|
SCREW CANNULATED ASNIS III 4.0X32MM
|
Facility
OP
|
$197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.46 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Aetna of IA Commercial |
$177.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$177.30
|
| Rate for Payer: Aetna of IA Medicare |
$112.29
|
| Rate for Payer: Amerigroup Medicaid |
$99.43
|
| Rate for Payer: Amerigroup Medicare |
$99.48
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$98.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.46
|
| Rate for Payer: Medical Associates Commercial |
$147.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$98.50
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$99.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$147.75
|
| Rate for Payer: United Healthcare Commercial |
$177.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.23
|
|
|
SCREW CANNULATED ASNIS III 4.0X34MM
|
Facility
IP
|
$197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.90 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Aetna of IA Commercial |
$177.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$177.30
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.75
|
| Rate for Payer: Medical Associates Commercial |
$147.75
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: United Healthcare Commercial |
$177.30
|
|
|
SCREW CANNULATED ASNIS III 4.0X34MM
|
Facility
OP
|
$197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.46 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Aetna of IA Commercial |
$177.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$177.30
|
| Rate for Payer: Aetna of IA Medicare |
$112.29
|
| Rate for Payer: Amerigroup Medicaid |
$99.43
|
| Rate for Payer: Amerigroup Medicare |
$99.48
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$98.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.46
|
| Rate for Payer: Medical Associates Commercial |
$147.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$98.50
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$99.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$147.75
|
| Rate for Payer: United Healthcare Commercial |
$177.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.23
|
|
|
SCREW CANNULATED ASNIS III 4.0X36MM
|
Facility
IP
|
$249.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.30 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Aetna of IA Commercial |
$224.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$224.10
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$186.75
|
| Rate for Payer: Medical Associates Commercial |
$186.75
|
| Rate for Payer: Midlands Choice Commercial |
$174.30
|
| Rate for Payer: United Healthcare Commercial |
$224.10
|
|
|
SCREW CANNULATED ASNIS III 4.0X36MM
|
Facility
OP
|
$249.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.45 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Aetna of IA Commercial |
$224.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$224.10
|
| Rate for Payer: Aetna of IA Medicare |
$141.93
|
| Rate for Payer: Amerigroup Medicaid |
$125.67
|
| Rate for Payer: Amerigroup Medicare |
$125.74
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$186.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$124.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$124.45
|
| Rate for Payer: Medical Associates Commercial |
$186.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$124.50
|
| Rate for Payer: Midlands Choice Commercial |
$174.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$126.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$186.75
|
| Rate for Payer: United Healthcare Commercial |
$224.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$146.91
|
|
|
SCREW CANNULATED ASNIS III 4.0X38MM
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Aetna of IA Medicare |
$115.14
|
| Rate for Payer: Amerigroup Medicaid |
$101.95
|
| Rate for Payer: Amerigroup Medicare |
$102.01
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$101.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.96
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$101.00
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$151.50
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.18
|
|
|
SCREW CANNULATED ASNIS III 4.0X38MM
|
Facility
IP
|
$202.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
|
|
SCREW CANNULATED ASNIS III 4.0X40MM
|
Facility
OP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.45 |
| Max. Negotiated Rate |
$234.90 |
| Rate for Payer: Aetna of IA Commercial |
$234.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.90
|
| Rate for Payer: Aetna of IA Medicare |
$148.77
|
| Rate for Payer: Amerigroup Medicaid |
$131.73
|
| Rate for Payer: Amerigroup Medicare |
$131.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$130.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$130.45
|
| Rate for Payer: Medical Associates Commercial |
$195.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$130.50
|
| Rate for Payer: Midlands Choice Commercial |
$182.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$132.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$195.75
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.99
|
|
|
SCREW CANNULATED ASNIS III 4.0X40MM
|
Facility
IP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.70 |
| Max. Negotiated Rate |
$234.90 |
| Rate for Payer: Aetna of IA Commercial |
$234.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.90
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.75
|
| Rate for Payer: Medical Associates Commercial |
$195.75
|
| Rate for Payer: Midlands Choice Commercial |
$182.70
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
|
|
SCREW CANNULATED ASNIS III 4.0X42MM
|
Facility
IP
|
$202.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
|
|
SCREW CANNULATED ASNIS III 4.0X42MM
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Aetna of IA Medicare |
$115.14
|
| Rate for Payer: Amerigroup Medicaid |
$101.95
|
| Rate for Payer: Amerigroup Medicare |
$102.01
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$101.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.96
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$101.00
