|
SCREW LOCKING SOS 3.0XL30MM
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046650
|
|
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 SOS 3.0XL8MM
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046639
|
|
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
|
|
|
SCREW LOCKING SOS 3.0XL8MM
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046639
|
|
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 SOS 4.0XL46MM
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.30 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of IA Commercial |
$134.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$134.10
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.75
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
|
|
SCREW LOCKING SOS 4.0XL46MM
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of IA Commercial |
$134.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$134.10
|
| Rate for Payer: Aetna of IA Medicare |
$84.93
|
| Rate for Payer: Amerigroup Medicaid |
$85.94
|
| Rate for Payer: Amerigroup Medicare |
$67.72
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$85.11
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.05
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$86.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.11
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.91
|
|
|
SCREW LOCKING SOS 4.0XL48MM
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of IA Commercial |
$134.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$134.10
|
| Rate for Payer: Aetna of IA Medicare |
$84.93
|
| Rate for Payer: Amerigroup Medicaid |
$85.94
|
| Rate for Payer: Amerigroup Medicare |
$67.72
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$85.11
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.05
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$86.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.11
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.91
|
|
|
SCREW LOCKING SOS 4.0XL48MM
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.30 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of IA Commercial |
$134.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$134.10
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.75
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
|
|
SCREW LOCKING SOS 4.0XL50MM
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.30 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of IA Commercial |
$134.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$134.10
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.75
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
|
|
SCREW LOCKING SOS 4.0XL50MM
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of IA Commercial |
$134.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$134.10
|
| Rate for Payer: Aetna of IA Medicare |
$84.93
|
| Rate for Payer: Amerigroup Medicaid |
$85.94
|
| Rate for Payer: Amerigroup Medicare |
$67.72
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$85.11
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.05
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$86.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.11
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.91
|
|
|
SCREW LOCKING SOS 4.0XL55MM
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.30 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of IA Commercial |
$134.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$134.10
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.75
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
|
|
SCREW LOCKING SOS 4.0XL55MM
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of IA Commercial |
$134.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$134.10
|
| Rate for Payer: Aetna of IA Medicare |
$84.93
|
| Rate for Payer: Amerigroup Medicaid |
$85.94
|
| Rate for Payer: Amerigroup Medicare |
$67.72
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$85.11
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.05
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$86.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.11
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.91
|
|
|
SCREW LOCKING SOS 4.0XL60MM
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.30 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of IA Commercial |
$134.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$134.10
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.75
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
|
|
SCREW LOCKING SOS 4.0XL60MM
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of IA Commercial |
$134.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$134.10
|
| Rate for Payer: Aetna of IA Medicare |
$84.93
|
| Rate for Payer: Amerigroup Medicaid |
$85.94
|
| Rate for Payer: Amerigroup Medicare |
$67.72
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$85.11
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.05
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$86.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.11
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.91
|
|
|
SCREW LOCKING T10 3.5X16MM
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna of IA Commercial |
$203.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$203.40
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$169.50
|
| Rate for Payer: Medical Associates Commercial |
$169.50
|
| Rate for Payer: Midlands Choice Commercial |
$158.20
|
| Rate for Payer: United Healthcare Commercial |
$203.40
|
|
|
SCREW LOCKING T10 3.5X16MM
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.70 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna of IA Commercial |
$203.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$203.40
|
| Rate for Payer: Aetna of IA Medicare |
$128.82
|
| Rate for Payer: Amerigroup Medicaid |
$130.36
|
| Rate for Payer: Amerigroup Medicare |
$102.72
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$169.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$101.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$129.09
|
| Rate for Payer: Medical Associates Commercial |
$169.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$101.70
|
| Rate for Payer: Midlands Choice Commercial |
$158.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$130.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$116.96
|
| Rate for Payer: United Healthcare Commercial |
$203.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$133.34
|
|
|
SCREW LOCKING T10 3.5X18MM
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna of IA Commercial |
$203.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$203.40
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$169.50
|
| Rate for Payer: Medical Associates Commercial |
$169.50
|
| Rate for Payer: Midlands Choice Commercial |
$158.20
|
| Rate for Payer: United Healthcare Commercial |
$203.40
|
|
|
SCREW LOCKING T10 3.5X18MM
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.70 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna of IA Commercial |
$203.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$203.40
|
| Rate for Payer: Aetna of IA Medicare |
$128.82
|
| Rate for Payer: Amerigroup Medicaid |
$130.36
|
| Rate for Payer: Amerigroup Medicare |
$102.72
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$169.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$101.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$129.09
|
| Rate for Payer: Medical Associates Commercial |
$169.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$101.70
|
| Rate for Payer: Midlands Choice Commercial |
$158.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$130.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$116.96
|
| Rate for Payer: United Healthcare Commercial |
$203.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$133.34
|
|
|
SCREW LONG THREAD,4.0X 30MM, CANNULATED
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047132
|
|
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 30MM, CANNULATED
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.75 |
| 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 |
$77.87
|
| Rate for Payer: Amerigroup Medicare |
$61.36
|
| 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 |
$60.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$77.11
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$60.75
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$78.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$69.86
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.65
|
|
|
SCREW LONG THREAD,4.0X 35MM, CANNULATED
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.75 |
| 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 |
$77.87
|
| Rate for Payer: Amerigroup Medicare |
$61.36
|
| 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 |
$60.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$77.11
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$60.75
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$78.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$69.86
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.65
|
|
|
SCREW LONG THREAD,4.0X 35MM, CANNULATED
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047133
|
|
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
|
HCPCS C1713
|
| Hospital Charge Code |
8047134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.75 |
| 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 |
$77.87
|
| Rate for Payer: Amerigroup Medicare |
$61.36
|
| 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 |
$60.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$77.11
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$60.75
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$78.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$69.86
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.65
|
|
|
SCREW LONG THREAD,4.0X 40MM, CANNULATED
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 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 45MM, CANNULATED
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.75 |
| 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 |
$77.87
|
| Rate for Payer: Amerigroup Medicare |
$61.36
|
| 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 |
$60.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$77.11
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$60.75
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$78.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$69.86
|
| 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
|
HCPCS 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
|
|
