|
IMPLANT TITANIUM LAG SCREW 10.5X120MM
|
Facility
OP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.38 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Aetna of IA Medicare |
$352.83
|
| Rate for Payer: Amerigroup Medicaid |
$312.41
|
| Rate for Payer: Amerigroup Medicare |
$312.60
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$309.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$309.38
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$309.50
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$314.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$464.25
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$365.21
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X125MM
|
Facility
OP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.38 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Aetna of IA Medicare |
$352.83
|
| Rate for Payer: Amerigroup Medicaid |
$312.41
|
| Rate for Payer: Amerigroup Medicare |
$312.60
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$309.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$309.38
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$309.50
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$314.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$464.25
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$365.21
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X125MM
|
Facility
IP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.30 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X130MM
|
Facility
OP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.38 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Aetna of IA Medicare |
$352.83
|
| Rate for Payer: Amerigroup Medicaid |
$312.41
|
| Rate for Payer: Amerigroup Medicare |
$312.60
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$309.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$309.38
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$309.50
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$314.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$464.25
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$365.21
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X130MM
|
Facility
IP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.30 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X70MM
|
Facility
OP
|
$536.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.89 |
| Max. Negotiated Rate |
$482.40 |
| Rate for Payer: Aetna of IA Commercial |
$482.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$482.40
|
| Rate for Payer: Aetna of IA Medicare |
$305.52
|
| Rate for Payer: Amerigroup Medicaid |
$270.52
|
| Rate for Payer: Amerigroup Medicare |
$270.68
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$402.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$268.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$267.89
|
| Rate for Payer: Medical Associates Commercial |
$402.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$268.00
|
| Rate for Payer: Midlands Choice Commercial |
$375.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$272.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$402.00
|
| Rate for Payer: United Healthcare Commercial |
$482.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$316.24
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X70MM
|
Facility
IP
|
$536.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$375.20 |
| Max. Negotiated Rate |
$482.40 |
| Rate for Payer: Aetna of IA Commercial |
$482.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$482.40
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$402.00
|
| Rate for Payer: Medical Associates Commercial |
$402.00
|
| Rate for Payer: Midlands Choice Commercial |
$375.20
|
| Rate for Payer: United Healthcare Commercial |
$482.40
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X75MM
|
Facility
OP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.38 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Aetna of IA Medicare |
$352.83
|
| Rate for Payer: Amerigroup Medicaid |
$312.41
|
| Rate for Payer: Amerigroup Medicare |
$312.60
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$309.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$309.38
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$309.50
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$314.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$464.25
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$365.21
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X75MM
|
Facility
IP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.30 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X80MM
|
Facility
IP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.30 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X80MM
|
Facility
OP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.38 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Aetna of IA Medicare |
$352.83
|
| Rate for Payer: Amerigroup Medicaid |
$312.41
|
| Rate for Payer: Amerigroup Medicare |
$312.60
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$309.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$309.38
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$309.50
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$314.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$464.25
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$365.21
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X85MM
|
Facility
OP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.38 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Aetna of IA Medicare |
$352.83
|
| Rate for Payer: Amerigroup Medicaid |
$312.41
|
| Rate for Payer: Amerigroup Medicare |
$312.60
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$309.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$309.38
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$309.50
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$314.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$464.25
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$365.21
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X85MM
|
Facility
IP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.30 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X90MM
|
Facility
OP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.38 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Aetna of IA Medicare |
$352.83
|
| Rate for Payer: Amerigroup Medicaid |
$312.41
|
| Rate for Payer: Amerigroup Medicare |
$312.60
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$309.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$309.38
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$309.50
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$314.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$464.25
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$365.21
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X90MM
|
Facility
IP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.30 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X95MM
|
Facility
IP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.30 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
|
|
IMPLANT TITANIUM LAG SCREW 10.5X95MM
|
Facility
OP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.38 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of IA Commercial |
$557.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$557.10
|
| Rate for Payer: Aetna of IA Medicare |
$352.83
|
| Rate for Payer: Amerigroup Medicaid |
$312.41
|
| Rate for Payer: Amerigroup Medicare |
$312.60
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$464.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$309.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$309.38
|
| Rate for Payer: Medical Associates Commercial |
$464.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$309.50
|
| Rate for Payer: Midlands Choice Commercial |
$433.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$314.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$464.25
|
| Rate for Payer: United Healthcare Commercial |
$557.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$365.21
|
|
|
IMPLANT TITANIUM LOCK SCREW 5X25 FULL TH
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.46 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of IA Commercial |
$193.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$193.50
|
| Rate for Payer: Aetna of IA Medicare |
$122.55
|
| Rate for Payer: Amerigroup Medicaid |
$108.51
|
| Rate for Payer: Amerigroup Medicare |
$108.58
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$161.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$107.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.46
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$107.50
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$109.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$161.25
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$126.85
|
|
|
IMPLANT TITANIUM LOCK SCREW 5X25 FULL TH
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of IA Commercial |
$193.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$193.50
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$161.25
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
|
|
IMPLANT TITANIUM LOCK SCREW 5X30 FULL TH
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of IA Commercial |
$193.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$193.50
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$161.25
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
|
|
IMPLANT TITANIUM LOCK SCREW 5X30 FULL TH
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.46 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of IA Commercial |
$193.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$193.50
|
| Rate for Payer: Aetna of IA Medicare |
$122.55
|
| Rate for Payer: Amerigroup Medicaid |
$108.51
|
| Rate for Payer: Amerigroup Medicare |
$108.58
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$161.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$107.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.46
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$107.50
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$109.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$161.25
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$126.85
|
|
|
IMPLANT TITANIUM LOCK SCREW 5X35 FULL TH
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.46 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of IA Commercial |
$193.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$193.50
|
| Rate for Payer: Aetna of IA Medicare |
$122.55
|
| Rate for Payer: Amerigroup Medicaid |
$108.51
|
| Rate for Payer: Amerigroup Medicare |
$108.58
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$161.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$107.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.46
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$107.50
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$109.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$161.25
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$126.85
|
|
|
IMPLANT TITANIUM LOCK SCREW 5X35 FULL TH
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of IA Commercial |
$193.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$193.50
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$161.25
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
|
|
IMPLANT TITANIUM LOCK SCREW 5X40 FULL TH
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.46 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of IA Commercial |
$193.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$193.50
|
| Rate for Payer: Aetna of IA Medicare |
$122.55
|
| Rate for Payer: Amerigroup Medicaid |
$108.51
|
| Rate for Payer: Amerigroup Medicare |
$108.58
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$161.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$107.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.46
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$107.50
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$109.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$161.25
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$126.85
|
|
|
IMPLANT TITANIUM LOCK SCREW 5X40 FULL TH
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of IA Commercial |
$193.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$193.50
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$161.25
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
|