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$151.50
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.18
|
|
|
SCREW CANNULATED ASNIS III 4.0X44MM
|
Facility
IP
|
$202.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
|
|
SCREW CANNULATED ASNIS III 4.0X44MM
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Aetna of IA Medicare |
$115.14
|
| Rate for Payer: Amerigroup Medicaid |
$101.95
|
| Rate for Payer: Amerigroup Medicare |
$102.01
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$101.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.96
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$101.00
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$151.50
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.18
|
|
|
SCREW CANNULATED ASNIS III 4.0X46MM
|
Facility
IP
|
$202.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
|
|
SCREW CANNULATED ASNIS III 4.0X46MM
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Aetna of IA Medicare |
$115.14
|
| Rate for Payer: Amerigroup Medicaid |
$101.95
|
| Rate for Payer: Amerigroup Medicare |
$102.01
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$101.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.96
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$101.00
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$151.50
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.18
|
|
|
SCREW CANNULATED ASNIS III 4.0X48MM
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Aetna of IA Medicare |
$115.14
|
| Rate for Payer: Amerigroup Medicaid |
$101.95
|
| Rate for Payer: Amerigroup Medicare |
$102.01
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$101.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.96
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$101.00
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$151.50
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.18
|
|
|
SCREW CANNULATED ASNIS III 4.0X48MM
|
Facility
IP
|
$202.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
|
|
SCREW CANNULATED ASNIS III 4.0X50MM
|
Facility
IP
|
$202.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
|
|
SCREW CANNULATED ASNIS III 4.0X50MM
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Aetna of IA Medicare |
$115.14
|
| Rate for Payer: Amerigroup Medicaid |
$101.95
|
| Rate for Payer: Amerigroup Medicare |
$102.01
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$101.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.96
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$101.00
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$151.50
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.18
|
|
|
SCREW CANNULATED ASNIS III 4.0X55MM
|
Facility
IP
|
$202.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
|
|
SCREW CANNULATED ASNIS III 4.0X55MM
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Aetna of IA Medicare |
$115.14
|
| Rate for Payer: Amerigroup Medicaid |
$101.95
|
| Rate for Payer: Amerigroup Medicare |
$102.01
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$101.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.96
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$101.00
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$151.50
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.18
|
|
|
SCREW CANNULATED ASNIS III 4.0X60MM
|
Facility
OP
|
$203.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.46 |
| Max. Negotiated Rate |
$182.70 |
| Rate for Payer: Aetna of IA Commercial |
$182.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$182.70
|
| Rate for Payer: Aetna of IA Medicare |
$115.71
|
| Rate for Payer: Amerigroup Medicaid |
$102.45
|
| Rate for Payer: Amerigroup Medicare |
$102.52
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$152.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$101.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$101.46
|
| Rate for Payer: Medical Associates Commercial |
$152.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$101.50
|
| Rate for Payer: Midlands Choice Commercial |
$142.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$103.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$152.25
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.77
|
|
|
SCREW CANNULATED ASNIS III 4.0X60MM
|
Facility
IP
|
$203.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$182.70 |
| Rate for Payer: Aetna of IA Commercial |
$182.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$182.70
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$152.25
|
| Rate for Payer: Medical Associates Commercial |
$152.25
|
| Rate for Payer: Midlands Choice Commercial |
$142.10
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
|
|
SCREW CANNULATED HEADED 3.5X26MM
|
Facility
OP
|
$374.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.93 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Aetna of IA Commercial |
$336.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$336.60
|
| Rate for Payer: Aetna of IA Medicare |
$213.18
|
| Rate for Payer: Amerigroup Medicaid |
$188.76
|
| Rate for Payer: Amerigroup Medicare |
$188.87
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$280.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$187.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$186.93
|
| Rate for Payer: Medical Associates Commercial |
$280.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$187.00
|
| Rate for Payer: Midlands Choice Commercial |
$261.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$189.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$280.50
|
| Rate for Payer: United Healthcare Commercial |
$336.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$220.66
|
|
|
SCREW CANNULATED HEADED 3.5X26MM
|
Facility
IP
|
$374.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$261.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Aetna of IA Commercial |
$336.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$336.60
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$280.50
|
| Rate for Payer: Medical Associates Commercial |
$280.50
|
| Rate for Payer: Midlands Choice Commercial |
$261.80
|
| Rate for Payer: United Healthcare Commercial |
$336.60
|
|
