|
SCREW LONG THREAD,4.0X 50MM, CANNULATED
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
|
|
SCREW LONG THREAD,4.0X 50MM, CANNULATED
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047136
|
|
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 55MM, CANNULATED
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
|
|
SCREW LONG THREAD,4.0X 55MM, CANNULATED
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047137
|
|
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 60MM, CANNULATED
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
|
|
SCREW LONG THREAD,4.0X 60MM, CANNULATED
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047138
|
|
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 LOW PROFILE 3X12MM
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Aetna of IA Commercial |
$267.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$267.30
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.75
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: United Healthcare Commercial |
$267.30
|
|
|
SCREW LOW PROFILE 3X12MM
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.65 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Aetna of IA Commercial |
$267.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$267.30
|
| Rate for Payer: Aetna of IA Medicare |
$169.29
|
| Rate for Payer: Amerigroup Medicaid |
$171.31
|
| Rate for Payer: Amerigroup Medicare |
$134.99
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$133.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$169.65
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$133.65
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$172.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$153.70
|
| Rate for Payer: United Healthcare Commercial |
$267.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$175.23
|
|
|
SCREW LOW PROFILE 3X14MM
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Aetna of IA Commercial |
$267.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$267.30
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.75
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: United Healthcare Commercial |
$267.30
|
|
|
SCREW LOW PROFILE 3X14MM
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.65 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Aetna of IA Commercial |
$267.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$267.30
|
| Rate for Payer: Aetna of IA Medicare |
$169.29
|
| Rate for Payer: Amerigroup Medicaid |
$171.31
|
| Rate for Payer: Amerigroup Medicare |
$134.99
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$133.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$169.65
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$133.65
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$172.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$153.70
|
| Rate for Payer: United Healthcare Commercial |
$267.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$175.23
|
|
|
SCREW LOW PROFILE 3X18MM
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Aetna of IA Commercial |
$267.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$267.30
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.75
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: United Healthcare Commercial |
$267.30
|
|
|
SCREW LOW PROFILE 3X18MM
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.65 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Aetna of IA Commercial |
$267.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$267.30
|
| Rate for Payer: Aetna of IA Medicare |
$169.29
|
| Rate for Payer: Amerigroup Medicaid |
$171.31
|
| Rate for Payer: Amerigroup Medicare |
$134.99
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$133.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$169.65
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$133.65
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$172.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$153.70
|
| Rate for Payer: United Healthcare Commercial |
$267.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$175.23
|
|
|
SCREW LOW PROFILE 3X20MM
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.65 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Aetna of IA Commercial |
$267.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$267.30
|
| Rate for Payer: Aetna of IA Medicare |
$169.29
|
| Rate for Payer: Amerigroup Medicaid |
$171.31
|
| Rate for Payer: Amerigroup Medicare |
$134.99
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$133.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$169.65
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$133.65
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$172.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$153.70
|
| Rate for Payer: United Healthcare Commercial |
$267.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$175.23
|
|
|
SCREW LOW PROFILE 3X20MM
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Aetna of IA Commercial |
$267.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$267.30
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$222.75
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: United Healthcare Commercial |
$267.30
|
|
|
SCREW NON LOCKING 10MM
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.90 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Aetna of IA Commercial |
$109.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$109.80
|
| Rate for Payer: Aetna of IA Medicare |
$69.54
|
| Rate for Payer: Amerigroup Medicaid |
$70.37
|
| Rate for Payer: Amerigroup Medicare |
$55.45
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$91.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$54.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.69
|
| Rate for Payer: Medical Associates Commercial |
$91.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$54.90
|
| Rate for Payer: Midlands Choice Commercial |
$85.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$63.14
|
| Rate for Payer: United Healthcare Commercial |
$109.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$71.98
|
|
|
SCREW NON LOCKING 10MM
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Aetna of IA Commercial |
$109.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$109.80
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$91.50
|
| Rate for Payer: Medical Associates Commercial |
$91.50
|
| Rate for Payer: Midlands Choice Commercial |
$85.40
|
| Rate for Payer: United Healthcare Commercial |
$109.80
|
|
|
SCREW NON LOCKING 12MM
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna of IA Commercial |
$115.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$115.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.00
|
| Rate for Payer: Medical Associates Commercial |
$96.00
|
| Rate for Payer: Midlands Choice Commercial |
$89.60
|
| Rate for Payer: United Healthcare Commercial |
$115.20
|
|
|
SCREW NON LOCKING 12MM
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna of IA Commercial |
$115.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$115.20
|
| Rate for Payer: Aetna of IA Medicare |
$72.96
|
| Rate for Payer: Amerigroup Medicaid |
$73.83
|
| Rate for Payer: Amerigroup Medicare |
$58.18
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.11
|
| Rate for Payer: Medical Associates Commercial |
$96.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.60
|
| Rate for Payer: Midlands Choice Commercial |
$89.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$66.24
|
| Rate for Payer: United Healthcare Commercial |
$115.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$75.52
|
|
|
SCREW NON LOCKING 18MM
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046710
|
|
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 NON LOCKING 18MM
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
|
|
SCREW NON-LOCKING 3MMX14MM
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026153
|
|
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 NON-LOCKING 3MMX14MM
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna of IA Commercial |
$251.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$251.10
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$209.25
|
| Rate for Payer: Medical Associates Commercial |
$209.25
|
| Rate for Payer: Midlands Choice Commercial |
$195.30
|
| Rate for Payer: United Healthcare Commercial |
$251.10
|
|
|
SCREW NON-LOCKING 3MMX20MM
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026154
|
|
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 NON-LOCKING 3MMX20MM
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026154
|
|
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 NON LOCKING BONE 2.7 X 14MM
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna of IA Commercial |
$115.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$115.20
|
| Rate for Payer: Aetna of IA Medicare |
$72.96
|
| Rate for Payer: Amerigroup Medicaid |
$73.83
|
| Rate for Payer: Amerigroup Medicare |
$58.18
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.11
|
| Rate for Payer: Medical Associates Commercial |
$96.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.60
|
| Rate for Payer: Midlands Choice Commercial |
$89.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$66.24
|
| Rate for Payer: United Healthcare Commercial |
$115.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$75.52
|
|
