerigroup Medicaid |
$168.07
|
| Rate for Payer: Amerigroup Medicare |
$168.16
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$166.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$166.43
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$166.50
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$169.00
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$168.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$249.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$249.75
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
|
|
3.5MMX18MM GL ANKLE LOCKING SCREW
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758436
|
|
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
|
|
|
3.5MMX18MM GL ANKLE LOCKING SCREW
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758436
|
|
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
|
|
|
3.5MMX20MM GL ANKLE LOCKING SCREW
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8760635
|
|
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
|
|
|
3.5MMX20MM GL ANKLE LOCKING SCREW
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8760635
|
|
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
|
|
