|
SCREW INTERFERENCE 10
|
Facility
OP
|
$414.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.92 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of IA Commercial |
$372.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$372.60
|
| Rate for Payer: Aetna of IA Medicare |
$235.98
|
| Rate for Payer: Amerigroup Medicaid |
$208.95
|
| Rate for Payer: Amerigroup Medicare |
$209.07
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$310.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$207.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$206.92
|
| Rate for Payer: Medical Associates Commercial |
$310.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$207.00
|
| Rate for Payer: Midlands Choice Commercial |
$289.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$210.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$310.50
|
| Rate for Payer: United Healthcare Commercial |
$372.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$244.26
|
|
|
SCREW INTERFERENCE 10
|
Facility
IP
|
$414.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$289.80 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of IA Commercial |
$372.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$372.60
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$310.50
|
| Rate for Payer: Medical Associates Commercial |
$310.50
|
| Rate for Payer: Midlands Choice Commercial |
$289.80
|
| Rate for Payer: United Healthcare Commercial |
$372.60
|
|
|
SCREW INTERFERENCE 10X23
|
Facility
IP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
|
|
SCREW INTERFERENCE 10X23
|
Facility
OP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.42 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Aetna of IA Medicare |
$230.85
|
| Rate for Payer: Amerigroup Medicaid |
$204.40
|
| Rate for Payer: Amerigroup Medicare |
$204.52
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$202.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.42
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$205.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$303.75
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
|
SCREW INTERFERENCE 7X23MM
|
Facility
OP
|
$414.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.92 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of IA Commercial |
$372.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$372.60
|
| Rate for Payer: Aetna of IA Medicare |
$235.98
|
| Rate for Payer: Amerigroup Medicaid |
$208.95
|
| Rate for Payer: Amerigroup Medicare |
$209.07
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$310.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$207.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$206.92
|
| Rate for Payer: Medical Associates Commercial |
$310.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$207.00
|
| Rate for Payer: Midlands Choice Commercial |
$289.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$210.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$310.50
|
| Rate for Payer: United Healthcare Commercial |
$372.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$244.26
|
|
|
SCREW INTERFERENCE 7X23MM
|
Facility
IP
|
$414.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$289.80 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of IA Commercial |
$372.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$372.60
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$310.50
|
| Rate for Payer: Medical Associates Commercial |
$310.50
|
| Rate for Payer: Midlands Choice Commercial |
$289.80
|
| Rate for Payer: United Healthcare Commercial |
$372.60
|
|
|
SCREW INTERFERENCE 8
|
Facility
OP
|
$414.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.92 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of IA Commercial |
$372.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$372.60
|
| Rate for Payer: Aetna of IA Medicare |
$235.98
|
| Rate for Payer: Amerigroup Medicaid |
$208.95
|
| Rate for Payer: Amerigroup Medicare |
$209.07
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$310.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$207.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$206.92
|
| Rate for Payer: Medical Associates Commercial |
$310.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$207.00
|
| Rate for Payer: Midlands Choice Commercial |
$289.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$210.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$310.50
|
| Rate for Payer: United Healthcare Commercial |
$372.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$244.26
|
|
|
SCREW INTERFERENCE 8
|
Facility
IP
|
$414.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$289.80 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of IA Commercial |
$372.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$372.60
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$310.50
|
| Rate for Payer: Medical Associates Commercial |
$310.50
|
| Rate for Payer: Midlands Choice Commercial |
$289.80
|
| Rate for Payer: United Healthcare Commercial |
$372.60
|
|
|
SCREW INTERFERENCE 8X23MM
|
Facility
OP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.42 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Aetna of IA Medicare |
$230.85
|
| Rate for Payer: Amerigroup Medicaid |
$204.40
|
| Rate for Payer: Amerigroup Medicare |
$204.52
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$202.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.42
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$205.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$303.75
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
|
SCREW INTERFERENCE 8X23MM
|
Facility
IP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
|
|
SCREW INTERFERENCE 8X28MM
|
Facility
IP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
|
|
SCREW INTERFERENCE 8X28MM
|
Facility
OP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.42 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Aetna of IA Medicare |
$230.85
|
| Rate for Payer: Amerigroup Medicaid |
$204.40
|
| Rate for Payer: Amerigroup Medicare |
$204.52
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$202.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.42
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$205.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$303.75
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
|
SCREW INTERFERENCE 9
|
Facility
OP
|
$414.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.92 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of IA Commercial |
$372.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$372.60
|
| Rate for Payer: Aetna of IA Medicare |
$235.98
|
| Rate for Payer: Amerigroup Medicaid |
$208.95
|
| Rate for Payer: Amerigroup Medicare |
$209.07
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$310.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$207.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$206.92
|
| Rate for Payer: Medical Associates Commercial |
$310.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$207.00
|
| Rate for Payer: Midlands Choice Commercial |
$289.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$210.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$310.50
|
| Rate for Payer: United Healthcare Commercial |
$372.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$244.26
|
|
|
SCREW INTERFERENCE 9
|
Facility
IP
|
