|
SCREW CANNULATED ASNIS III 4.0X20MM
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.90 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Aetna of IA Commercial |
$177.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$177.30
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.75
|
| Rate for Payer: Medical Associates Commercial |
$147.75
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: United Healthcare Commercial |
$177.30
|
|
|
SCREW CANNULATED ASNIS III 4.0X20MM
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.65 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Aetna of IA Commercial |
$177.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$177.30
|
| Rate for Payer: Aetna of IA Medicare |
$112.29
|
| Rate for Payer: Amerigroup Medicaid |
$113.63
|
| Rate for Payer: Amerigroup Medicare |
$89.54
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$88.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$112.53
|
| Rate for Payer: Medical Associates Commercial |
$147.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.65
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.95
|
| Rate for Payer: United Healthcare Commercial |
$177.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.23
|
|
|
SCREW CANNULATED ASNIS III 4.0X22MM
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046444
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.65 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Aetna of IA Commercial |
$177.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$177.30
|
| Rate for Payer: Aetna of IA Medicare |
$112.29
|
| Rate for Payer: Amerigroup Medicaid |
$113.63
|
| Rate for Payer: Amerigroup Medicare |
$89.54
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$88.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$112.53
|
| Rate for Payer: Medical Associates Commercial |
$147.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.65
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.95
|
| Rate for Payer: United Healthcare Commercial |
$177.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.23
|
|
|
SCREW CANNULATED ASNIS III 4.0X22MM
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046444
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.90 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Aetna of IA Commercial |
$177.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$177.30
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.75
|
| Rate for Payer: Medical Associates Commercial |
$147.75
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: United Healthcare Commercial |
$177.30
|
|
|
SCREW CANNULATED ASNIS III 4.0X24MM
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.90 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Aetna of IA Commercial |
$177.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$177.30
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.75
|
| Rate for Payer: Medical Associates Commercial |
$147.75
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: United Healthcare Commercial |
$177.30
|
|
|
SCREW CANNULATED ASNIS III 4.0X24MM
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.65 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Aetna of IA Commercial |
$177.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$177.30
|
| Rate for Payer: Aetna of IA Medicare |
$112.29
|
| Rate for Payer: Amerigroup Medicaid |
$113.63
|
| Rate for Payer: Amerigroup Medicare |
$89.54
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$88.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$112.53
|
| Rate for Payer: Medical Associates Commercial |
$147.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.65
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.95
|
| Rate for Payer: United Healthcare Commercial |
$177.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.23
|
|
|
SCREW CANNULATED ASNIS III 4.0X26MM
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna of IA Commercial |
$214.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$214.20
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$178.50
|
| Rate for Payer: Medical Associates Commercial |
$178.50
|
| Rate for Payer: Midlands Choice Commercial |
$166.60
|
| Rate for Payer: United Healthcare Commercial |
$214.20
|
|
|
SCREW CANNULATED ASNIS III 4.0X26MM
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna of IA Commercial |
$214.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$214.20
|
| Rate for Payer: Aetna of IA Medicare |
$135.66
|
| Rate for Payer: Amerigroup Medicaid |
$137.28
|
| Rate for Payer: Amerigroup Medicare |
$108.17
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$178.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$107.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$135.95
|
| Rate for Payer: Medical Associates Commercial |
$178.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$107.10
|
| Rate for Payer: Midlands Choice Commercial |
$166.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$137.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$123.16
|
| Rate for Payer: United Healthcare Commercial |
$214.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$140.42
|
|
|
SCREW CANNULATED ASNIS III 4.0X28MM
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.65 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Aetna of IA Commercial |
$177.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$177.30
|
| Rate for Payer: Aetna of IA Medicare |
$112.29
|
| Rate for Payer: Amerigroup Medicaid |
$113.63
|
| Rate for Payer: Amerigroup Medicare |
$89.54
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$88.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$112.53
|
| Rate for Payer: Medical Associates Commercial |
$147.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.65
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.95
|
| Rate for Payer: United Healthcare Commercial |
$177.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.23
|
|
|
SCREW CANNULATED ASNIS III 4.0X28MM
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.90 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Aetna of IA Commercial |
$177.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$177.30
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.75
|
| Rate for Payer: Medical Associates Commercial |
$147.75
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: United Healthcare Commercial |
$177.30
|
|
|
SCREW CANNULATED ASNIS III 4.0X30MM
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046448
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.10 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Aetna of IA Commercial |
$218.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$218.70
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$182.25
|
| Rate for Payer: Medical Associates Commercial |
$182.25
|
| Rate for Payer: Midlands Choice Commercial |
$170.10
|
| Rate for Payer: United Healthcare Commercial |
$218.70
|
|
|
SCREW CANNULATED ASNIS III 4.0X30MM
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046448
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.35 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Aetna of IA Commercial |
$218.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$218.70
|
| Rate for Payer: Aetna of IA Medicare |
$138.51
|
