|
SCREW LAG CANN 4.0MM X 20MM
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046282
|
|
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 20MM
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046282
|
|
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 22MM
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046287
|
|
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 22MM
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046287
|
|
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 24MM
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046288
|
|
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 24MM
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046288
|
|
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 26MM
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046289
|
|
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 26MM
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046289
|
|
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 28MM
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046290
|
|
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 28MM
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046290
|
|
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 30MM
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046291
|
|
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 30MM
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046291
|
|
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 32MM
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046299
|
|
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 32MM
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046299
|
|
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 34MM
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046292
|
|
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 34MM
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046292
|
|
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 36MM
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046293
|
|
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 36MM
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046293
|
|
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 38MM
|
Facility
OP
|
$306.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046294
|
|
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: Partners Health Alliance Commercial |
$229.50
|
| Rate for Payer: United Healthcare Commercial |
$275.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$180.54
|
|
|
SCREW LAG CANN 4.0MM X 38MM
|
Facility
IP
|
$306.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046294
|
|
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 LAG CANN 4.0MM X 40MM
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046295
|
|
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 40MM
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046295
|
|
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 44MM
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046296
|
|
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 44MM
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046296
|
|
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 48MM
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046297
|
|
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
|
|
