|
IMPLANT TITANIUM LOCK SCREW 5X45 FULL TH
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046342
|
|
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 5X45 FULL TH
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046342
|
|
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 5X50 FULL TH
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046343
|
|
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 5X50 FULL TH
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046343
|
|
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 5X55 FULL TH
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046344
|
|
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 5X55 FULL TH
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046344
|
|
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 5X60 FULL TH
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046345
|
|
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 5X60 FULL TH
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046345
|
|
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 5X65 FULL TH
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046346
|
|
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 5X65 FULL TH
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046346
|
|
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 5X70 FULL TH
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046347
|
|
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 5X70 FULL TH
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046347
|
|
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 5X75 FULL TH
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046348
|
|
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 5X75 FULL TH
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046348
|
|
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 5X80 FULL TH
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046349
|
|
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 5X80 FULL TH
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046349
|
|
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 5X85 FULL TH
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046350
|
|
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 5X85 FULL TH
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046350
|
|
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 5X90 FULL TH
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046351
|
|
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 5X90 FULL TH
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046351
|
|
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 LONG NAIL 11X300X125L
|
Facility
OP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.56 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,116.40
|
| Rate for Payer: Amerigroup Medicare |
$1,117.06
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,105.56
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,122.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
|
IMPLANT TITANIUM LONG NAIL 11X300X125L
|
Facility
IP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.40 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
|
|
IMPLANT TITANIUM LONG NAIL 11X300X125R
|
Facility
IP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.40 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
|
|
IMPLANT TITANIUM LONG NAIL 11X300X125R
|
Facility
OP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.56 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,116.40
|
| Rate for Payer: Amerigroup Medicare |
$1,117.06
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,105.56
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,122.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
|
IMPLANT TITANIUM LONG NAIL 11X320X125L
|
Facility
IP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.40 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
|
