|
SCREW SHORT THREAD,4.0X45MM, CANNULATED
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047128
|
|
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,4.0X45MM, CANNULATED
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047128
|
|
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 50MM, CANNULATED
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047129
|
|
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 50MM, CANNULATED
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047129
|
|
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 55MM, CANNULATED
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047130
|
|
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 55MM, CANNULATED
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047130
|
|
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 60MM, CANNULATED
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047131
|
|
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 60MM, CANNULATED
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047131
|
|
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 SNAP OFF QUICK FIX
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$502.20 |
| Rate for Payer: Aetna of IA Commercial |
$502.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$502.20
|
| Rate for Payer: Aetna of IA Medicare |
$318.06
|
| Rate for Payer: Amerigroup Medicaid |
$321.85
|
| Rate for Payer: Amerigroup Medicare |
$253.61
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$418.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$251.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$318.73
|
| Rate for Payer: Medical Associates Commercial |
$418.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$251.10
|
| Rate for Payer: Midlands Choice Commercial |
$390.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$323.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$288.76
|
| Rate for Payer: United Healthcare Commercial |
$502.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$329.22
|
|
|
SCREW SNAP OFF QUICK FIX
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$390.60 |
| Max. Negotiated Rate |
$502.20 |
| Rate for Payer: Aetna of IA Commercial |
$502.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$502.20
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$418.50
|
| Rate for Payer: Medical Associates Commercial |
$418.50
|
| Rate for Payer: Midlands Choice Commercial |
$390.60
|
| Rate for Payer: United Healthcare Commercial |
$502.20
|
|
|
SCREW SNAP OFF QUICKFIX 3X15MM
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$178.20 |
| Max. Negotiated Rate |
$356.40 |
| Rate for Payer: Aetna of IA Commercial |
$356.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$356.40
|
| Rate for Payer: Aetna of IA Medicare |
$225.72
|
| Rate for Payer: Amerigroup Medicaid |
$228.41
|
| Rate for Payer: Amerigroup Medicare |
$179.98
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$297.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$178.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$226.20
|
| Rate for Payer: Medical Associates Commercial |
$297.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$178.20
|
| Rate for Payer: Midlands Choice Commercial |
$277.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$229.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$204.93
|
| Rate for Payer: United Healthcare Commercial |
$356.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$233.64
|
|
|
SCREW SNAP OFF QUICKFIX 3X15MM
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$356.40 |
| Rate for Payer: Aetna of IA Commercial |
$356.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$356.40
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$297.00
|
| Rate for Payer: Medical Associates Commercial |
$297.00
|
| Rate for Payer: Midlands Choice Commercial |
$277.20
|
| Rate for Payer: United Healthcare Commercial |
$356.40
|
|
|
SCREW SNAP OFF QUICKFIX 3X17MM
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$390.60 |
| Max. Negotiated Rate |
$502.20 |
| Rate for Payer: Aetna of IA Commercial |
$502.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$502.20
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$418.50
|
| Rate for Payer: Medical Associates Commercial |
$418.50
|
| Rate for Payer: Midlands Choice Commercial |
$390.60
|
| Rate for Payer: United Healthcare Commercial |
$502.20
|
|
|
SCREW SNAP OFF QUICKFIX 3X17MM
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$502.20 |
| Rate for Payer: Aetna of IA Commercial |
$502.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$502.20
|
| Rate for Payer: Aetna of IA Medicare |
$318.06
|
| Rate for Payer: Amerigroup Medicaid |
$321.85
|
| Rate for Payer: Amerigroup Medicare |
$253.61
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$418.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$251.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$318.73
|
| Rate for Payer: Medical Associates Commercial |
$418.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$251.10
|
| Rate for Payer: Midlands Choice Commercial |
$390.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$323.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$288.76
|
| Rate for Payer: United Healthcare Commercial |
$502.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$329.22
|
|
|
SCREW SOLID LAG, 5.5MM X 30MM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
|
|
SCREW SOLID LAG, 5.5MM X 30MM
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Aetna of IA Medicare |
$153.90
|
| Rate for Payer: Amerigroup Medicaid |
$155.74
|
| Rate for Payer: Amerigroup Medicare |
$122.72
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$121.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$154.22
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$156.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$139.72
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.30
|
|
|
SCREW SOLID LAG, 5.5MM X 35MM
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Aetna of IA Medicare |
$153.90
|
| Rate for Payer: Amerigroup Medicaid |
$155.74
|
| Rate for Payer: Amerigroup Medicare |
$122.72
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$121.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$154.22
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$156.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$139.72
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.30
|
|
|
SCREW SOLID LAG, 5.5MM X 35MM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
|
|
SCREW SOLID LAG, 5.5MM X 40MM
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Aetna of IA Medicare |
$153.90
|
| Rate for Payer: Amerigroup Medicaid |
$155.74
|
| Rate for Payer: Amerigroup Medicare |
$122.72
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$121.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$154.22
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$156.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$139.72
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.30
|
|
|
SCREW SOLID LAG, 5.5MM X 40MM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
|
|
SCREW SOLID LAG, 5.5MM X 45MM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
|
|
SCREW SOLID LAG, 5.5MM X 45MM
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Aetna of IA Medicare |
$153.90
|
| Rate for Payer: Amerigroup Medicaid |
$155.74
|
| Rate for Payer: Amerigroup Medicare |
$122.72
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$121.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$154.22
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$156.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$139.72
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.30
|
|
|
SCREW SOLID LAG, 5.5MM X 50MM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
|
|
SCREW SOLID LAG, 5.5MM X 50MM
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Aetna of IA Medicare |
$153.90
|
| Rate for Payer: Amerigroup Medicaid |
$155.74
|
| Rate for Payer: Amerigroup Medicare |
$122.72
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$121.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$154.22
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$156.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$139.72
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$159.30
|
|
|
SCREW SOLID LAG, 5.5MM X 55MM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of IA Commercial |
$243.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$243.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.50
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$243.00
|
|