| Rate for Payer: Amerigroup Medicaid |
$140.16
|
| Rate for Payer: Amerigroup Medicare |
$110.44
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$182.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$109.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$138.80
|
| Rate for Payer: Medical Associates Commercial |
$182.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$109.35
|
| Rate for Payer: Midlands Choice Commercial |
$170.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$140.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$125.75
|
| Rate for Payer: United Healthcare Commercial |
$218.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$143.37
|
|
|
SCREW CANNULATED ASNIS III 4.0X32MM
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.65 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Aetna of IA Commercial |
$177.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$177.30
|
| Rate for Payer: Aetna of IA Medicare |
$112.29
|
| Rate for Payer: Amerigroup Medicaid |
$113.63
|
| Rate for Payer: Amerigroup Medicare |
$89.54
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$88.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$112.53
|
| Rate for Payer: Medical Associates Commercial |
$147.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.65
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.95
|
| Rate for Payer: United Healthcare Commercial |
$177.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.23
|
|
|
SCREW CANNULATED ASNIS III 4.0X32MM
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.90 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Aetna of IA Commercial |
$177.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$177.30
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.75
|
| Rate for Payer: Medical Associates Commercial |
$147.75
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: United Healthcare Commercial |
$177.30
|
|
|
SCREW CANNULATED ASNIS III 4.0X34MM
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.65 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Aetna of IA Commercial |
$177.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$177.30
|
| Rate for Payer: Aetna of IA Medicare |
$112.29
|
| Rate for Payer: Amerigroup Medicaid |
$113.63
|
| Rate for Payer: Amerigroup Medicare |
$89.54
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$88.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$112.53
|
| Rate for Payer: Medical Associates Commercial |
$147.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.65
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.95
|
| Rate for Payer: United Healthcare Commercial |
$177.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.23
|
|
|
SCREW CANNULATED ASNIS III 4.0X34MM
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.90 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Aetna of IA Commercial |
$177.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$177.30
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.75
|
| Rate for Payer: Medical Associates Commercial |
$147.75
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: United Healthcare Commercial |
$177.30
|
|
|
SCREW CANNULATED ASNIS III 4.0X36MM
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.30 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Aetna of IA Commercial |
$224.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$224.10
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$186.75
|
| Rate for Payer: Medical Associates Commercial |
$186.75
|
| Rate for Payer: Midlands Choice Commercial |
$174.30
|
| Rate for Payer: United Healthcare Commercial |
$224.10
|
|
|
SCREW CANNULATED ASNIS III 4.0X36MM
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.05 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Aetna of IA Commercial |
$224.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$224.10
|
| Rate for Payer: Aetna of IA Medicare |
$141.93
|
| Rate for Payer: Amerigroup Medicaid |
$143.62
|
| Rate for Payer: Amerigroup Medicare |
$113.17
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$186.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$112.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$142.23
|
| Rate for Payer: Medical Associates Commercial |
$186.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$112.05
|
| Rate for Payer: Midlands Choice Commercial |
$174.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$144.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$128.86
|
| Rate for Payer: United Healthcare Commercial |
$224.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$146.91
|
|
|
SCREW CANNULATED ASNIS III 4.0X38MM
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.90 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Aetna of IA Medicare |
$115.14
|
| Rate for Payer: Amerigroup Medicaid |
$116.51
|
| Rate for Payer: Amerigroup Medicare |
$91.81
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$115.38
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.90
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$117.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.54
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.18
|
|
|
SCREW CANNULATED ASNIS III 4.0X38MM
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
|
|
SCREW CANNULATED ASNIS III 4.0X40MM
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.45 |
| 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 |
$150.54
|
| Rate for Payer: Amerigroup Medicare |
$118.62
|
| 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 |
$117.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$149.08
|
| Rate for Payer: Medical Associates Commercial |
$195.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$117.45
|
| Rate for Payer: Midlands Choice Commercial |
$182.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$151.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.07
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.99
|
|
|
SCREW CANNULATED ASNIS III 4.0X40MM
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046453
|
|
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 CANNULATED ASNIS III 4.0X42MM
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.90 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Aetna of IA Medicare |
$115.14
|
| Rate for Payer: Amerigroup Medicaid |
$116.51
|
| Rate for Payer: Amerigroup Medicare |
$91.81
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$115.38
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.90
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$117.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.54
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.18
|
|
|
SCREW CANNULATED ASNIS III 4.0X42MM
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
|
|
SCREW CANNULATED ASNIS III 4.0X44MM
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.90 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Aetna of IA Medicare |
$115.14
|
| Rate for Payer: Amerigroup Medicaid |
$116.51
|
| Rate for Payer: Amerigroup Medicare |
$91.81
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$115.38
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.90
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$117.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.54
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.18
|
|
