|
SCREW LOCKING 2.7X118MM, LPS, SS
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.48 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Aetna of IA Medicare |
$54.15
|
| Rate for Payer: Amerigroup Medicaid |
$47.95
|
| Rate for Payer: Amerigroup Medicare |
$47.98
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$47.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.48
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.50
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$48.21
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$48.18
|
| Rate for Payer: Oscar Health of IA Commercial |
$71.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.25
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.05
|
|
|
SCREW LOCKING 2.7X12MM, LPS, SS
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
|
|
SCREW LOCKING 2.7X12MM, LPS, SS
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.48 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Aetna of IA Medicare |
$54.15
|
| Rate for Payer: Amerigroup Medicaid |
$47.95
|
| Rate for Payer: Amerigroup Medicare |
$47.98
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$47.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.48
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.50
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$48.21
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$48.18
|
| Rate for Payer: Oscar Health of IA Commercial |
$71.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.25
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.05
|
|
|
SCREW LOCKING 2.7X12MM, LPS, SS-20
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
|
|
SCREW LOCKING 2.7X12MM, LPS, SS-20
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.48 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Aetna of IA Medicare |
$54.15
|
| Rate for Payer: Amerigroup Medicaid |
$47.95
|
| Rate for Payer: Amerigroup Medicare |
$47.98
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$47.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.48
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.50
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$48.21
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$48.18
|
| Rate for Payer: Oscar Health of IA Commercial |
$71.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.25
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.05
|
|
|
SCREW LOCKING 2.7X12MM, LPS, SS-26
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
|
|
SCREW LOCKING 2.7X12MM, LPS, SS-26
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.48 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Aetna of IA Medicare |
$54.15
|
| Rate for Payer: Amerigroup Medicaid |
$47.95
|
| Rate for Payer: Amerigroup Medicare |
$47.98
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$47.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.48
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.50
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$48.21
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$48.18
|
| Rate for Payer: Oscar Health of IA Commercial |
$71.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.25
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.05
|
|
|
SCREW LOCKING 2.7X14MM, LPS, SS
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.48 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Aetna of IA Medicare |
$54.15
|
| Rate for Payer: Amerigroup Medicaid |
$47.95
|
| Rate for Payer: Amerigroup Medicare |
$47.98
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$47.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.48
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.50
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$48.21
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$48.18
|
| Rate for Payer: Oscar Health of IA Commercial |
$71.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.25
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.05
|
|
|
SCREW LOCKING 2.7X14MM, LPS, SS
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
|
|
SCREW LOCKING 2.7X15MM
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna of IA Commercial |
$292.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$292.50
|
| Rate for Payer: Aetna of IA Medicare |
$185.25
|
| Rate for Payer: Amerigroup Medicaid |
$164.03
|
| Rate for Payer: Amerigroup Medicare |
$164.12
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$243.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$162.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$162.44
|
| Rate for Payer: Medical Associates Commercial |
$243.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$162.50
|
| Rate for Payer: Midlands Choice Commercial |
$227.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$164.94
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$164.84
|
| Rate for Payer: Oscar Health of IA Commercial |
$243.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$243.75
|
| Rate for Payer: United Healthcare Commercial |
$292.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$191.75
|
|
|
SCREW LOCKING 2.7X15MM
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna of IA Commercial |
$292.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$292.50
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$243.75
|
| Rate for Payer: Medical Associates Commercial |
$243.75
|
| Rate for Payer: Midlands Choice Commercial |
$227.50
|
| Rate for Payer: United Healthcare Commercial |
$292.50
|
|
|
SCREW LOCKING 2.7X16MM, LPS, SS
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.48 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Aetna of IA Medicare |
$54.15
|
| Rate for Payer: Amerigroup Medicaid |
$47.95
|
| Rate for Payer: Amerigroup Medicare |
$47.98
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$47.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.48
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.50
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$48.21
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$48.18
|
| Rate for Payer: Oscar Health of IA Commercial |
$71.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.25
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.05
|
|
|
SCREW LOCKING 2.7X16MM, LPS, SS
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
|
|
SCREW LOCKING 2.7X22MM, LPS, SS
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.48 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Aetna of IA Medicare |
$54.15
|
| Rate for Payer: Amerigroup Medicaid |
$47.95
|
| Rate for Payer: Amerigroup Medicare |
$47.98
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$47.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.48
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.50
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$48.21
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$48.18
|
| Rate for Payer: Oscar Health of IA Commercial |
$71.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.25
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.05
|
|
|
SCREW LOCKING 2.7X22MM, LPS, SS
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
|
|
SCREW LOCKING 2.7X24MM, LPS, SS
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.48 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Aetna of IA Medicare |
$54.15
|
| Rate for Payer: Amerigroup Medicaid |
$47.95
|
| Rate for Payer: Amerigroup Medicare |
$47.98
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$47.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.48
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.50
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$48.21
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$48.18
|
| Rate for Payer: Oscar Health of IA Commercial |
$71.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.25
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.05
|
|
|
SCREW LOCKING 2.7X24MM, LPS, SS
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
|
|
SCREW LOCKING 3.0X16MM
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna of IA Commercial |
$137.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$137.70
|
| Rate for Payer: Aetna of IA Medicare |
$87.21
|
| Rate for Payer: Amerigroup Medicaid |
$77.22
|
| Rate for Payer: Amerigroup Medicare |
$77.26
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$76.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$76.47
|
| Rate for Payer: Medical Associates Commercial |
$114.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$76.50
|
| Rate for Payer: Midlands Choice Commercial |
$107.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$77.65
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$77.60
|
| Rate for Payer: Oscar Health of IA Commercial |
$114.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$114.75
|
| Rate for Payer: United Healthcare Commercial |
$137.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$90.27
|
|
|
SCREW LOCKING 3.0X16MM
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna of IA Commercial |
$137.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$137.70
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.75
|
| Rate for Payer: Medical Associates Commercial |
$114.75
|
| Rate for Payer: Midlands Choice Commercial |
$107.10
|
| Rate for Payer: United Healthcare Commercial |
$137.70
|
|
|
SCREW LOCKING 3.5 X 10 MM LPS, SS
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
SCREW LOCKING 3.5 X 10 MM LPS, SS
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$100.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$148.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
SCREW LOCKING 3.5 X 12 MM LPS, SS
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
SCREW LOCKING 3.5 X 12 MM LPS, SS
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$100.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$148.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
SCREW LOCKING 3.5 X14 MM LPS, SS
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
SCREW LOCKING 3.5 X14 MM LPS, SS
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$100.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$148.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
