|
LOCKING COMPR NARROW 8 HOLE / L 151MM
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.60 |
| 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: Aetna of IA Medicare |
$107.16
|
| Rate for Payer: Amerigroup Medicaid |
$108.44
|
| Rate for Payer: Amerigroup Medicare |
$85.45
|
| 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 |
$84.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.39
|
| Rate for Payer: Medical Associates Commercial |
$141.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$84.60
|
| Rate for Payer: Midlands Choice Commercial |
$131.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$108.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$97.29
|
| 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
|
HCPCS 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
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS 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 COMPR NARROW 9 HOLE / L 169MM
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.60 |
| 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: Aetna of IA Medicare |
$107.16
|
| Rate for Payer: Amerigroup Medicaid |
$108.44
|
| Rate for Payer: Amerigroup Medicare |
$85.45
|
| 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 |
$84.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.39
|
| Rate for Payer: Medical Associates Commercial |
$141.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$84.60
|
| Rate for Payer: Midlands Choice Commercial |
$131.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$108.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$97.29
|
| Rate for Payer: United Healthcare Commercial |
$169.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$110.92
|
|
|
LOCKING DISTAL FIBULA PLATE RIGHT 6H
|
Facility
|
OP
|
$1,395.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8783228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.75 |
| 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 |
$804.64
|
| Rate for Payer: Amerigroup Medicare |
$634.03
|
| 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 |
$627.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$796.82
|
| Rate for Payer: Medical Associates Commercial |
$1,046.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$627.75
|
| Rate for Payer: Midlands Choice Commercial |
$976.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$808.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$721.91
|
| 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
|
HCPCS 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
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8814836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.10 |
| 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 |
$114.21
|
| Rate for Payer: Amerigroup Medicare |
$89.99
|
| 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 |
$89.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.10
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.10
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.46
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
LOCKING SCREW 2.2MMX14MM
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS 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 2.2MMX16MM
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS 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
|
HCPCS C1713
|
| Hospital Charge Code |
8815110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.85 |
| 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 |
$192.07
|
| Rate for Payer: Amerigroup Medicare |
$151.35
|
| 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 |
$149.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$190.21
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$149.85
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$193.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$172.33
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
|
|
LOCKING SCREW 2.4MMX10MM
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8700306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| 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: Aetna of IA Medicare |
$164.16
|
| Rate for Payer: Amerigroup Medicaid |
$166.12
|
| Rate for Payer: Amerigroup Medicare |
$130.90
|
| 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 |
$129.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$164.51
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$129.60
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$166.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$149.04
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$169.92
|
|
|
LOCKING SCREW 2.4MMX10MM
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 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 2.4MMX12MM
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8700308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| 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: Aetna of IA Medicare |
$164.16
|
| Rate for Payer: Amerigroup Medicaid |
$166.12
|
| Rate for Payer: Amerigroup Medicare |
$130.90
|
| 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 |
$129.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$164.51
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$129.60
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$166.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$149.04
|
| 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
|
HCPCS 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
|
|
|
LOCKING SCREW 2.4MMX20
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8734822
|
|
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 2.4MMX20
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8734822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| 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: Aetna of IA Medicare |
$164.16
|
| Rate for Payer: Amerigroup Medicaid |
$166.12
|
| Rate for Payer: Amerigroup Medicare |
$130.90
|
| 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 |
$129.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$164.51
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$129.60
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$166.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$149.04
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$169.92
|
|
|
LOCKING SCREW 2.4X18MM
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8700310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.40 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna of IA Commercial |
$307.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$307.80
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$256.50
|
| Rate for Payer: Medical Associates Commercial |
$256.50
|
| Rate for Payer: Midlands Choice Commercial |
$239.40
|
| Rate for Payer: United Healthcare Commercial |
$307.80
|
|
|
LOCKING SCREW 2.4X18MM
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8700310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna of IA Commercial |
$307.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$307.80
|
| Rate for Payer: Aetna of IA Medicare |
$194.94
|
| Rate for Payer: Amerigroup Medicaid |
$197.27
|
| Rate for Payer: Amerigroup Medicare |
$155.44
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$256.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$153.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$195.35
|
| Rate for Payer: Medical Associates Commercial |
$256.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$153.90
|
| Rate for Payer: Midlands Choice Commercial |
$239.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$198.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$176.98
|
| Rate for Payer: United Healthcare Commercial |
$307.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$201.78
|
|
|
LOCKING SCREW 2.7MMX10MM
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8793255
|
|
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 2.7MMX10MM
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8793255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.85 |
| 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 |
$192.07
|
| Rate for Payer: Amerigroup Medicare |
$151.35
|
| 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 |
$149.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$190.21
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$149.85
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$193.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$172.33
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
|
|
LOCKING SCREW 2.7MMX14MM
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8759896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.05 |
| Max. Negotiated Rate |
$332.10 |
| Rate for Payer: Aetna of IA Commercial |
$332.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$332.10
|
| Rate for Payer: Aetna of IA Medicare |
$210.33
|
| Rate for Payer: Amerigroup Medicaid |
$212.84
|
| Rate for Payer: Amerigroup Medicare |
$167.71
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$276.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$166.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$210.77
|
| Rate for Payer: Medical Associates Commercial |
$276.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$166.05
|
| Rate for Payer: Midlands Choice Commercial |
$258.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$213.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$190.96
|
| Rate for Payer: United Healthcare Commercial |
$332.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$217.71
|
|
|
LOCKING SCREW 2.7MMX14MM
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8759896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.30 |
| Max. Negotiated Rate |
$332.10 |
| Rate for Payer: Aetna of IA Commercial |
$332.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$332.10
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$276.75
|
| Rate for Payer: Medical Associates Commercial |
$276.75
|
| Rate for Payer: Midlands Choice Commercial |
$258.30
|
| Rate for Payer: United Healthcare Commercial |
$332.10
|
|
|
LOCKING SCREW 2.7MMX16MM
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8759898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.30 |
| Max. Negotiated Rate |
$332.10 |
| Rate for Payer: Aetna of IA Commercial |
$332.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$332.10
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$276.75
|
| Rate for Payer: Medical Associates Commercial |
$276.75
|
| Rate for Payer: Midlands Choice Commercial |
$258.30
|
| Rate for Payer: United Healthcare Commercial |
$332.10
|
|
|
LOCKING SCREW 2.7MMX16MM
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8759898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.05 |
| Max. Negotiated Rate |
$332.10 |
| Rate for Payer: Aetna of IA Commercial |
$332.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$332.10
|
| Rate for Payer: Aetna of IA Medicare |
$210.33
|
| Rate for Payer: Amerigroup Medicaid |
$212.84
|
| Rate for Payer: Amerigroup Medicare |
$167.71
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$276.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$166.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$210.77
|
| Rate for Payer: Medical Associates Commercial |
$276.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$166.05
|
| Rate for Payer: Midlands Choice Commercial |
$258.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$213.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$190.96
|
| Rate for Payer: United Healthcare Commercial |
$332.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$217.71
|
|
|
LOCKING SCREW 2.7MMX24MM
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8956488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Aetna of IA Medicare |
$230.85
|
| Rate for Payer: Amerigroup Medicaid |
$233.60
|
| Rate for Payer: Amerigroup Medicare |
$184.07
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$182.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$231.34
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$182.25
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$234.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$209.59
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
