|
SCREW CANCELLOUS 6.5 X 95MM 16MMT/L
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Aetna of IA Medicare |
$22.80
|
| Rate for Payer: Amerigroup Medicaid |
$20.19
|
| Rate for Payer: Amerigroup Medicare |
$20.20
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.99
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.30
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$20.29
|
| Rate for Payer: Oscar Health of IA Commercial |
$30.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.60
|
|
|
SCREW CANCELLOUS 6.5 X 95MM 32MMT/L
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
|
|
SCREW CANCELLOUS 6.5 X 95MM 32MMT/L
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Aetna of IA Medicare |
$22.80
|
| Rate for Payer: Amerigroup Medicaid |
$20.19
|
| Rate for Payer: Amerigroup Medicare |
$20.20
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.99
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.30
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$20.29
|
| Rate for Payer: Oscar Health of IA Commercial |
$30.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.60
|
|
|
SCREW CANCELLOUS BONE 6.5MM X 20MM
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.44 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Aetna of IA Commercial |
$263.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$263.70
|
| Rate for Payer: Aetna of IA Medicare |
$167.01
|
| Rate for Payer: Amerigroup Medicaid |
$147.88
|
| Rate for Payer: Amerigroup Medicare |
$147.96
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$219.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$146.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$146.44
|
| Rate for Payer: Medical Associates Commercial |
$219.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$146.50
|
| Rate for Payer: Midlands Choice Commercial |
$205.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$148.70
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$148.61
|
| Rate for Payer: Oscar Health of IA Commercial |
$219.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$219.75
|
| Rate for Payer: United Healthcare Commercial |
$263.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$172.87
|
|
|
SCREW CANCELLOUS BONE 6.5MM X 20MM
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.10 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Aetna of IA Commercial |
$263.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$263.70
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$219.75
|
| Rate for Payer: Medical Associates Commercial |
$219.75
|
| Rate for Payer: Midlands Choice Commercial |
$205.10
|
| Rate for Payer: United Healthcare Commercial |
$263.70
|
|
|
SCREW CANCELLOUS BONE 6.5MM X 25MM
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Aetna of IA Commercial |
$255.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$255.60
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$213.00
|
| Rate for Payer: Medical Associates Commercial |
$213.00
|
| Rate for Payer: Midlands Choice Commercial |
$198.80
|
| Rate for Payer: United Healthcare Commercial |
$255.60
|
|
|
SCREW CANCELLOUS BONE 6.5MM X 25MM
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.94 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Aetna of IA Commercial |
$255.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$255.60
|
| Rate for Payer: Aetna of IA Medicare |
$161.88
|
| Rate for Payer: Amerigroup Medicaid |
$143.33
|
| Rate for Payer: Amerigroup Medicare |
$143.42
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$213.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$142.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$141.94
|
| Rate for Payer: Medical Associates Commercial |
$213.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$142.00
|
| Rate for Payer: Midlands Choice Commercial |
$198.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$144.13
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$144.04
|
| Rate for Payer: Oscar Health of IA Commercial |
$213.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$213.00
|
| Rate for Payer: United Healthcare Commercial |
$255.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$167.56
|
|
|
SCREW CANCELLOUS BONE 6.5MM X 30MM
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Aetna of IA Commercial |
$243.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.90
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$203.25
|
| Rate for Payer: Medical Associates Commercial |
$203.25
|
| Rate for Payer: Midlands Choice Commercial |
$189.70
|
| Rate for Payer: United Healthcare Commercial |
$243.90
|
|
|
SCREW CANCELLOUS BONE 6.5MM X 30MM
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.45 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Aetna of IA Commercial |
$243.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.90
|
| Rate for Payer: Aetna of IA Medicare |
$154.47
|
| Rate for Payer: Amerigroup Medicaid |
$136.77
|
| Rate for Payer: Amerigroup Medicare |
$136.86
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$203.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$135.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$135.45
|
| Rate for Payer: Medical Associates Commercial |
$203.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$135.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$137.53
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$137.45
|
| Rate for Payer: Oscar Health of IA Commercial |
$203.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$203.25
|
| Rate for Payer: United Healthcare Commercial |
$243.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.89
|
|
|
SCREW CANCELLOUS BONE 6.5MM X 35MM
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.10 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Aetna of IA Commercial |
$263.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$263.70
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$219.75
|
| Rate for Payer: Medical Associates Commercial |
$219.75
|
| Rate for Payer: Midlands Choice Commercial |
$205.10
|
| Rate for Payer: United Healthcare Commercial |
$263.70
|
|
|
SCREW CANCELLOUS BONE 6.5MM X 35MM
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.44 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Aetna of IA Commercial |
$263.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$263.70
|
| Rate for Payer: Aetna of IA Medicare |
$167.01
|
| Rate for Payer: Amerigroup Medicaid |
$147.88
|
| Rate for Payer: Amerigroup Medicare |
$147.96
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$219.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$146.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$146.44
|
| Rate for Payer: Medical Associates Commercial |
$219.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$146.50
|
| Rate for Payer: Midlands Choice Commercial |
$205.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$148.70
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$148.61
|
| Rate for Payer: Oscar Health of IA Commercial |
$219.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$219.75
|
| Rate for Payer: United Healthcare Commercial |
$263.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$172.87
|
|
|
SCREW CANCELLOUS FULL THREAD X 10
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046573
|
|
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: Molina Healthcare Managed Medicare |
$12.17
|
| Rate for Payer: Oscar Health of IA Commercial |
$18.00
|
| 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 10
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046573
|
|
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 12
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046574
|
|
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: Molina Healthcare Managed Medicare |
$12.17
|
| Rate for Payer: Oscar Health of IA Commercial |
$18.00
|
| 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 12
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046574
|
|
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 14
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046575
|
|
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: Molina Healthcare Managed Medicare |
$12.17
|
| Rate for Payer: Oscar Health of IA Commercial |
$18.00
|
| 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 14
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046575
|
|
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 16
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046576
|
|
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: Molina Healthcare Managed Medicare |
$12.17
|
| Rate for Payer: Oscar Health of IA Commercial |
$18.00
|
| 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 16
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046576
|
|
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 18
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046577
|
|
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 18
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046577
|
|
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: Molina Healthcare Managed Medicare |
$12.17
|
| Rate for Payer: Oscar Health of IA Commercial |
$18.00
|
| 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 20
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046578
|
|
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 20
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046578
|
|
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: Molina Healthcare Managed Medicare |
$12.17
|
| Rate for Payer: Oscar Health of IA Commercial |
$18.00
|
| 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 22
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046579
|
|
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 22
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046579
|
|
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: Molina Healthcare Managed Medicare |
$12.17
|
| Rate for Payer: Oscar Health of IA Commercial |
$18.00
|
| 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
|
|
