|
SCREW BONE T7 2.7X16MM
|
Facility
OP
|
$84.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of IA Commercial |
$75.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$75.60
|
| Rate for Payer: Aetna of IA Medicare |
$47.88
|
| Rate for Payer: Amerigroup Medicaid |
$42.39
|
| Rate for Payer: Amerigroup Medicare |
$42.42
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.98
|
| Rate for Payer: Medical Associates Commercial |
$63.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.00
|
| Rate for Payer: Midlands Choice Commercial |
$58.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$63.00
|
| Rate for Payer: United Healthcare Commercial |
$75.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$49.56
|
|
|
SCREW BONE T7 2.7X16MM
|
Facility
IP
|
$84.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of IA Commercial |
$75.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$75.60
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.00
|
| Rate for Payer: Medical Associates Commercial |
$63.00
|
| Rate for Payer: Midlands Choice Commercial |
$58.80
|
| Rate for Payer: United Healthcare Commercial |
$75.60
|
|
|
SCREW BONE T7 2.7X18MM
|
Facility
IP
|
$84.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of IA Commercial |
$75.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$75.60
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.00
|
| Rate for Payer: Medical Associates Commercial |
$63.00
|
| Rate for Payer: Midlands Choice Commercial |
$58.80
|
| Rate for Payer: United Healthcare Commercial |
$75.60
|
|
|
SCREW BONE T7 2.7X18MM
|
Facility
OP
|
$84.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of IA Commercial |
$75.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$75.60
|
| Rate for Payer: Aetna of IA Medicare |
$47.88
|
| Rate for Payer: Amerigroup Medicaid |
$42.39
|
| Rate for Payer: Amerigroup Medicare |
$42.42
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.98
|
| Rate for Payer: Medical Associates Commercial |
$63.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.00
|
| Rate for Payer: Midlands Choice Commercial |
$58.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$63.00
|
| Rate for Payer: United Healthcare Commercial |
$75.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$49.56
|
|
|
SCREW CANCELLOUS
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046595
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Aetna of IA Medicare |
$13.68
|
| Rate for Payer: Amerigroup Medicaid |
$12.11
|
| Rate for Payer: Amerigroup Medicare |
$12.12
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.16
|
|
|
SCREW CANCELLOUS
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046595
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
|
|
SCREW CANCELLOUS 3.0 X 10MM, LPS, SS
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
SCREW CANCELLOUS 3.0 X 10MM, LPS, SS
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
SCREW CANCELLOUS 3.0 X 12MM, LPS, SS
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
SCREW CANCELLOUS 3.0 X 12MM, LPS, SS
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
SCREW CANCELLOUS 3.0 X 14MM, LPS, SS
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047085
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
SCREW CANCELLOUS 3.0 X 14MM, LPS, SS
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047085
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
SCREW CANCELLOUS 3.0 X 16MM, LPS, SS
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
SCREW CANCELLOUS 3.0 X 16MM, LPS, SS
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
SCREW CANCELLOUS 3.0 X 18MM, LPS, SS
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
SCREW CANCELLOUS 3.0 X 18MM, LPS, SS
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
SCREW CANCELLOUS 3.0 X 20MM, LPS, SS
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
SCREW CANCELLOUS 3.0 X 20MM, LPS, SS
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
SCREW CANCELLOUS 3.0 X 22MM, LPS, SS
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
SCREW CANCELLOUS 3.0 X 22MM, LPS, SS
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
SCREW CANCELLOUS 3.0 X 24MM, LPS, SS
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
SCREW CANCELLOUS 3.0 X 24MM, LPS, SS
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
SCREW CANCELLOUS 3.0 X 26MM, LPS, SS
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
SCREW CANCELLOUS 3.0 X 26MM, LPS, SS
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
SCREW CANCELLOUS 3.0 X 28MM, LPS, SS
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
