|
SCREW CORTICAL SELF TAP 4.5X62MM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046524
|
|
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 4.5X64
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046525
|
|
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 4.5X64
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046525
|
|
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 4.5X66
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046526
|
|
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 4.5X66
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046526
|
|
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 4.5X68MM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046527
|
|
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 4.5X68MM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046527
|
|
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 4.5X70MM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046528
|
|
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 4.5X70MM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046528
|
|
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 GAP PLATE HIP 6.5MM X 20MM
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
|
|
SCREW GAP PLATE HIP 6.5MM X 20MM
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.93 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Aetna of IA Medicare |
$196.08
|
| Rate for Payer: Amerigroup Medicaid |
$173.62
|
| Rate for Payer: Amerigroup Medicare |
$173.72
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$172.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$171.93
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$172.00
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$174.58
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$174.48
|
| Rate for Payer: Oscar Health of IA Commercial |
$258.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$258.00
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$202.96
|
|
|
SCREW GAP PLATE HIP 6.5MM X 25MM
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.93 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Aetna of IA Medicare |
$196.08
|
| Rate for Payer: Amerigroup Medicaid |
$173.62
|
| Rate for Payer: Amerigroup Medicare |
$173.72
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$172.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$171.93
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$172.00
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$174.58
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$174.48
|
| Rate for Payer: Oscar Health of IA Commercial |
$258.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$258.00
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$202.96
|
|
|
SCREW GAP PLATE HIP 6.5MM X 25MM
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
|
|
SCREW GAP PLATE HIP 6.5MM X 30MM
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.70 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Aetna of IA Commercial |
$297.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$297.90
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$248.25
|
| Rate for Payer: Medical Associates Commercial |
$248.25
|
| Rate for Payer: Midlands Choice Commercial |
$231.70
|
| Rate for Payer: United Healthcare Commercial |
$297.90
|
|
|
SCREW GAP PLATE HIP 6.5MM X 30MM
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.43 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Aetna of IA Commercial |
$297.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$297.90
|
| Rate for Payer: Aetna of IA Medicare |
$188.67
|
| Rate for Payer: Amerigroup Medicaid |
$167.06
|
| Rate for Payer: Amerigroup Medicare |
$167.16
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$248.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$165.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$165.43
|
| Rate for Payer: Medical Associates Commercial |
$248.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$165.50
|
| Rate for Payer: Midlands Choice Commercial |
$231.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$167.98
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$167.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$248.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$248.25
|
| Rate for Payer: United Healthcare Commercial |
$297.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$195.29
|
|
|
SCREW GAP PLATE HIP 6.5MM X 35MM
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.93 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Aetna of IA Medicare |
$196.08
|
| Rate for Payer: Amerigroup Medicaid |
$173.62
|
| Rate for Payer: Amerigroup Medicare |
$173.72
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$172.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$171.93
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$172.00
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$174.58
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$174.48
|
| Rate for Payer: Oscar Health of IA Commercial |
$258.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$258.00
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$202.96
|
|
|
SCREW GAP PLATE HIP 6.5MM X 35MM
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
|
|
SCREW GRIDLOCKING 3.5X 26MM
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8831367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$152.94 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna of IA Commercial |
$275.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$275.40
|
| Rate for Payer: Aetna of IA Medicare |
$174.42
|
| Rate for Payer: Amerigroup Medicaid |
$154.44
|
| Rate for Payer: Amerigroup Medicare |
$154.53
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$229.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$153.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$152.94
|
| Rate for Payer: Medical Associates Commercial |
$229.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$153.00
|
| Rate for Payer: Midlands Choice Commercial |
$214.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$155.30
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$155.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$229.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$229.50
|
| Rate for Payer: United Healthcare Commercial |
$275.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$180.54
|
|
|
SCREW GRIDLOCKING 3.5X 26MM
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8831367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna of IA Commercial |
$275.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$275.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$229.50
|
| Rate for Payer: Medical Associates Commercial |
$229.50
|
| Rate for Payer: Midlands Choice Commercial |
$214.20
|
| Rate for Payer: United Healthcare Commercial |
$275.40
|
|
|
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 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: Molina Healthcare Managed Medicare |
$209.98
|
| Rate for Payer: Oscar Health of IA Commercial |
$310.50
|
| 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 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: Molina Healthcare Managed Medicare |
$205.42
|
| Rate for Payer: Oscar Health of IA Commercial |
$303.75
|
| 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 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 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 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: Molina Healthcare Managed Medicare |
$209.98
|
| Rate for Payer: Oscar Health of IA Commercial |
$310.50
|
| 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
|
|