$414.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$289.80 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of IA Commercial |
$372.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$372.60
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$310.50
|
| Rate for Payer: Medical Associates Commercial |
$310.50
|
| Rate for Payer: Midlands Choice Commercial |
$289.80
|
| Rate for Payer: United Healthcare Commercial |
$372.60
|
|
|
SCREW INTERFERENCE 9X23MM
|
Facility
OP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.42 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Aetna of IA Medicare |
$230.85
|
| Rate for Payer: Amerigroup Medicaid |
$204.40
|
| Rate for Payer: Amerigroup Medicare |
$204.52
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$202.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.42
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$205.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$303.75
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
|
SCREW INTERFERENCE 9X23MM
|
Facility
IP
|
$405.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
|
|
SCREW LAG CANN 2.0MM X 10MM
|
Facility
OP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.45 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Aetna of IA Commercial |
$240.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$240.30
|
| Rate for Payer: Aetna of IA Medicare |
$152.19
|
| Rate for Payer: Amerigroup Medicaid |
$134.75
|
| Rate for Payer: Amerigroup Medicare |
$134.84
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$200.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$133.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$133.45
|
| Rate for Payer: Medical Associates Commercial |
$200.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$133.50
|
| Rate for Payer: Midlands Choice Commercial |
$186.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$135.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$200.25
|
| Rate for Payer: United Healthcare Commercial |
$240.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$157.53
|
|
|
SCREW LAG CANN 2.0MM X 10MM
|
Facility
IP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.90 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Aetna of IA Commercial |
$240.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$240.30
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$200.25
|
| Rate for Payer: Medical Associates Commercial |
$200.25
|
| Rate for Payer: Midlands Choice Commercial |
$186.90
|
| Rate for Payer: United Healthcare Commercial |
$240.30
|
|
|
SCREW LAG CANN 2.0MM X 12MM
|
Facility
OP
|
$279.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.44 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna of IA Commercial |
$251.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$251.10
|
| Rate for Payer: Aetna of IA Medicare |
$159.03
|
| Rate for Payer: Amerigroup Medicaid |
$140.81
|
| Rate for Payer: Amerigroup Medicare |
$140.90
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$209.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$139.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$139.44
|
| Rate for Payer: Medical Associates Commercial |
$209.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$139.50
|
| Rate for Payer: Midlands Choice Commercial |
$195.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$141.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$209.25
|
| Rate for Payer: United Healthcare Commercial |
$251.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$164.61
|
|
|
SCREW LAG CANN 2.0MM X 12MM
|
Facility
IP
|
$279.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna of IA Commercial |
$251.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$251.10
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$209.25
|
| Rate for Payer: Medical Associates Commercial |
$209.25
|
| Rate for Payer: Midlands Choice Commercial |
$195.30
|
| Rate for Payer: United Healthcare Commercial |
$251.10
|
|
|
SCREW LAG CANN 2.0MM X 14MM
|
Facility
OP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.45 |
| Max. Negotiated Rate |
$234.90 |
| Rate for Payer: Aetna of IA Commercial |
$234.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.90
|
| Rate for Payer: Aetna of IA Medicare |
$148.77
|
| Rate for Payer: Amerigroup Medicaid |
$131.73
|
| Rate for Payer: Amerigroup Medicare |
$131.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$130.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$130.45
|
| Rate for Payer: Medical Associates Commercial |
$195.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$130.50
|
| Rate for Payer: Midlands Choice Commercial |
$182.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$132.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$195.75
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.99
|
|
|
SCREW LAG CANN 2.0MM X 14MM
|
Facility
IP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.70 |
| Max. Negotiated Rate |
$234.90 |
| Rate for Payer: Aetna of IA Commercial |
$234.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.90
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.75
|
| Rate for Payer: Medical Associates Commercial |
$195.75
|
| Rate for Payer: Midlands Choice Commercial |
$182.70
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
|
|
SCREW LAG CANN 2.0MM X 16MM
|
Facility
IP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.70 |
| Max. Negotiated Rate |
$234.90 |
| Rate for Payer: Aetna of IA Commercial |
$234.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.90
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.75
|
| Rate for Payer: Medical Associates Commercial |
$195.75
|
| Rate for Payer: Midlands Choice Commercial |
$182.70
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
|
|
SCREW LAG CANN 2.0MM X 16MM
|
Facility
OP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.45 |
| Max. Negotiated Rate |
$234.90 |
| Rate for Payer: Aetna of IA Commercial |
$234.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.90
|
| Rate for Payer: Aetna of IA Medicare |
$148.77
|
| Rate for Payer: Amerigroup Medicaid |
$131.73
|
| Rate for Payer: Amerigroup Medicare |
$131.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$130.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$130.45
|
| Rate for Payer: Medical Associates Commercial |
$195.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$130.50
|
| Rate for Payer: Midlands Choice Commercial |
$182.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$132.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$195.75
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.99
|
|
|
SCREW LAG CANN 2.0MM X 18MM
|
Facility
OP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.45 |
| Max. Negotiated Rate |
$234.90 |
| Rate for Payer: Aetna of IA Commercial |
$234.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.90
|
| Rate for Payer: Aetna of IA Medicare |
$148.77
|
| Rate for Payer: Amerigroup Medicaid |
$131.73
|
| Rate for Payer: Amerigroup Medicare |
$131.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$130.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$130.45
|
| Rate for Payer: Medical Associates Commercial |
$195.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$130.50
|
| Rate for Payer: Midlands Choice Commercial |
$182.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$132.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$195.75
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.99
|
|
