|
SCREW LOCKING 2.7X12MM, LPS, SS-20
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Aetna of IA Medicare |
$54.15
|
| Rate for Payer: Amerigroup Medicaid |
$54.80
|
| Rate for Payer: Amerigroup Medicare |
$43.18
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.26
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.75
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.16
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.05
|
|
|
SCREW LOCKING 2.7X12MM, LPS, SS-26
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Aetna of IA Medicare |
$54.15
|
| Rate for Payer: Amerigroup Medicaid |
$54.80
|
| Rate for Payer: Amerigroup Medicare |
$43.18
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.26
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.75
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.16
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.05
|
|
|
SCREW LOCKING 2.7X12MM, LPS, SS-26
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
|
|
SCREW LOCKING 2.7X14MM, LPS, SS
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Aetna of IA Medicare |
$54.15
|
| Rate for Payer: Amerigroup Medicaid |
$54.80
|
| Rate for Payer: Amerigroup Medicare |
$43.18
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.26
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.75
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.16
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.05
|
|
|
SCREW LOCKING 2.7X14MM, LPS, SS
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
|
|
SCREW LOCKING 2.7X15MM
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna of IA Commercial |
$292.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$292.50
|
| Rate for Payer: Aetna of IA Medicare |
$185.25
|
| Rate for Payer: Amerigroup Medicaid |
$187.46
|
| Rate for Payer: Amerigroup Medicare |
$147.71
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$243.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$146.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$185.64
|
| Rate for Payer: Medical Associates Commercial |
$243.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$146.25
|
| Rate for Payer: Midlands Choice Commercial |
$227.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$188.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$168.19
|
| Rate for Payer: United Healthcare Commercial |
$292.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$191.75
|
|
|
SCREW LOCKING 2.7X15MM
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna of IA Commercial |
$292.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$292.50
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$243.75
|
| Rate for Payer: Medical Associates Commercial |
$243.75
|
| Rate for Payer: Midlands Choice Commercial |
$227.50
|
| Rate for Payer: United Healthcare Commercial |
$292.50
|
|
|
SCREW LOCKING 2.7X16MM, LPS, SS
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
|
|
SCREW LOCKING 2.7X16MM, LPS, SS
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Aetna of IA Medicare |
$54.15
|
| Rate for Payer: Amerigroup Medicaid |
$54.80
|
| Rate for Payer: Amerigroup Medicare |
$43.18
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.26
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.75
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.16
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.05
|
|
|
SCREW LOCKING 2.7X22MM, LPS, SS
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Aetna of IA Medicare |
$54.15
|
| Rate for Payer: Amerigroup Medicaid |
$54.80
|
| Rate for Payer: Amerigroup Medicare |
$43.18
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.26
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.75
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.16
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.05
|
|
|
SCREW LOCKING 2.7X22MM, LPS, SS
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
|
|
SCREW LOCKING 2.7X24MM, LPS, SS
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Aetna of IA Medicare |
$54.15
|
| Rate for Payer: Amerigroup Medicaid |
$54.80
|
| Rate for Payer: Amerigroup Medicare |
$43.18
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.26
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.75
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.16
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$56.05
|
|
|
SCREW LOCKING 2.7X24MM, LPS, SS
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of IA Commercial |
$85.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.50
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.25
|
| Rate for Payer: Medical Associates Commercial |
$71.25
|
| Rate for Payer: Midlands Choice Commercial |
$66.50
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
|
|
SCREW LOCKING 3.0X16MM
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna of IA Commercial |
$137.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$137.70
|
| Rate for Payer: Aetna of IA Medicare |
$87.21
|
| Rate for Payer: Amerigroup Medicaid |
$88.25
|
| Rate for Payer: Amerigroup Medicare |
$69.54
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$68.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$87.39
|
| Rate for Payer: Medical Associates Commercial |
$114.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$68.85
|
| Rate for Payer: Midlands Choice Commercial |
$107.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$88.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$79.18
|
| Rate for Payer: United Healthcare Commercial |
$137.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$90.27
|
|
|
SCREW LOCKING 3.0X16MM
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna of IA Commercial |
$137.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$137.70
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.75
|
| Rate for Payer: Medical Associates Commercial |
$114.75
|
| Rate for Payer: Midlands Choice Commercial |
$107.10
|
| Rate for Payer: United Healthcare Commercial |
$137.70
|
|
|
SCREW LOCKING 3.5 X 10 MM LPS, SS
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
SCREW LOCKING 3.5 X 10 MM LPS, SS
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$114.21
|
| Rate for Payer: Amerigroup Medicare |
$89.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$89.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.10
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.10
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.46
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
SCREW LOCKING 3.5 X 12 MM LPS, SS
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
SCREW LOCKING 3.5 X 12 MM LPS, SS
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$114.21
|
| Rate for Payer: Amerigroup Medicare |
$89.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$89.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.10
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.10
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.46
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
SCREW LOCKING 3.5 X14 MM LPS, SS
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$114.21
|
| Rate for Payer: Amerigroup Medicare |
$89.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$89.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.10
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.10
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.46
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
SCREW LOCKING 3.5 X14 MM LPS, SS
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
SCREW LOCKING 3.5 X 16 MM LPS, SS
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$114.21
|
| Rate for Payer: Amerigroup Medicare |
$89.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$89.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.10
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.10
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.46
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
SCREW LOCKING 3.5 X 16 MM LPS, SS
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
SCREW LOCKING 3.5 X 18 MM LPS, SS
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Aetna of IA Medicare |
$56.43
|
| Rate for Payer: Amerigroup Medicaid |
$57.10
|
| Rate for Payer: Amerigroup Medicare |
$45.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$44.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.55
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.55
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.23
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.41
|
|
|
SCREW LOCKING 3.5 X 18 MM LPS, SS
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
|
