|
SCREW PERIPROSTH 5.0X18MM
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.96 |
| 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 |
$101.95
|
| Rate for Payer: Amerigroup Medicare |
$102.01
|
| 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 |
$101.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.96
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$101.00
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$151.50
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.18
|
|
|
SCREW PERIPROSTH 5.0X18MM
|
Facility
IP
|
$202.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046637
|
|
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 PERIPROSTH 5.0X20MM
|
Facility
IP
|
$202.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046638
|
|
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 PERIPROSTH 5.0X20MM
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.96 |
| 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 |
$101.95
|
| Rate for Payer: Amerigroup Medicare |
$102.01
|
| 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 |
$101.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.96
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$101.00
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$151.50
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.18
|
|
|
SCREW SHORT THREAD,4.0X30MM, CANNULATED
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
|
|
SCREW SHORT THREAD,4.0X30MM, CANNULATED
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Aetna of IA Medicare |
$76.95
|
| Rate for Payer: Amerigroup Medicaid |
$68.13
|
| Rate for Payer: Amerigroup Medicare |
$68.18
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.47
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.25
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.65
|
|
|
SCREW SHORT THREAD,4.0X35MM, CANNULATED
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Aetna of IA Medicare |
$76.95
|
| Rate for Payer: Amerigroup Medicaid |
$68.13
|
| Rate for Payer: Amerigroup Medicare |
$68.18
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.47
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.25
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.65
|
|
|
SCREW SHORT THREAD,4.0X35MM, CANNULATED
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
|
|
SCREW SHORT THREAD,4.0X 40MM, CANNULATED
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Aetna of IA Medicare |
$76.95
|
| Rate for Payer: Amerigroup Medicaid |
$68.13
|
| Rate for Payer: Amerigroup Medicare |
$68.18
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.47
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.25
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.65
|
|
|
SCREW SHORT THREAD,4.0X 40MM, CANNULATED
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
|
|
SCREW SHORT THREAD,4.0X45MM, CANNULATED
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
|
|
SCREW SHORT THREAD,4.0X45MM, CANNULATED
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Aetna of IA Medicare |
$76.95
|
| Rate for Payer: Amerigroup Medicaid |
$68.13
|
| Rate for Payer: Amerigroup Medicare |
$68.18
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.47
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.25
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.65
|
|
|
SCREW SHORT THREAD,4.0X 50MM, CANNULATED
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Aetna of IA Medicare |
$76.95
|
| Rate for Payer: Amerigroup Medicaid |
$68.13
|
| Rate for Payer: Amerigroup Medicare |
$68.18
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.47
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.25
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.65
|
|
|
SCREW SHORT THREAD,4.0X 50MM, CANNULATED
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
|
|
SCREW SHORT THREAD,4.0X 55MM, CANNULATED
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Aetna of IA Medicare |
$76.95
|
| Rate for Payer: Amerigroup Medicaid |
$68.13
|
| Rate for Payer: Amerigroup Medicare |
$68.18
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.47
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.25
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.65
|
|
|
SCREW SHORT THREAD,4.0X 55MM, CANNULATED
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
|
|
SCREW SHORT THREAD,4.0X 60MM, CANNULATED
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
|
|
SCREW SHORT THREAD,4.0X 60MM, CANNULATED
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Aetna of IA Medicare |
$76.95
|
| Rate for Payer: Amerigroup Medicaid |
$68.13
|
| Rate for Payer: Amerigroup Medicare |
$68.18
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.47
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.25
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.65
|
|
|
SCREW SNAP OFF QUICK FIX
|
Facility
OP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.89 |
| Max. Negotiated Rate |
$502.20 |
| Rate for Payer: Aetna of IA Commercial |
$502.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$502.20
|
| Rate for Payer: Aetna of IA Medicare |
$318.06
|
| Rate for Payer: Amerigroup Medicaid |
$281.62
|
| Rate for Payer: Amerigroup Medicare |
$281.79
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$418.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$279.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$278.89
|
| Rate for Payer: Medical Associates Commercial |
$418.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$279.00
|
| Rate for Payer: Midlands Choice Commercial |
$390.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$283.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$418.50
|
| Rate for Payer: United Healthcare Commercial |
$502.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$329.22
|
|
|
SCREW SNAP OFF QUICK FIX
|
Facility
IP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$390.60 |
| Max. Negotiated Rate |
$502.20 |
| Rate for Payer: Aetna of IA Commercial |
$502.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$502.20
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$418.50
|
| Rate for Payer: Medical Associates Commercial |
$418.50
|
| Rate for Payer: Midlands Choice Commercial |
$390.60
|
| Rate for Payer: United Healthcare Commercial |
$502.20
|
|
|
SCREW SNAP OFF QUICKFIX 3X15MM
|
Facility
IP
|
$396.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$356.40 |
| Rate for Payer: Aetna of IA Commercial |
$356.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$356.40
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$297.00
|
| Rate for Payer: Medical Associates Commercial |
$297.00
|
| Rate for Payer: Midlands Choice Commercial |
$277.20
|
| Rate for Payer: United Healthcare Commercial |
$356.40
|
|
|
SCREW SNAP OFF QUICKFIX 3X15MM
|
Facility
OP
|
$396.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.92 |
| Max. Negotiated Rate |
$356.40 |
| Rate for Payer: Aetna of IA Commercial |
$356.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$356.40
|
| Rate for Payer: Aetna of IA Medicare |
$225.72
|
| Rate for Payer: Amerigroup Medicaid |
$199.86
|
| Rate for Payer: Amerigroup Medicare |
$199.98
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$297.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$198.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$197.92
|
| Rate for Payer: Medical Associates Commercial |
$297.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$198.00
|
| Rate for Payer: Midlands Choice Commercial |
$277.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$200.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$297.00
|
| Rate for Payer: United Healthcare Commercial |
$356.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$233.64
|
|
|
SCREW SNAP OFF QUICKFIX 3X17MM
|
Facility
IP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$390.60 |
| Max. Negotiated Rate |
$502.20 |
| Rate for Payer: Aetna of IA Commercial |
$502.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$502.20
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$418.50
|
| Rate for Payer: Medical Associates Commercial |
$418.50
|
| Rate for Payer: Midlands Choice Commercial |
$390.60
|
| Rate for Payer: United Healthcare Commercial |
$502.20
|
|
|
SCREW SNAP OFF QUICKFIX 3X17MM
|
Facility
OP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.89 |
| Max. Negotiated Rate |
$502.20 |
| Rate for Payer: Aetna of IA Commercial |
$502.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$502.20
|
| Rate for Payer: Aetna of IA Medicare |
$318.06
|
| Rate for Payer: Amerigroup Medicaid |
$281.62
|
| Rate for Payer: Amerigroup Medicare |
$281.79
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$418.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$279.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$278.89
|
| Rate for Payer: Medical Associates Commercial |
$418.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$279.00
|
| Rate for Payer: Midlands Choice Commercial |
$390.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$283.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$418.50
|
| Rate for Payer: United Healthcare Commercial |
$502.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$329.22
|
|
|
SCREW SOLID LAG, 5.5MM X 30MM
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.95 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Aetna of IA Medicare |
$153.90
|
| Rate for Payer: Amerigroup Medicaid |
$136.27
|
| Rate for Payer: Amerigroup Medicare |
$136.35
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$135.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$134.95
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$137.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$202.50
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.30
|
|
