|
SCREW NON LOCKING BONE 2.7 X 14MM
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046708
|
|
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 BONE 2.7 X 16MM
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046709
|
|
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 BONE 2.7 X 16MM
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046709
|
|
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 BONE 2.7 X 20MM
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046711
|
|
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 BONE 2.7 X 20MM
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046711
|
|
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 PEEK TENODESIS 5.5X8.8MM
|
Facility
|
IP
|
$590.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.00 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: Aetna of IA Commercial |
$531.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$531.00
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$442.50
|
| Rate for Payer: Medical Associates Commercial |
$442.50
|
| Rate for Payer: Midlands Choice Commercial |
$413.00
|
| Rate for Payer: United Healthcare Commercial |
$531.00
|
|
|
SCREW PEEK TENODESIS 5.5X8.8MM
|
Facility
|
OP
|
$590.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.50 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: Aetna of IA Commercial |
$531.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$531.00
|
| Rate for Payer: Aetna of IA Medicare |
$336.30
|
| Rate for Payer: Amerigroup Medicaid |
$340.31
|
| Rate for Payer: Amerigroup Medicare |
$268.16
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$442.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$265.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$337.01
|
| Rate for Payer: Medical Associates Commercial |
$442.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$265.50
|
| Rate for Payer: Midlands Choice Commercial |
$413.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$341.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$305.32
|
| Rate for Payer: United Healthcare Commercial |
$531.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$348.10
|
|
|
SCREW PERIPROSTH 5.0X10MM
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.90 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Aetna of IA Medicare |
$115.14
|
| Rate for Payer: Amerigroup Medicaid |
$116.51
|
| Rate for Payer: Amerigroup Medicare |
$91.81
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$115.38
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.90
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$117.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.54
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.18
|
|
|
SCREW PERIPROSTH 5.0X10MM
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
|
|
SCREW PERIPROSTH 5.0X12MM
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.90 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Aetna of IA Medicare |
$115.14
|
| Rate for Payer: Amerigroup Medicaid |
$116.51
|
| Rate for Payer: Amerigroup Medicare |
$91.81
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$115.38
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.90
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$117.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.54
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.18
|
|
|
SCREW PERIPROSTH 5.0X12MM
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
|
|
SCREW PERIPROSTH 5.0X14MM
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.90 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Aetna of IA Medicare |
$115.14
|
| Rate for Payer: Amerigroup Medicaid |
$116.51
|
| Rate for Payer: Amerigroup Medicare |
$91.81
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$115.38
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.90
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$117.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.54
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.18
|
|
|
SCREW PERIPROSTH 5.0X14MM
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
|
|
SCREW PERIPROSTH 5.0X16MM
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.90 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Aetna of IA Medicare |
$115.14
|
| Rate for Payer: Amerigroup Medicaid |
$116.51
|
| Rate for Payer: Amerigroup Medicare |
$91.81
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$115.38
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.90
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$117.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.54
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.18
|
|
|
SCREW PERIPROSTH 5.0X16MM
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
|
|
SCREW PERIPROSTH 5.0X18MM
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.90 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Aetna of IA Medicare |
$115.14
|
| Rate for Payer: Amerigroup Medicaid |
$116.51
|
| Rate for Payer: Amerigroup Medicare |
$91.81
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$115.38
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.90
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$117.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.54
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.18
|
|
|
SCREW PERIPROSTH 5.0X18MM
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
|
|
SCREW PERIPROSTH 5.0X20MM
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.90 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Aetna of IA Medicare |
$115.14
|
| Rate for Payer: Amerigroup Medicaid |
$116.51
|
| Rate for Payer: Amerigroup Medicare |
$91.81
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$115.38
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.90
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$117.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.54
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.18
|
|
|
SCREW PERIPROSTH 5.0X20MM
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of IA Commercial |
$181.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$181.80
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$151.50
|
| Rate for Payer: Medical Associates Commercial |
$151.50
|
| Rate for Payer: Midlands Choice Commercial |
$141.40
|
| Rate for Payer: United Healthcare Commercial |
$181.80
|
|
|
SCREW SHORT THREAD,4.0X30MM, CANNULATED
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047125
|
|
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 SHORT THREAD,4.0X30MM, CANNULATED
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047125
|
|
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 SHORT THREAD,4.0X35MM, CANNULATED
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047126
|
|
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 SHORT THREAD,4.0X35MM, CANNULATED
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047126
|
|
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 SHORT THREAD,4.0X 40MM, CANNULATED
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047127
|
|
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 SHORT THREAD,4.0X 40MM, CANNULATED
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047127
|
|
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
|
|
