|
SCREW CORTEX 3.5MMX14MM
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046796
|
|
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 3.5MMX14MM
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046796
|
|
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 3.5MMX16MM
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047009
|
|
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 3.5MMX16MM
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047009
|
|
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 3.5MMX18MM
|
Facility
IP
|
$17.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046965
|
|
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 3.5MMX18MM
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046965
|
|
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 3.5MMX20MM
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046392
|
|
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 3.5MMX20MM
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046392
|
|
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 3.5MMX22MM
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of IA Commercial |
$16.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.20
|
| Rate for Payer: Aetna of IA Medicare |
$10.26
|
| Rate for Payer: Amerigroup Medicaid |
$9.08
|
| Rate for Payer: Amerigroup Medicare |
$9.09
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9.00
|
| Rate for Payer: Medical Associates Commercial |
$13.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.00
|
| Rate for Payer: Midlands Choice Commercial |
$12.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$13.50
|
| Rate for Payer: United Healthcare Commercial |
$16.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$10.62
|
|
|
SCREW CORTEX 3.5MMX22MM
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of IA Commercial |
$16.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.20
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.50
|
| Rate for Payer: Medical Associates Commercial |
$13.50
|
| Rate for Payer: Midlands Choice Commercial |
$12.60
|
| Rate for Payer: United Healthcare Commercial |
$16.20
|
|
|
SCREW CORTEX 3.5MMX24MM
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046921
|
|
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 3.5MMX24MM
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046921
|
|
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 3.5MMX26MM
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047020
|
|
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 3.5MMX26MM
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047020
|
|
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 3.5MMX28MM
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046369
|
|
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 3.5MMX28MM
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046369
|
|
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 3.5MMX32MM
|
Facility
IP
|
$34.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046370
|
|
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 3.5MMX32MM
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046370
|
|
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 3.5MMX34MM
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046242
|
|
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 3.5MMX34MM
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046242
|
|
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 3.5MMX36MM
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046368
|
|
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 3.5MMX36MM
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046368
|
|
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 3.5MMX40MM
|
Facility
OP
|
$27.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046371
|
|
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 3.5MMX40MM
|
Facility
IP
|
$27.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046371
|
|
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 3.5MMX45MM
|
Facility
IP
|
$27.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046372
|
|
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
|
|
