|
SCREW LAG CANN 2.4MM X 10MM
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046262
|
|
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 LAG CANN 2.4MM X 12MM
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046263
|
|
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 LAG CANN 2.4MM X 12MM
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046263
|
|
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 LAG CANN 2.4MM X 14MM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.00 |
| 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: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
|
|
SCREW LAG CANN 2.4MM X 14MM
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.50 |
| 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 |
$155.74
|
| Rate for Payer: Amerigroup Medicare |
$122.72
|
| 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 |
$121.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$154.22
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$156.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$139.72
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.30
|
|
|
SCREW LAG CANN 2.4MM X 16MM
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046409
|
|
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 LAG CANN 2.4MM X 16MM
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046409
|
|
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 LAG CANN 2.4MM X 18MM
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046265
|
|
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 LAG CANN 2.4MM X 18MM
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046265
|
|
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 LAG CANN 2.4MM X 20MM
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046266
|
|
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 LAG CANN 2.4MM X 20MM
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046266
|
|
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 LAG CANN 2.4MM X 22MM
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046267
|
|
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 LAG CANN 2.4MM X 22MM
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046267
|
|
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 LAG CANN 2.4MM X 24MM
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.55 |
| 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: Aetna of IA Medicare |
$159.03
|
| Rate for Payer: Amerigroup Medicaid |
$160.93
|
| Rate for Payer: Amerigroup Medicare |
$126.81
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$209.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$125.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$159.36
|
| Rate for Payer: Medical Associates Commercial |
$209.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$125.55
|
| Rate for Payer: Midlands Choice Commercial |
$195.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$161.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$144.38
|
| Rate for Payer: United Healthcare Commercial |
$251.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$164.61
|
|
|
SCREW LAG CANN 2.4MM X 24MM
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046268
|
|
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
|
|
|
SCREW LAG CANN 2.4MM X 26MM
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046269
|
|
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 LAG CANN 2.4MM X 26MM
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046269
|
|
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 LAG CANN 2.4MM X 28MM
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046270
|
|
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 LAG CANN 2.4MM X 28MM
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046270
|
|
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 LAG CANN 2.4MM X 30MM
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046271
|
|
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 LAG CANN 2.4MM X 30MM
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046271
|
|
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 LAG CANN 2.4MM X 6MM
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046260
|
|
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 LAG CANN 2.4MM X 6MM
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046260
|
|
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 LAG CANN 2.4MM X 8MM
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046261
|
|
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 LAG CANN 2.4MM X 8MM
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046261
|
|
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
|
|
