|
SCREW CORTEX 2.7 16MM
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046499
|
|
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 2.7MMX10MM
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
SCREW CORTEX 2.7MMX10MM
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
SCREW CORTEX 2.7MMX12MM
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046718
|
|
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 2.7MMX12MM
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046718
|
|
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 2.7MMX14MM
|
Facility
OP
|
$27.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046465
|
|
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 2.7MMX14MM
|
Facility
IP
|
$27.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046465
|
|
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 2.7MMX16MM
|
Facility
OP
|
$19.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046973
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Aetna of IA Commercial |
$17.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.10
|
| Rate for Payer: Aetna of IA Medicare |
$10.83
|
| Rate for Payer: Amerigroup Medicaid |
$9.59
|
| Rate for Payer: Amerigroup Medicare |
$9.60
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9.50
|
| Rate for Payer: Medical Associates Commercial |
$14.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.50
|
| Rate for Payer: Midlands Choice Commercial |
$13.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.25
|
| Rate for Payer: United Healthcare Commercial |
$17.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.21
|
|
|
SCREW CORTEX 2.7MMX16MM
|
Facility
IP
|
$19.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046973
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Aetna of IA Commercial |
$17.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.10
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.25
|
| Rate for Payer: Medical Associates Commercial |
$14.25
|
| Rate for Payer: Midlands Choice Commercial |
$13.30
|
| Rate for Payer: United Healthcare Commercial |
$17.10
|
|
|
SCREW CORTEX 2.7MMX18MM
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
SCREW CORTEX 2.7MMX18MM
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
SCREW CORTEX 2.7MMX20MM
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047024
|
|
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 2.7MMX20MM
|
Facility
IP
|
$13.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047024
|
|
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 2.7MMX22MM
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
SCREW CORTEX 2.7MMX22MM
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
SCREW CORTEX 2.7MMX24MM
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
SCREW CORTEX 2.7MMX24MM
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
SCREW CORTEX 2.7MMX6MM
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046954
|
|
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 2.7MMX6MM
|
Facility
IP
|
$13.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046954
|
|
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 2.7MMX8MM
|
Facility
IP
|
$15.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna of IA Commercial |
$13.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.50
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.25
|
| Rate for Payer: Medical Associates Commercial |
$11.25
|
| Rate for Payer: Midlands Choice Commercial |
$10.50
|
| Rate for Payer: United Healthcare Commercial |
$13.50
|
|
|
SCREW CORTEX 2.7MMX8MM
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna of IA Commercial |
$13.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.50
|
| Rate for Payer: Aetna of IA Medicare |
$8.55
|
| Rate for Payer: Amerigroup Medicaid |
$7.57
|
| Rate for Payer: Amerigroup Medicare |
$7.58
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.50
|
| Rate for Payer: Medical Associates Commercial |
$11.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.50
|
| Rate for Payer: Midlands Choice Commercial |
$10.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.25
|
| Rate for Payer: United Healthcare Commercial |
$13.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.85
|
|
|
SCREW CORTEX 3.5MMX10MM
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of IA Commercial |
$15.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$15.30
|
| Rate for Payer: Aetna of IA Medicare |
$9.69
|
| Rate for Payer: Amerigroup Medicaid |
$8.58
|
| Rate for Payer: Amerigroup Medicare |
$8.58
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.50
|
| Rate for Payer: Medical Associates Commercial |
$12.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.50
|
| Rate for Payer: Midlands Choice Commercial |
$11.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.75
|
| Rate for Payer: United Healthcare Commercial |
$15.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$10.03
|
|
|
SCREW CORTEX 3.5MMX10MM
|
Facility
IP
|
$17.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of IA Commercial |
$15.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$15.30
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12.75
|
| Rate for Payer: Medical Associates Commercial |
$12.75
|
| Rate for Payer: Midlands Choice Commercial |
$11.90
|
| Rate for Payer: United Healthcare Commercial |
$15.30
|
|
|
SCREW CORTEX 3.5MMX12MM
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
SCREW CORTEX 3.5MMX12MM
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
