|
LOCKING COMPR NARROW 2 HOLE / L 43MM
|
Facility
OP
|
$160.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.97 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna of IA Commercial |
$144.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.00
|
| Rate for Payer: Aetna of IA Medicare |
$91.20
|
| Rate for Payer: Amerigroup Medicaid |
$80.75
|
| Rate for Payer: Amerigroup Medicare |
$80.80
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$80.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.97
|
| Rate for Payer: Medical Associates Commercial |
$120.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.00
|
| Rate for Payer: Midlands Choice Commercial |
$112.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$120.00
|
| Rate for Payer: United Healthcare Commercial |
$144.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.40
|
|
|
LOCKING COMPR NARROW 2 HOLE / L 43MM
|
Facility
IP
|
$160.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna of IA Commercial |
$144.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.00
|
| Rate for Payer: Medical Associates Commercial |
$120.00
|
| Rate for Payer: Midlands Choice Commercial |
$112.00
|
| Rate for Payer: United Healthcare Commercial |
$144.00
|
|
|
LOCKING COMPR NARROW 3 HOLE / L 61MM
|
Facility
OP
|
$160.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.97 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna of IA Commercial |
$144.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.00
|
| Rate for Payer: Aetna of IA Medicare |
$91.20
|
| Rate for Payer: Amerigroup Medicaid |
$80.75
|
| Rate for Payer: Amerigroup Medicare |
$80.80
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$80.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.97
|
| Rate for Payer: Medical Associates Commercial |
$120.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.00
|
| Rate for Payer: Midlands Choice Commercial |
$112.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$120.00
|
| Rate for Payer: United Healthcare Commercial |
$144.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.40
|
|
|
LOCKING COMPR NARROW 3 HOLE / L 61MM
|
Facility
IP
|
$160.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna of IA Commercial |
$144.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.00
|
| Rate for Payer: Medical Associates Commercial |
$120.00
|
| Rate for Payer: Midlands Choice Commercial |
$112.00
|
| Rate for Payer: United Healthcare Commercial |
$144.00
|
|
|
LOCKING COMPR NARROW 4 HOLE / L 79MM
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of IA Commercial |
$135.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$112.50
|
| Rate for Payer: Medical Associates Commercial |
$112.50
|
| Rate for Payer: Midlands Choice Commercial |
$105.00
|
| Rate for Payer: United Healthcare Commercial |
$135.00
|
|
|
LOCKING COMPR NARROW 4 HOLE / L 79MM
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of IA Commercial |
$135.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.00
|
| Rate for Payer: Aetna of IA Medicare |
$85.50
|
| Rate for Payer: Amerigroup Medicaid |
$75.70
|
| Rate for Payer: Amerigroup Medicare |
$75.75
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$112.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$75.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.97
|
| Rate for Payer: Medical Associates Commercial |
$112.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$105.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$76.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$112.50
|
| Rate for Payer: United Healthcare Commercial |
$135.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$88.50
|
|
|
LOCKING COMPR NARROW 5 HOLE / L 97MM
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of IA Commercial |
$135.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$112.50
|
| Rate for Payer: Medical Associates Commercial |
$112.50
|
| Rate for Payer: Midlands Choice Commercial |
$105.00
|
| Rate for Payer: United Healthcare Commercial |
$135.00
|
|
|
LOCKING COMPR NARROW 5 HOLE / L 97MM
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of IA Commercial |
$135.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.00
|
| Rate for Payer: Aetna of IA Medicare |
$85.50
|
| Rate for Payer: Amerigroup Medicaid |
$75.70
|
| Rate for Payer: Amerigroup Medicare |
$75.75
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$112.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$75.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.97
|
| Rate for Payer: Medical Associates Commercial |
$112.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$105.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$76.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$112.50
|
| Rate for Payer: United Healthcare Commercial |
$135.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$88.50
|
|
|
LOCKING COMPR NARROW 6 HOLE / L 115MM
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of IA Commercial |
$135.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$112.50
|
| Rate for Payer: Medical Associates Commercial |
$112.50
|
| Rate for Payer: Midlands Choice Commercial |
$105.00
|
| Rate for Payer: United Healthcare Commercial |
$135.00
|
|
|
LOCKING COMPR NARROW 6 HOLE / L 115MM
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of IA Commercial |
$135.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.00
|
| Rate for Payer: Aetna of IA Medicare |
$85.50
|
| Rate for Payer: Amerigroup Medicaid |
$75.70
|
| Rate for Payer: Amerigroup Medicare |
$75.75
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$112.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$75.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.97
|
| Rate for Payer: Medical Associates Commercial |
$112.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$105.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$76.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$112.50
|
| Rate for Payer: United Healthcare Commercial |
$135.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$88.50
|
|
|
LOCKING COMPR NARROW 7 HOLE / L 133MM
|
Facility
IP
|
$188.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.60 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna of IA Commercial |
$169.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$169.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$141.00
|
| Rate for Payer: Medical Associates Commercial |
$141.00
|
| Rate for Payer: Midlands Choice Commercial |
$131.60
|
| Rate for Payer: United Healthcare Commercial |
$169.20
|
|
|
LOCKING COMPR NARROW 7 HOLE / L 133MM
|
Facility
OP
|
$188.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.96 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna of IA Commercial |
$169.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$169.20
|
| Rate for Payer: Aetna of IA Medicare |
$107.16
|
| Rate for Payer: Amerigroup Medicaid |
$94.88
|
| Rate for Payer: Amerigroup Medicare |
$94.94
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$141.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$94.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$93.96
|
| Rate for Payer: Medical Associates Commercial |
$141.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$94.00
