|
SCREW CORTEX 1.5MMX7MM
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Aetna of IA Medicare |
$19.38
|
| Rate for Payer: Amerigroup Medicaid |
$17.16
|
| Rate for Payer: Amerigroup Medicare |
$17.17
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.99
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.00
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$25.50
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.06
|
|
|
SCREW CORTEX 1.5MMX7MM
|
Facility
IP
|
$34.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
|
|
SCREW CORTEX 1.5MMX8MM
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Aetna of IA Medicare |
$19.38
|
| Rate for Payer: Amerigroup Medicaid |
$17.16
|
| Rate for Payer: Amerigroup Medicare |
$17.17
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.99
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.00
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$25.50
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.06
|
|
|
SCREW CORTEX 1.5MMX8MM
|
Facility
IP
|
$34.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
|
|
SCREW CORTEX 1.5MMX9MM
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Aetna of IA Medicare |
$19.38
|
| Rate for Payer: Amerigroup Medicaid |
$17.16
|
| Rate for Payer: Amerigroup Medicare |
$17.17
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.99
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.00
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$25.50
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.06
|
|
|
SCREW CORTEX 1.5MMX9MM
|
Facility
IP
|
$34.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
|
|
SCREW CORTEX 2.0MMX10MM
|
Facility
OP
|
$27.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.49 |
| Max. Negotiated Rate |
$24.30 |
| Rate for Payer: Aetna of IA Commercial |
$24.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.30
|
| Rate for Payer: Aetna of IA Medicare |
$15.39
|
| Rate for Payer: Amerigroup Medicaid |
$13.63
|
| Rate for Payer: Amerigroup Medicare |
$13.64
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.49
|
| Rate for Payer: Medical Associates Commercial |
$20.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.50
|
| Rate for Payer: Midlands Choice Commercial |
$18.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.25
|
| Rate for Payer: United Healthcare Commercial |
$24.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.93
|
|
|
SCREW CORTEX 2.0MMX10MM
|
Facility
IP
|
$27.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$24.30 |
| Rate for Payer: Aetna of IA Commercial |
$24.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.30
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.25
|
| Rate for Payer: Medical Associates Commercial |
$20.25
|
| Rate for Payer: Midlands Choice Commercial |
$18.90
|
| Rate for Payer: United Healthcare Commercial |
$24.30
|
|
|
SCREW CORTEX 2.0MMX12MM
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna of IA Commercial |
$20.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.70
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.25
|
| Rate for Payer: Medical Associates Commercial |
$17.25
|
| Rate for Payer: Midlands Choice Commercial |
$16.10
|
| Rate for Payer: United Healthcare Commercial |
$20.70
|
|
|
SCREW CORTEX 2.0MMX12MM
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna of IA Commercial |
$20.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.70
|
| Rate for Payer: Aetna of IA Medicare |
$13.11
|
| Rate for Payer: Amerigroup Medicaid |
$11.61
|
| Rate for Payer: Amerigroup Medicare |
$11.62
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.50
|
| Rate for Payer: Medical Associates Commercial |
$17.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.50
|
| Rate for Payer: Midlands Choice Commercial |
$16.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$17.25
|
| Rate for Payer: United Healthcare Commercial |
$20.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.57
|
|
|
SCREW CORTEX 2.0MMX14MM
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna of IA Commercial |
$20.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.70
|
| Rate for Payer: Aetna of IA Medicare |
$13.11
|
| Rate for Payer: Amerigroup Medicaid |
$11.61
|
| Rate for Payer: Amerigroup Medicare |
$11.62
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.50
|
| Rate for Payer: Medical Associates Commercial |
$17.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.50
|
| Rate for Payer: Midlands Choice Commercial |
$16.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$17.25
|
| Rate for Payer: United Healthcare Commercial |
$20.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.57
|
|
|
SCREW CORTEX 2.0MMX14MM
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna of IA Commercial |
$20.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.70
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.25
|
| Rate for Payer: Medical Associates Commercial |
$17.25
|
| Rate for Payer: Midlands Choice Commercial |
$16.10
|
| Rate for Payer: United Healthcare Commercial |
$20.70
|
|
|
SCREW CORTEX 2.0MMX16MM
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.99 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of IA Commercial |
$32.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.40
|
| Rate for Payer: Aetna of IA Medicare |
$20.52
|
| Rate for Payer: Amerigroup Medicaid |
$18.17
|
| Rate for Payer: Amerigroup Medicare |
$18.18
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.99
|
| Rate for Payer: Medical Associates Commercial |
$27.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$25.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.00
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.24
|
|
|
