|
SCREW CORTICAL 3.5X55MM SELF CUTTING
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046497
|
|
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 3.5X60 MM, LPS, SS
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047110
|
|
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 CORTICAL 3.5X60 MM, LPS, SS
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047110
|
|
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 CORTICAL 3.5X60MM SELF CUTTING
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046498
|
|
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 3.5X60MM SELF CUTTING
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046498
|
|
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 BONE 3.5X14 MM, LPS, SS
|
Facility
IP
|
$63.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna of IA Commercial |
$56.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$56.70
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.25
|
| Rate for Payer: Medical Associates Commercial |
$47.25
|
| Rate for Payer: Midlands Choice Commercial |
$44.10
|
| Rate for Payer: United Healthcare Commercial |
$56.70
|
|
|
SCREW CORTICAL BONE 3.5X14 MM, LPS, SS
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna of IA Commercial |
$56.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$56.70
|
| Rate for Payer: Aetna of IA Medicare |
$35.91
|
| Rate for Payer: Amerigroup Medicaid |
$31.80
|
| Rate for Payer: Amerigroup Medicare |
$31.82
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.49
|
| Rate for Payer: Medical Associates Commercial |
$47.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.50
|
| Rate for Payer: Midlands Choice Commercial |
$44.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$31.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$47.25
|
| Rate for Payer: United Healthcare Commercial |
$56.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.17
|
|
|
SCREW CORTICAL SELF TAP
|
Facility
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
|
|
SCREW CORTICAL SELF TAP
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Aetna of IA Medicare |
$15.96
|
| Rate for Payer: Amerigroup Medicaid |
$14.13
|
| Rate for Payer: Amerigroup Medicare |
$14.14
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.99
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.52
|
|
|
SCREW CORTICAL SELF TAP-1
|
Facility
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
|
|
SCREW CORTICAL SELF TAP-1
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Aetna of IA Medicare |
$15.96
|
| Rate for Payer: Amerigroup Medicaid |
$14.13
|
| Rate for Payer: Amerigroup Medicare |
$14.14
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.99
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.52
|
|
|
SCREW CORTICAL SELF TAP-2
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Aetna of IA Medicare |
$15.96
|
| Rate for Payer: Amerigroup Medicaid |
$14.13
|
| Rate for Payer: Amerigroup Medicare |
$14.14
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.99
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.52
|
|
|
SCREW CORTICAL SELF TAP-2
|
Facility
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
|
|
SCREW CORTICAL SELF TAP-3
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Aetna of IA Medicare |
$15.96
|
| Rate for Payer: Amerigroup Medicaid |
$14.13
|
| Rate for Payer: Amerigroup Medicare |
$14.14
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.99
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.52
|
|
|
SCREW CORTICAL SELF TAP-3
|
Facility
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
|
|
SCREW CORTICAL SELF TAP 4.5X14MM
|
Facility
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
|
|
SCREW CORTICAL SELF TAP 4.5X14MM
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Aetna of IA Medicare |
$15.96
|
| Rate for Payer: Amerigroup Medicaid |
$14.13
|
| Rate for Payer: Amerigroup Medicare |
$14.14
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.99
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.52
|
|
|
SCREW CORTICAL SELF TAP 4.5X16MM
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Aetna of IA Medicare |
$15.96
|
| Rate for Payer: Amerigroup Medicaid |
$14.13
|
| Rate for Payer: Amerigroup Medicare |
$14.14
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.99
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.52
|
|
|
SCREW CORTICAL SELF TAP 4.5X16MM
|
Facility
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
|
|
SCREW CORTICAL SELF TAP 4.5X18
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Aetna of IA Medicare |
$15.96
|
| Rate for Payer: Amerigroup Medicaid |
$14.13
|
| Rate for Payer: Amerigroup Medicare |
$14.14
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.99
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.52
|
|
|
SCREW CORTICAL SELF TAP 4.5X18
|
Facility
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
|
|
SCREW CORTICAL SELF TAP 45X20MM
|
Facility
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
|
|
SCREW CORTICAL SELF TAP 45X20MM
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Aetna of IA Medicare |
$15.96
|
| Rate for Payer: Amerigroup Medicaid |
$14.13
|
| Rate for Payer: Amerigroup Medicare |
$14.14
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.99
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.52
|
|
|
SCREW CORTICAL SELF TAP 4.5X24
|
Facility
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
|
|
SCREW CORTICAL SELF TAP 4.5X24
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Aetna of IA Medicare |
$15.96
|
| Rate for Payer: Amerigroup Medicaid |
$14.13
|
| Rate for Payer: Amerigroup Medicare |
$14.14
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.99
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.52
|
|
