|
SCREW CORTICAL SELF TAP 4.5X66
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
|
|
SCREW CORTICAL SELF TAP 4.5X68MM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Aetna of IA Medicare |
$15.96
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$12.73
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.60
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.49
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.52
|
|
|
SCREW CORTICAL SELF TAP 4.5X68MM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
|
|
SCREW CORTICAL SELF TAP 4.5X70MM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Aetna of IA Medicare |
$15.96
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$12.73
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.60
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.49
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.52
|
|
|
SCREW CORTICAL SELF TAP 4.5X70MM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of IA Commercial |
$25.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.00
|
| Rate for Payer: Medical Associates Commercial |
$21.00
|
| Rate for Payer: Midlands Choice Commercial |
$19.60
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
|
|
SCREW GAP PLATE HIP 6.5MM X 20MM
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Aetna of IA Medicare |
$196.08
|
| Rate for Payer: Amerigroup Medicaid |
$198.42
|
| Rate for Payer: Amerigroup Medicare |
$156.35
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$154.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$196.49
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$154.80
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$199.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$178.02
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$202.96
|
|
|
SCREW GAP PLATE HIP 6.5MM X 20MM
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
|
|
SCREW GAP PLATE HIP 6.5MM X 25MM
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Aetna of IA Medicare |
$196.08
|
| Rate for Payer: Amerigroup Medicaid |
$198.42
|
| Rate for Payer: Amerigroup Medicare |
$156.35
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$154.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$196.49
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$154.80
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$199.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$178.02
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$202.96
|
|
|
SCREW GAP PLATE HIP 6.5MM X 25MM
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
|
|
SCREW GAP PLATE HIP 6.5MM X 30MM
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.95 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Aetna of IA Commercial |
$297.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$297.90
|
| Rate for Payer: Aetna of IA Medicare |
$188.67
|
| Rate for Payer: Amerigroup Medicaid |
$190.92
|
| Rate for Payer: Amerigroup Medicare |
$150.44
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$248.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$148.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$189.07
|
| Rate for Payer: Medical Associates Commercial |
$248.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$148.95
|
| Rate for Payer: Midlands Choice Commercial |
$231.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$191.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$171.29
|
| Rate for Payer: United Healthcare Commercial |
$297.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$195.29
|
|
|
SCREW GAP PLATE HIP 6.5MM X 30MM
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.70 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Aetna of IA Commercial |
$297.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$297.90
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$248.25
|
| Rate for Payer: Medical Associates Commercial |
$248.25
|
| Rate for Payer: Midlands Choice Commercial |
$231.70
|
| Rate for Payer: United Healthcare Commercial |
$297.90
|
|
|
SCREW GAP PLATE HIP 6.5MM X 35MM
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Aetna of IA Medicare |
$196.08
|
| Rate for Payer: Amerigroup Medicaid |
$198.42
|
| Rate for Payer: Amerigroup Medicare |
$156.35
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$154.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$196.49
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$154.80
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$199.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$178.02
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$202.96
|
|
|
SCREW GAP PLATE HIP 6.5MM X 35MM
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
|
|
SCREW GRIDLOCKING 3.5X 26MM
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8831367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna of IA Commercial |
$275.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$275.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$229.50
|
| Rate for Payer: Medical Associates Commercial |
$229.50
|
| Rate for Payer: Midlands Choice Commercial |
$214.20
|
| Rate for Payer: United Healthcare Commercial |
$275.40
|
|
|
SCREW GRIDLOCKING 3.5X 26MM
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8831367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.70 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna of IA Commercial |
$275.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$275.40
|
| Rate for Payer: Aetna of IA Medicare |
$174.42
|
| Rate for Payer: Amerigroup Medicaid |
$176.50
|
| Rate for Payer: Amerigroup Medicare |
$139.08
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$229.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$137.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$174.79
|
| Rate for Payer: Medical Associates Commercial |
$229.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$137.70
|
| Rate for Payer: Midlands Choice Commercial |
$214.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$177.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$158.36
