|
SCREW LAG CANN 3.0MM X 24MM
|
Facility
OP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046273
|
|
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 3.0MM X 26MM
|
Facility
IP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046274
|
|
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 3.0MM X 26MM
|
Facility
OP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046274
|
|
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 3.0MM X 28MM
|
Facility
IP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046275
|
|
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 3.0MM X 28MM
|
Facility
OP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046275
|
|
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 3.0MM X 30MM
|
Facility
OP
|
$271.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.45 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Aetna of IA Commercial |
$243.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.90
|
| Rate for Payer: Aetna of IA Medicare |
$154.47
|
| Rate for Payer: Amerigroup Medicaid |
$136.77
|
| Rate for Payer: Amerigroup Medicare |
$136.86
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$203.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$135.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$135.45
|
| Rate for Payer: Medical Associates Commercial |
$203.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$135.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$137.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$203.25
|
| Rate for Payer: United Healthcare Commercial |
$243.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.89
|
|
|
SCREW LAG CANN 3.0MM X 30MM
|
Facility
IP
|
$271.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Aetna of IA Commercial |
$243.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.90
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$203.25
|
| Rate for Payer: Medical Associates Commercial |
$203.25
|
| Rate for Payer: Midlands Choice Commercial |
$189.70
|
| Rate for Payer: United Healthcare Commercial |
$243.90
|
|
|
SCREW LAG CANN 3.0MM X 32MM
|
Facility
OP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046276
|
|
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 3.0MM X 32MM
|
Facility
IP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046276
|
|
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 3.0MM X 34MM
|
Facility
OP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046277
|
|
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 3.0MM X 34MM
|
Facility
IP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046277
|
|
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 3.0MM X 36MM
|
Facility
OP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046278
|
|
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 3.0MM X 36MM
|
Facility
IP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046278
|
|
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 3.0MM X 38MM
|
Facility
OP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046279
|
|
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 3.0MM X 38MM
|
Facility
IP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046279
|
|
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 3.0MM X 40MM
|
Facility
IP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046281
|
|
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 3.0MM X 40MM
|
Facility
OP
|
$261.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046281
|
|
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 4.0MM X 12MM
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.95 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna of IA Commercial |
$226.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$226.80
|
| Rate for Payer: Aetna of IA Medicare |
$143.64
|
| Rate for Payer: Amerigroup Medicaid |
$127.18
|
| Rate for Payer: Amerigroup Medicare |
$127.26
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$126.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.95
|
| Rate for Payer: Medical Associates Commercial |
$189.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$126.00
|
| Rate for Payer: Midlands Choice Commercial |
$176.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$226.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$148.68
|
|
|
SCREW LAG CANN 4.0MM X 12MM
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna of IA Commercial |
$226.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$226.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.00
|
| Rate for Payer: Medical Associates Commercial |
$189.00
|
| Rate for Payer: Midlands Choice Commercial |
$176.40
|
| Rate for Payer: United Healthcare Commercial |
$226.80
|
|
|
SCREW LAG CANN 4.0MM X 14MM
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.95 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna of IA Commercial |
$226.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$226.80
|
| Rate for Payer: Aetna of IA Medicare |
$143.64
|
| Rate for Payer: Amerigroup Medicaid |
$127.18
|
| Rate for Payer: Amerigroup Medicare |
$127.26
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$126.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.95
|
| Rate for Payer: Medical Associates Commercial |
$189.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$126.00
|
| Rate for Payer: Midlands Choice Commercial |
$176.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$226.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$148.68
|
|
|
SCREW LAG CANN 4.0MM X 14MM
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna of IA Commercial |
$226.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$226.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.00
|
| Rate for Payer: Medical Associates Commercial |
$189.00
|
| Rate for Payer: Midlands Choice Commercial |
$176.40
|
| Rate for Payer: United Healthcare Commercial |
$226.80
|
|
|
SCREW LAG CANN 4.0MM X 16MM
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna of IA Commercial |
$226.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$226.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.00
|
| Rate for Payer: Medical Associates Commercial |
$189.00
|
| Rate for Payer: Midlands Choice Commercial |
$176.40
|
| Rate for Payer: United Healthcare Commercial |
$226.80
|
|
|
SCREW LAG CANN 4.0MM X 16MM
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.95 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna of IA Commercial |
$226.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$226.80
|
| Rate for Payer: Aetna of IA Medicare |
$143.64
|
| Rate for Payer: Amerigroup Medicaid |
$127.18
|
| Rate for Payer: Amerigroup Medicare |
$127.26
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$126.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.95
|
| Rate for Payer: Medical Associates Commercial |
$189.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$126.00
|
| Rate for Payer: Midlands Choice Commercial |
$176.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$226.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$148.68
|
|
|
SCREW LAG CANN 4.0MM X 18MM
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna of IA Commercial |
$226.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$226.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.00
|
| Rate for Payer: Medical Associates Commercial |
$189.00
|
| Rate for Payer: Midlands Choice Commercial |
$176.40
|
| Rate for Payer: United Healthcare Commercial |
$226.80
|
|
|
SCREW LAG CANN 4.0MM X 18MM
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.95 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna of IA Commercial |
$226.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$226.80
|
| Rate for Payer: Aetna of IA Medicare |
$143.64
|
| Rate for Payer: Amerigroup Medicaid |
$127.18
|
| Rate for Payer: Amerigroup Medicare |
$127.26
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$126.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.95
|
| Rate for Payer: Medical Associates Commercial |
$189.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$126.00
|
| Rate for Payer: Midlands Choice Commercial |
$176.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$226.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$148.68
|
|
