|
SCREW CORTICAL SELF TAP 4.5X32MM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046509
|
|
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: Molina Healthcare Managed Medicare |
$14.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$21.00
|
| 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 4.5X32MM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046509
|
|
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 4.5X34
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046510
|
|
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 4.5X34
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046510
|
|
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: Molina Healthcare Managed Medicare |
$14.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$21.00
|
| 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 4.5X36
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046511
|
|
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 4.5X36
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046511
|
|
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: Molina Healthcare Managed Medicare |
$14.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$21.00
|
| 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 4.5X38MM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046512
|
|
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: Molina Healthcare Managed Medicare |
$14.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$21.00
|
| 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 4.5X38MM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046512
|
|
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 4.5X40MM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046513
|
|
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: Molina Healthcare Managed Medicare |
$14.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$21.00
|
| 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 4.5X40MM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046513
|
|
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 4.5X42
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046514
|
|
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 4.5X42
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046514
|
|
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: Molina Healthcare Managed Medicare |
$14.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$21.00
|
| 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 4.5X44MM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046515
|
|
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: Molina Healthcare Managed Medicare |
$14.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$21.00
|
| 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 4.5X44MM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046515
|
|
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 4.5X46MM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046516
|
|
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 4.5X46MM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046516
|
|
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: Molina Healthcare Managed Medicare |
$14.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$21.00
|
| 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 4.5X50MM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046518
|
|
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: Molina Healthcare Managed Medicare |
$14.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$21.00
|
| 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 4.5X50MM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046518
|
|
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 4.5X52MM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046519
|
|
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 4.5X52MM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046519
|
|
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: Molina Healthcare Managed Medicare |
$14.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$21.00
|
| 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 4.5X54MM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046520
|
|
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: Molina Healthcare Managed Medicare |
$14.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$21.00
|
| 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 4.5X54MM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046520
|
|
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 4.5X58
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046522
|
|
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: Molina Healthcare Managed Medicare |
$14.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$21.00
|
| 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 4.5X58
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046522
|
|
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 4.5X62MM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046524
|
|
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: Molina Healthcare Managed Medicare |
$14.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$21.00
|
| 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
|
|