|
| Rate for Payer: United Healthcare Commercial |
$275.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$180.54
|
|
|
SCREW INTERFERENCE 10
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$289.80 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of IA Commercial |
$372.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$372.60
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$310.50
|
| Rate for Payer: Medical Associates Commercial |
$310.50
|
| Rate for Payer: Midlands Choice Commercial |
$289.80
|
| Rate for Payer: United Healthcare Commercial |
$372.60
|
|
|
SCREW INTERFERENCE 10
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.30 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of IA Commercial |
$372.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$372.60
|
| Rate for Payer: Aetna of IA Medicare |
$235.98
|
| Rate for Payer: Amerigroup Medicaid |
$238.80
|
| Rate for Payer: Amerigroup Medicare |
$188.16
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$310.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$186.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$236.48
|
| Rate for Payer: Medical Associates Commercial |
$310.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$186.30
|
| Rate for Payer: Midlands Choice Commercial |
$289.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$239.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$214.24
|
| Rate for Payer: United Healthcare Commercial |
$372.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$244.26
|
|
|
SCREW INTERFERENCE 10X23
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Aetna of IA Medicare |
$230.85
|
| Rate for Payer: Amerigroup Medicaid |
$233.60
|
| Rate for Payer: Amerigroup Medicare |
$184.07
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$182.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$231.34
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$182.25
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$234.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$209.59
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
|
SCREW INTERFERENCE 10X23
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
|
|
SCREW INTERFERENCE 7X23MM
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$289.80 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of IA Commercial |
$372.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$372.60
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$310.50
|
| Rate for Payer: Medical Associates Commercial |
$310.50
|
| Rate for Payer: Midlands Choice Commercial |
$289.80
|
| Rate for Payer: United Healthcare Commercial |
$372.60
|
|
|
SCREW INTERFERENCE 7X23MM
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.30 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of IA Commercial |
$372.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$372.60
|
| Rate for Payer: Aetna of IA Medicare |
$235.98
|
| Rate for Payer: Amerigroup Medicaid |
$238.80
|
| Rate for Payer: Amerigroup Medicare |
$188.16
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$310.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$186.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$236.48
|
| Rate for Payer: Medical Associates Commercial |
$310.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$186.30
|
| Rate for Payer: Midlands Choice Commercial |
$289.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$239.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$214.24
|
| Rate for Payer: United Healthcare Commercial |
$372.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$244.26
|
|
|
SCREW INTERFERENCE 8
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.30 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of IA Commercial |
$372.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$372.60
|
| Rate for Payer: Aetna of IA Medicare |
$235.98
|
| Rate for Payer: Amerigroup Medicaid |
$238.80
|
| Rate for Payer: Amerigroup Medicare |
$188.16
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$310.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$186.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$236.48
|
| Rate for Payer: Medical Associates Commercial |
$310.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$186.30
|
| Rate for Payer: Midlands Choice Commercial |
$289.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$239.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$214.24
|
| Rate for Payer: United Healthcare Commercial |
$372.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$244.26
|
|
|
SCREW INTERFERENCE 8
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$289.80 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of IA Commercial |
$372.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$372.60
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$310.50
|
| Rate for Payer: Medical Associates Commercial |
$310.50
|
| Rate for Payer: Midlands Choice Commercial |
$289.80
|
| Rate for Payer: United Healthcare Commercial |
$372.60
|
|
|
SCREW INTERFERENCE 8X23MM
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Aetna of IA Medicare |
$230.85
|
| Rate for Payer: Amerigroup Medicaid |
$233.60
|
| Rate for Payer: Amerigroup Medicare |
$184.07
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$182.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$231.34
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$182.25
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$234.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$209.59
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$238.95
|
|
|
SCREW INTERFERENCE 8X23MM
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of IA Commercial |
$364.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$364.50
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$303.75
|
| Rate for Payer: Medical Associates Commercial |
$303.75
|
| Rate for Payer: Midlands Choice Commercial |
$283.50
|
| Rate for Payer: United Healthcare Commercial |
$364.50
|
|
