|
SCREW CANCELLOUS FULL THREAD X 45
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046589
|
|
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 FULL THREAD X 50
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046590
|
|
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 FULL THREAD X 50
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046590
|
|
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 FULL THREAD X 55
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046591
|
|
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 FULL THREAD X 55
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046591
|
|
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 CANN COUNTERSINK 2.0/2.4MM
|
Facility
IP
|
$423.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.10 |
| Max. Negotiated Rate |
$380.70 |
| Rate for Payer: Aetna of IA Commercial |
$380.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$380.70
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$317.25
|
| Rate for Payer: Medical Associates Commercial |
$317.25
|
| Rate for Payer: Midlands Choice Commercial |
$296.10
|
| Rate for Payer: United Healthcare Commercial |
$380.70
|
|
|
SCREW CANN COUNTERSINK 2.0/2.4MM
|
Facility
OP
|
$423.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.42 |
| Max. Negotiated Rate |
$380.70 |
| Rate for Payer: Aetna of IA Commercial |
$380.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$380.70
|
| Rate for Payer: Aetna of IA Medicare |
$241.11
|
| Rate for Payer: Amerigroup Medicaid |
$213.49
|
| Rate for Payer: Amerigroup Medicare |
$213.62
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$317.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$211.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$211.42
|
| Rate for Payer: Medical Associates Commercial |
$317.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$211.50
|
| Rate for Payer: Midlands Choice Commercial |
$296.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$214.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$317.25
|
| Rate for Payer: United Healthcare Commercial |
$380.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$249.57
|
|
|
SCREW CANN COUNTERSINK 3.0/4.0MM
|
Facility
OP
|
$464.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.91 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna of IA Commercial |
$417.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$417.60
|
| Rate for Payer: Aetna of IA Medicare |
$264.48
|
| Rate for Payer: Amerigroup Medicaid |
$234.18
|
| Rate for Payer: Amerigroup Medicare |
$234.32
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$348.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$232.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$231.91
|
| Rate for Payer: Medical Associates Commercial |
$348.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$232.00
|
| Rate for Payer: Midlands Choice Commercial |
$324.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$235.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$348.00
|
| Rate for Payer: United Healthcare Commercial |
$417.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$273.76
|
|
|
SCREW CANN COUNTERSINK 3.0/4.0MM
|
Facility
IP
|
$464.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.80 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna of IA Commercial |
$417.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$417.60
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$348.00
|
| Rate for Payer: Medical Associates Commercial |
$348.00
|
| Rate for Payer: Midlands Choice Commercial |
$324.80
|
| Rate for Payer: United Healthcare Commercial |
$417.60
|
|
|
SCREW CANN LAG 6.7MMX40MM 18MM THREAD
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047234
|
|
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
|
|
|
SCREW CANN LAG 6.7MMX40MM 18MM THREAD
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047234
|
|
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
|
|
|
SCREW CANN LAG 6.7MMX45MM 18MM THREAD
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047235
|
|
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
|
|
|
SCREW CANN LAG 6.7MMX45MM 18MM THREAD
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047235
|
|
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
|
|
|
SCREW CANN LAG 6.7MMX50MM 18MM THREAD
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047236
|
|
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
|
|
|
SCREW CANN LAG 6.7MMX50MM 18MM THREAD
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047236
|
|
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
|
|
|
SCREW CANN LAG 6.7MMX55MM 18MM THREAD
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047237
|
|
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
|
|
|
SCREW CANN LAG 6.7MMX55MM 18MM THREAD
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047237
|
|
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
|
|
|
SCREW CANN LAG 6.7MMX60MM 18MM THREAD
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047238
|
|
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
|
|
|
SCREW CANN LAG 6.7MMX60MM 18MM THREAD
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047238
|
|
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
|
|
|
SCREW CANN LAG 6.7MMX65MM 18MM THREAD
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047239
|
|
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
|
|
|
SCREW CANN LAG 6.7MMX65MM 18MM THREAD
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047239
|
|
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
|
|
|
SCREW CANN LAG 6.7MMX70MM 18MM THREAD
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047240
|
|
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
|
|
|
SCREW CANN LAG 6.7MMX70MM 18MM THREAD
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047240
|
|
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
|
|
|
SCREW CANN LAG 6.7MMX75MM 18MM THREAD
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047241
|
|
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
|
|
|
SCREW CANN LAG 6.7MMX75MM 18MM THREAD
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047241
|
|
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
|
|
