|
SCREW CANNULATED ASNIS III 4.0X14MM
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046440
|
|
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 4.0X14MM
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046440
|
|
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: Molina Healthcare Managed Medicare |
$99.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$147.75
|
| 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 4.0X16MM
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046441
|
|
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 4.0X16MM
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046441
|
|
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: Molina Healthcare Managed Medicare |
$99.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$147.75
|
| 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 4.0X18MM
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046442
|
|
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 4.0X18MM
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046442
|
|
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: Molina Healthcare Managed Medicare |
$99.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$147.75
|
| 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 4.0X20MM
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046443
|
|
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: Molina Healthcare Managed Medicare |
$99.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$147.75
|
| 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 4.0X20MM
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046443
|
|
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 4.0X22MM
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046444
|
|
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: Molina Healthcare Managed Medicare |
$99.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$147.75
|
| 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 4.0X22MM
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046444
|
|
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 4.0X24MM
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046445
|
|
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 4.0X24MM
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046445
|
|
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: Molina Healthcare Managed Medicare |
$99.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$147.75
|
| 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 4.0X26MM
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna of IA Commercial |
$214.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$214.20
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$178.50
|
| Rate for Payer: Medical Associates Commercial |
$178.50
|
| Rate for Payer: Midlands Choice Commercial |
$166.60
|
| Rate for Payer: United Healthcare Commercial |
$214.20
|
|
|
SCREW CANNULATED ASNIS III 4.0X26MM
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.95 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna of IA Commercial |
$214.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$214.20
|
| Rate for Payer: Aetna of IA Medicare |
$135.66
|
| Rate for Payer: Amerigroup Medicaid |
$120.12
|
| Rate for Payer: Amerigroup Medicare |
$120.19
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$178.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$119.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$118.95
|
| Rate for Payer: Medical Associates Commercial |
$178.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$119.00
|
| Rate for Payer: Midlands Choice Commercial |
$166.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$120.78
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$120.71
|
| Rate for Payer: Oscar Health of IA Commercial |
$178.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$178.50
|
| Rate for Payer: United Healthcare Commercial |
$214.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$140.42
|
|
|
SCREW CANNULATED ASNIS III 4.0X28MM
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046447
|
|
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 4.0X28MM
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046447
|
|
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: Molina Healthcare Managed Medicare |
$99.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$147.75
|
| 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 4.0X30MM
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046448
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.10 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Aetna of IA Commercial |
$218.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$218.70
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$182.25
|
| Rate for Payer: Medical Associates Commercial |
$182.25
|
| Rate for Payer: Midlands Choice Commercial |
$170.10
|
| Rate for Payer: United Healthcare Commercial |
$218.70
|
|
|
SCREW CANNULATED ASNIS III 4.0X30MM
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046448
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.45 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Aetna of IA Commercial |
$218.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$218.70
|
| Rate for Payer: Aetna of IA Medicare |
$138.51
|
| Rate for Payer: Amerigroup Medicaid |
$122.64
|
| Rate for Payer: Amerigroup Medicare |
$122.72
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$182.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$121.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$121.45
|
| Rate for Payer: Medical Associates Commercial |
$182.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.50
|
| Rate for Payer: Midlands Choice Commercial |
$170.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$123.32
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$123.25
|
| Rate for Payer: Oscar Health of IA Commercial |
$182.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$182.25
|
| Rate for Payer: United Healthcare Commercial |
$218.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$143.37
|
|
|
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: Molina Healthcare Managed Medicare |
$99.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$147.75
|
| 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 4.0X32MM
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046449
|
|
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: Molina Healthcare Managed Medicare |
$99.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$147.75
|
| 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 4.0X36MM
|
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: Molina Healthcare Managed Medicare |
$126.29
|
| Rate for Payer: Oscar Health of IA Commercial |
$186.75
|
| 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 4.0X36MM
|
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 4.0X38MM
|
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
|
|
