|
SCREW CORTEX 3.5MMX45MM
|
Facility
OP
|
$27.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046372
|
|
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 3.5MMX50MM
|
Facility
OP
|
$27.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046374
|
|
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 3.5MMX50MM
|
Facility
IP
|
$27.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046374
|
|
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 CORTICAL 2.7X10MM SELF CUTTING
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046614
|
|
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 CORTICAL 2.7X10MM SELF CUTTING
|
Facility
IP
|
$34.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046614
|
|
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 CORTICAL 2.7X12MM
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Aetna of IA Medicare |
$13.68
|
| Rate for Payer: Amerigroup Medicaid |
$12.11
|
| Rate for Payer: Amerigroup Medicare |
$12.12
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.16
|
|
|
SCREW CORTICAL 2.7X12MM
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
|
|
SCREW CORTICAL 2.7X14
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Aetna of IA Medicare |
$13.68
|
| Rate for Payer: Amerigroup Medicaid |
$12.11
|
| Rate for Payer: Amerigroup Medicare |
$12.12
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.16
|
|
|
SCREW CORTICAL 2.7X14
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
|
|
SCREW CORTICAL 2.7X16MM
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of IA Commercial |
$27.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.50
|
| Rate for Payer: Medical Associates Commercial |
$22.50
|
| Rate for Payer: Midlands Choice Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$27.00
|
|
|
SCREW CORTICAL 2.7X16MM
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of IA Commercial |
$27.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.00
|
| Rate for Payer: Aetna of IA Medicare |
$17.10
|
| Rate for Payer: Amerigroup Medicaid |
$15.14
|
| Rate for Payer: Amerigroup Medicare |
$15.15
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.99
|
| Rate for Payer: Medical Associates Commercial |
$22.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.00
|
| Rate for Payer: Midlands Choice Commercial |
$21.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.50
|
| Rate for Payer: United Healthcare Commercial |
$27.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$17.70
|
|
|
SCREW CORTICAL 2.7X18MM
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
|
|
SCREW CORTICAL 2.7X18MM
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Aetna of IA Medicare |
$13.68
|
| Rate for Payer: Amerigroup Medicaid |
$12.11
|
| Rate for Payer: Amerigroup Medicare |
$12.12
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.16
|
|
|
SCREW CORTICAL 2.7X20MM
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Aetna of IA Medicare |
$13.68
|
| Rate for Payer: Amerigroup Medicaid |
$12.11
|
| Rate for Payer: Amerigroup Medicare |
$12.12
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.16
|
|
|
SCREW CORTICAL 2.7X20MM
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
|
|
SCREW CORTICAL 2.7X22MM
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
|
|
SCREW CORTICAL 2.7X22MM
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Aetna of IA Medicare |
$13.68
|
| Rate for Payer: Amerigroup Medicaid |
$12.11
|
| Rate for Payer: Amerigroup Medicare |
$12.12
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.16
|
|
|
SCREW CORTICAL 2.7X24MM
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Aetna of IA Medicare |
$13.68
|
| Rate for Payer: Amerigroup Medicaid |
$12.11
|
| Rate for Payer: Amerigroup Medicare |
$12.12
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.16
|
|
|
SCREW CORTICAL 2.7X24MM
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
|
|
SCREW CORTICAL 2.7X26MM
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
|
|
SCREW CORTICAL 2.7X26MM
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Aetna of IA Medicare |
$13.68
|
| Rate for Payer: Amerigroup Medicaid |
$12.11
|
| Rate for Payer: Amerigroup Medicare |
$12.12
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.16
|
|
|
SCREW CORTICAL 2.7X28MM
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
|
|
SCREW CORTICAL 2.7X28MM
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Aetna of IA Medicare |
$13.68
|
| Rate for Payer: Amerigroup Medicaid |
$12.11
|
| Rate for Payer: Amerigroup Medicare |
$12.12
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.16
|
|
|
SCREW CORTICAL 2.7X30MM
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
|
|
SCREW CORTICAL 2.7X30MM
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of IA Commercial |
$21.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.60
|
| Rate for Payer: Aetna of IA Medicare |
$13.68
|
| Rate for Payer: Amerigroup Medicaid |
$12.11
|
| Rate for Payer: Amerigroup Medicare |
$12.12
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.00
|
| Rate for Payer: Medical Associates Commercial |
$18.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.00
|
| Rate for Payer: Midlands Choice Commercial |
$16.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$21.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.16
|
|
