|
SCREW CANNULATED TI 4.0X48MM
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.96 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna of IA Commercial |
$201.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$201.60
|
| Rate for Payer: Aetna of IA Medicare |
$127.68
|
| Rate for Payer: Amerigroup Medicaid |
$113.05
|
| Rate for Payer: Amerigroup Medicare |
$113.12
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$168.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$112.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$111.96
|
| Rate for Payer: Medical Associates Commercial |
$168.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$112.00
|
| Rate for Payer: Midlands Choice Commercial |
$156.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$113.68
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$113.61
|
| Rate for Payer: Oscar Health of IA Commercial |
$168.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$168.00
|
| Rate for Payer: United Healthcare Commercial |
$201.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$132.16
|
|
|
SCREW CANNULATED TI 4.0X70MM
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046894
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.95 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Aetna of IA Commercial |
$221.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$221.40
|
| Rate for Payer: Aetna of IA Medicare |
$140.22
|
| Rate for Payer: Amerigroup Medicaid |
$124.16
|
| Rate for Payer: Amerigroup Medicare |
$124.23
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$184.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$123.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$122.95
|
| Rate for Payer: Medical Associates Commercial |
$184.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$123.00
|
| Rate for Payer: Midlands Choice Commercial |
$172.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$124.84
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$124.77
|
| Rate for Payer: Oscar Health of IA Commercial |
$184.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$184.50
|
| Rate for Payer: United Healthcare Commercial |
$221.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$145.14
|
|
|
SCREW CANNULATED TI 4.0X70MM
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046894
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Aetna of IA Commercial |
$221.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$221.40
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$184.50
|
| Rate for Payer: Medical Associates Commercial |
$184.50
|
| Rate for Payer: Midlands Choice Commercial |
$172.20
|
| Rate for Payer: United Healthcare Commercial |
$221.40
|
|
|
SCREW CANNULATED TIGER 2.4MMX28MM
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8734814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
SCREW CANNULATED TIGER 2.4MMX28MM
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8734814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$100.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$148.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
SCREW CANNULATED TIGER 4.00MMX30MM
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8713569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$100.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$148.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
SCREW CANNULATED TIGER 4.00MMX30MM
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8713569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
SCREW CANNULATED TIGER 4.0MMX30MM
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8814826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$119.70 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna of IA Commercial |
$153.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$153.90
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$128.25
|
| Rate for Payer: Medical Associates Commercial |
$128.25
|
| Rate for Payer: Midlands Choice Commercial |
$119.70
|
| Rate for Payer: United Healthcare Commercial |
$153.90
|
|
|
SCREW CANNULATED TIGER 4.0MMX30MM
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8814826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.47 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna of IA Commercial |
$153.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$153.90
|
| Rate for Payer: Aetna of IA Medicare |
$97.47
|
| Rate for Payer: Amerigroup Medicaid |
$86.30
|
| Rate for Payer: Amerigroup Medicare |
$86.36
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$128.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$85.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$85.47
|
| Rate for Payer: Medical Associates Commercial |
$128.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$119.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$86.78
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$86.73
|
| Rate for Payer: Oscar Health of IA Commercial |
$128.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$128.25
|
| Rate for Payer: United Healthcare Commercial |
$153.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$100.89
|
|
|
SCREW CORTEX 1.5MMX10MM
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046971
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna of IA Commercial |
$10.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.80
|
| Rate for Payer: Aetna of IA Medicare |
$6.84
|
| Rate for Payer: Amerigroup Medicaid |
$6.06
|
| Rate for Payer: Amerigroup Medicare |
$6.06
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.00
|
| Rate for Payer: Medical Associates Commercial |
$9.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.00
|
