|
SCREW LONG THREAD,4.0X 40MM, CANNULATED
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047134
|
|
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 LONG THREAD,4.0X 40MM, CANNULATED
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047134
|
|
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: Molina Healthcare Managed Medicare |
$68.47
|
| Rate for Payer: Oscar Health of IA Commercial |
$101.25
|
| 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 LONG THREAD,4.0X 45MM, CANNULATED
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047135
|
|
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 LONG THREAD,4.0X 45MM, CANNULATED
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047135
|
|
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: Molina Healthcare Managed Medicare |
$68.47
|
| Rate for Payer: Oscar Health of IA Commercial |
$101.25
|
| 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 LONG THREAD,4.0X 50MM, CANNULATED
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047136
|
|
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: Molina Healthcare Managed Medicare |
$68.47
|
| Rate for Payer: Oscar Health of IA Commercial |
$101.25
|
| 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 LONG THREAD,4.0X 50MM, CANNULATED
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047136
|
|
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 LONG THREAD,4.0X 55MM, CANNULATED
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047137
|
|
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: Molina Healthcare Managed Medicare |
$68.47
|
| Rate for Payer: Oscar Health of IA Commercial |
$101.25
|
| 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 LONG THREAD,4.0X 55MM, CANNULATED
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047137
|
|
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 LONG THREAD,4.0X 60MM, CANNULATED
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047138
|
|
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: Molina Healthcare Managed Medicare |
$68.47
|
| Rate for Payer: Oscar Health of IA Commercial |
$101.25
|
| 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 LONG THREAD,4.0X 60MM, CANNULATED
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047138
|
|
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 LOW PROFILE 3X12MM
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.44 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Aetna of IA Commercial |
$267.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$267.30
|
| Rate for Payer: Aetna of IA Medicare |
$169.29
|
| Rate for Payer: Amerigroup Medicaid |
$149.90
|
| Rate for Payer: Amerigroup Medicare |
$149.98
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$148.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$148.44
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$150.73
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$150.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$222.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$222.75
|
| Rate for Payer: United Healthcare Commercial |
$267.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$175.23
|
|
|
SCREW LOW PROFILE 3X12MM
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Aetna of IA Commercial |
$267.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$267.30
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.75
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: United Healthcare Commercial |
$267.30
|
|
|
SCREW LOW PROFILE 3X14MM
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.44 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Aetna of IA Commercial |
$267.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$267.30
|
| Rate for Payer: Aetna of IA Medicare |
$169.29
|
| Rate for Payer: Amerigroup Medicaid |
$149.90
|
| Rate for Payer: Amerigroup Medicare |
$149.98
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$148.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$148.44
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$150.73
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$150.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$222.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$222.75
|
| Rate for Payer: United Healthcare Commercial |
$267.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$175.23
|
|
|
SCREW LOW PROFILE 3X14MM
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Aetna of IA Commercial |
$267.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$267.30
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.75
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: United Healthcare Commercial |
$267.30
|
|
|
SCREW LOW PROFILE 3X18MM
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.44 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Aetna of IA Commercial |
$267.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$267.30
|
| Rate for Payer: Aetna of IA Medicare |
$169.29
|
| Rate for Payer: Amerigroup Medicaid |
$149.90
|
| Rate for Payer: Amerigroup Medicare |
$149.98
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$148.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$148.44
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$150.73
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$150.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$222.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$222.75
|
| Rate for Payer: United Healthcare Commercial |
$267.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$175.23
|
|
|
SCREW LOW PROFILE 3X18MM
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Aetna of IA Commercial |
$267.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$267.30
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.75
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: United Healthcare Commercial |
$267.30
|
|
|
SCREW LOW PROFILE 3X20MM
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Aetna of IA Commercial |
$267.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$267.30
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.75
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: United Healthcare Commercial |
$267.30
|
|
|
SCREW LOW PROFILE 3X20MM
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.44 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Aetna of IA Commercial |
$267.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$267.30
|
| Rate for Payer: Aetna of IA Medicare |
$169.29
|
| Rate for Payer: Amerigroup Medicaid |
$149.90
|
| Rate for Payer: Amerigroup Medicare |
$149.98
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$148.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$148.44
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$150.73
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$150.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$222.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$222.75
|
| Rate for Payer: United Healthcare Commercial |
$267.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$175.23
|
|
|
SCREW NON LOCKING 10MM
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Medical Associates Commercial |
$91.50
|
| Rate for Payer: Aetna of IA Commercial |
$109.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$109.80
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$91.50
|
| Rate for Payer: Midlands Choice Commercial |
$85.40
|
| Rate for Payer: United Healthcare Commercial |
$109.80
|
|
|
SCREW NON LOCKING 10MM
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.98 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Aetna of IA Commercial |
$109.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$109.80
|
| Rate for Payer: Aetna of IA Medicare |
$69.54
|
| Rate for Payer: Amerigroup Medicaid |
$61.57
|
| Rate for Payer: Amerigroup Medicare |
$61.61
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$91.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$61.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$60.98
|
| Rate for Payer: Medical Associates Commercial |
$91.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$61.00
|
| Rate for Payer: Midlands Choice Commercial |
$85.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$61.92
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$61.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$91.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$91.50
|
| Rate for Payer: United Healthcare Commercial |
$109.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$71.98
|
|
|
SCREW NON LOCKING 12MM
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.97 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna of IA Commercial |
$115.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$115.20
|
| Rate for Payer: Aetna of IA Medicare |
$72.96
|
| Rate for Payer: Amerigroup Medicaid |
$64.60
|
| Rate for Payer: Amerigroup Medicare |
$64.64
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$63.97
|
| Rate for Payer: Medical Associates Commercial |
$96.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.00
|
| Rate for Payer: Midlands Choice Commercial |
$89.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$64.96
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$64.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$96.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$96.00
|
| Rate for Payer: United Healthcare Commercial |
$115.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$75.52
|
|
|
SCREW NON LOCKING 12MM
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna of IA Commercial |
$115.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$115.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.00
|
| Rate for Payer: Medical Associates Commercial |
$96.00
|
| Rate for Payer: Midlands Choice Commercial |
$89.60
|
| Rate for Payer: United Healthcare Commercial |
$115.20
|
|
|
SCREW NON LOCKING 18MM
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046710
|
|
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 NON LOCKING 18MM
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046710
|
|
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: Molina Healthcare Managed Medicare |
$68.47
|
| Rate for Payer: Oscar Health of IA Commercial |
$101.25
|
| 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 NON-LOCKING 3MMX14MM
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna of IA Commercial |
$251.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$251.10
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$209.25
|
| Rate for Payer: Medical Associates Commercial |
$209.25
|
| Rate for Payer: Midlands Choice Commercial |
$195.30
|
| Rate for Payer: United Healthcare Commercial |
$251.10
|
|