SCREW CORTEX 2.0MMX16MM
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of IA Commercial |
$32.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.00
|
| Rate for Payer: Medical Associates Commercial |
$27.00
|
| Rate for Payer: Midlands Choice Commercial |
$25.20
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
|
|
SCREW CORTEX 2.0MMX18MM
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.99 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of IA Commercial |
$32.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.40
|
| Rate for Payer: Aetna of IA Medicare |
$20.52
|
| Rate for Payer: Amerigroup Medicaid |
$18.17
|
| Rate for Payer: Amerigroup Medicare |
$18.18
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.99
|
| Rate for Payer: Medical Associates Commercial |
$27.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$25.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.00
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.24
|
|
|
SCREW CORTEX 2.0MMX18MM
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of IA Commercial |
$32.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.00
|
| Rate for Payer: Medical Associates Commercial |
$27.00
|
| Rate for Payer: Midlands Choice Commercial |
$25.20
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
|
|
SCREW CORTEX 2.0MMX20MM
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.99 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of IA Commercial |
$32.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.40
|
| Rate for Payer: Aetna of IA Medicare |
$20.52
|
| Rate for Payer: Amerigroup Medicaid |
$18.17
|
| Rate for Payer: Amerigroup Medicare |
$18.18
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.99
|
| Rate for Payer: Medical Associates Commercial |
$27.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$25.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.00
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.24
|
|
|
SCREW CORTEX 2.0MMX20MM
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of IA Commercial |
$32.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.00
|
| Rate for Payer: Medical Associates Commercial |
$27.00
|
| Rate for Payer: Midlands Choice Commercial |
$25.20
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
|
|
SCREW CORTEX 2.0MMX6MM
|
Facility
IP
|
$13.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna of IA Commercial |
$11.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.70
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.75
|
| Rate for Payer: Medical Associates Commercial |
$9.75
|
| Rate for Payer: Midlands Choice Commercial |
$9.10
|
| Rate for Payer: United Healthcare Commercial |
$11.70
|
|
|
SCREW CORTEX 2.0MMX6MM
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna of IA Commercial |
$11.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.70
|
| Rate for Payer: Aetna of IA Medicare |
$7.41
|
| Rate for Payer: Amerigroup Medicaid |
$6.56
|
| Rate for Payer: Amerigroup Medicare |
$6.56
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.50
|
| Rate for Payer: Medical Associates Commercial |
$9.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.50
|
| Rate for Payer: Midlands Choice Commercial |
$9.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.75
|
| Rate for Payer: United Healthcare Commercial |
$11.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.67
|
|
|
SCREW CORTEX 2.0MMX8MM
|
Facility
IP
|
$34.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
|
|
SCREW CORTEX 2.0MMX8MM
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Aetna of IA Medicare |
$19.38
|
| Rate for Payer: Amerigroup Medicaid |
$17.16
|
| Rate for Payer: Amerigroup Medicare |
$17.17
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.99
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.00
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$25.50
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.06
|
|
|
SCREW CORTEX 2.7 14MM
|
Facility
IP
|
$37.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna of IA Commercial |
$33.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.30
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.75
|
| Rate for Payer: Medical Associates Commercial |
$27.75
|
| Rate for Payer: Midlands Choice Commercial |
$25.90
|
| Rate for Payer: United Healthcare Commercial |
$33.30
|
|
|
SCREW CORTEX 2.7 14MM
|
Facility
OP
|
$37.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna of IA Commercial |
$33.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.30
|
| Rate for Payer: Aetna of IA Medicare |
$21.09
|
| Rate for Payer: Amerigroup Medicaid |
$18.67
|
| Rate for Payer: Amerigroup Medicare |
$18.68
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.49
|
| Rate for Payer: Medical Associates Commercial |
$27.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.50
|
| Rate for Payer: Midlands Choice Commercial |
$25.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.75
|
| Rate for Payer: United Healthcare Commercial |
$33.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.83
|
|
|
SCREW CORTEX 2.7 16MM
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.99 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of IA Commercial |
$32.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.40
|
| Rate for Payer: Aetna of IA Medicare |
$20.52
|
| Rate for Payer: Amerigroup Medicaid |
$18.17
|
| Rate for Payer: Amerigroup Medicare |
$18.18
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.99
|
| Rate for Payer: Medical Associates Commercial |
$27.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$25.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.00
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.24
|
|