| Rate for Payer: Midlands Choice Commercial |
$8.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.09
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$6.09
|
| Rate for Payer: Oscar Health of IA Commercial |
$9.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.00
|
| Rate for Payer: United Healthcare Commercial |
$10.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.08
|
|
|
SCREW CORTEX 1.5MMX10MM
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046971
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna of IA Commercial |
$10.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.00
|
| Rate for Payer: Medical Associates Commercial |
$9.00
|
| Rate for Payer: Midlands Choice Commercial |
$8.40
|
| Rate for Payer: United Healthcare Commercial |
$10.80
|
|
|
SCREW CORTEX 1.5MMX11MM
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046996
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna of IA Commercial |
$10.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.00
|
| Rate for Payer: Medical Associates Commercial |
$9.00
|
| Rate for Payer: Midlands Choice Commercial |
$8.40
|
| Rate for Payer: United Healthcare Commercial |
$10.80
|
|
|
SCREW CORTEX 1.5MMX11MM
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046996
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna of IA Commercial |
$10.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.80
|
| Rate for Payer: Aetna of IA Medicare |
$6.84
|
| Rate for Payer: Amerigroup Medicaid |
$6.06
|
| Rate for Payer: Amerigroup Medicare |
$6.06
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.00
|
| Rate for Payer: Medical Associates Commercial |
$9.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.00
|
| Rate for Payer: Midlands Choice Commercial |
$8.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.09
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$6.09
|
| Rate for Payer: Oscar Health of IA Commercial |
$9.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.00
|
| Rate for Payer: United Healthcare Commercial |
$10.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.08
|
|
|
SCREW CORTEX 1.5MMX12MM
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna of IA Commercial |
$10.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.00
|
| Rate for Payer: Medical Associates Commercial |
$9.00
|
| Rate for Payer: Midlands Choice Commercial |
$8.40
|
| Rate for Payer: United Healthcare Commercial |
$10.80
|
|
|
SCREW CORTEX 1.5MMX12MM
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna of IA Commercial |
$10.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.80
|
| Rate for Payer: Aetna of IA Medicare |
$6.84
|
| Rate for Payer: Amerigroup Medicaid |
$6.06
|
| Rate for Payer: Amerigroup Medicare |
$6.06
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.00
|
| Rate for Payer: Medical Associates Commercial |
$9.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.00
|
| Rate for Payer: Midlands Choice Commercial |
$8.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.09
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$6.09
|
| Rate for Payer: Oscar Health of IA Commercial |
$9.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.00
|
| Rate for Payer: United Healthcare Commercial |
$10.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.08
|
|
|
SCREW CORTEX 1.5MMX14MM
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna of IA Commercial |
$10.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.00
|
| Rate for Payer: Medical Associates Commercial |
$9.00
|
| Rate for Payer: Midlands Choice Commercial |
$8.40
|
| Rate for Payer: United Healthcare Commercial |
$10.80
|
|
|
SCREW CORTEX 1.5MMX14MM
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna of IA Commercial |
$10.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.80
|
| Rate for Payer: Aetna of IA Medicare |
$6.84
|
| Rate for Payer: Amerigroup Medicaid |
$6.06
|
| Rate for Payer: Amerigroup Medicare |
$6.06
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.00
|
| Rate for Payer: Medical Associates Commercial |
$9.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.00
|
| Rate for Payer: Midlands Choice Commercial |
$8.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.09
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$6.09
|
| Rate for Payer: Oscar Health of IA Commercial |
$9.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.00
|
| Rate for Payer: United Healthcare Commercial |
$10.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.08
|
|
|
SCREW CORTEX 1.5MMX16MM
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047029
|
|
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: Molina Healthcare Managed Medicare |
$8.62
|
| Rate for Payer: Oscar Health of IA Commercial |
$12.75
|
| 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 1.5MMX16MM
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047029
|
|
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 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 1.5MMX7MM
|
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: Molina Healthcare Managed Medicare |
$17.24
|
| Rate for Payer: Oscar Health of IA Commercial |
$25.50
|
| 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
|
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: Molina Healthcare Managed Medicare |
$17.24
|
| Rate for Payer: Oscar Health of IA Commercial |
$25.50
|
| 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
|
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 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: Molina Healthcare Managed Medicare |
$17.24
|
| Rate for Payer: Oscar Health of IA Commercial |
$25.50
|
| 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
|
|