|
| Rate for Payer: Midlands Choice Commercial |
$131.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$95.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$141.00
|
| Rate for Payer: United Healthcare Commercial |
$169.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$110.92
|
|
|
LOCKING COMPR NARROW 8 HOLE / L 151MM
|
Facility
OP
|
$188.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.96 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna of IA Commercial |
$169.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$169.20
|
| Rate for Payer: Aetna of IA Medicare |
$107.16
|
| Rate for Payer: Amerigroup Medicaid |
$94.88
|
| Rate for Payer: Amerigroup Medicare |
$94.94
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$141.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$94.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$93.96
|
| Rate for Payer: Medical Associates Commercial |
$141.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$94.00
|
| Rate for Payer: Midlands Choice Commercial |
$131.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$95.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$141.00
|
| Rate for Payer: United Healthcare Commercial |
$169.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$110.92
|
|
|
LOCKING COMPR NARROW 8 HOLE / L 151MM
|
Facility
IP
|
$188.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.60 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna of IA Commercial |
$169.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$169.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$141.00
|
| Rate for Payer: Medical Associates Commercial |
$141.00
|
| Rate for Payer: Midlands Choice Commercial |
$131.60
|
| Rate for Payer: United Healthcare Commercial |
$169.20
|
|
|
LOCKING COMPR NARROW 9 HOLE / L 169MM
|
Facility
OP
|
$188.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.96 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna of IA Commercial |
$169.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$169.20
|
| Rate for Payer: Aetna of IA Medicare |
$107.16
|
| Rate for Payer: Amerigroup Medicaid |
$94.88
|
| Rate for Payer: Amerigroup Medicare |
$94.94
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$141.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$94.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$93.96
|
| Rate for Payer: Medical Associates Commercial |
$141.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$94.00
|
| Rate for Payer: Midlands Choice Commercial |
$131.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$95.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$141.00
|
| Rate for Payer: United Healthcare Commercial |
$169.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$110.92
|
|
|
LOCKING COMPR NARROW 9 HOLE / L 169MM
|
Facility
IP
|
$188.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.60 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna of IA Commercial |
$169.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$169.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$141.00
|
| Rate for Payer: Medical Associates Commercial |
$141.00
|
| Rate for Payer: Midlands Choice Commercial |
$131.60
|
| Rate for Payer: United Healthcare Commercial |
$169.20
|
|
|
LOCKING DISTAL FIBULA PLATE RIGHT 6H
|
Facility
OP
|
$1,395.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8783228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$697.22 |
| Max. Negotiated Rate |
$1,255.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,255.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,255.50
|
| Rate for Payer: Aetna of IA Medicare |
$795.15
|
| Rate for Payer: Amerigroup Medicaid |
$704.06
|
| Rate for Payer: Amerigroup Medicare |
$704.48
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,046.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$697.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$697.22
|
| Rate for Payer: Medical Associates Commercial |
$1,046.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$697.50
|
| Rate for Payer: Midlands Choice Commercial |
$976.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$707.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,046.25
|
| Rate for Payer: United Healthcare Commercial |
$1,255.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$823.05
|
|
|
LOCKING DISTAL FIBULA PLATE RIGHT 6H
|
Facility
IP
|
$1,395.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8783228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$976.50 |
| Max. Negotiated Rate |
$1,255.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,255.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,046.25
|
| Rate for Payer: Medical Associates Commercial |
$1,046.25
|
| Rate for Payer: Midlands Choice Commercial |
$976.50
|
| Rate for Payer: United Healthcare Commercial |
$1,255.50
|
|
|
LOCKING SCREW 2.2MMX14MM
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8814836
|
|
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
|
|
|
LOCKING SCREW 2.2MMX14MM
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8814836
|
|
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: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
LOCKING SCREW 2.2MMX16MM
|
Facility
IP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8815110
|
|
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
|
|
|
LOCKING SCREW 2.2MMX16MM
|
Facility
OP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8815110
|
|
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: Partners Health Alliance Commercial |
$249.75
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
|
|
LOCKING SCREW 2.4MMX10MM
|
Facility
IP
|
$288.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8700306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna of IA Commercial |
$259.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$259.20
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$216.00
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
|
|
LOCKING SCREW 2.4MMX10MM
|
Facility
OP
|
$288.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8700306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.94 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna of IA Commercial |
$259.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$259.20
|
| Rate for Payer: Aetna of IA Medicare |
$164.16
|
| Rate for Payer: Amerigroup Medicaid |
$145.35
|
| Rate for Payer: Amerigroup Medicare |
$145.44
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$216.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$144.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$143.94
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$144.00
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$146.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$216.00
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$169.92
|
|
|
LOCKING SCREW 2.4MMX12MM
|
Facility
IP
|
$288.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8700308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna of IA Commercial |
$259.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$259.20
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$216.00
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
|
