|
SCREW LOCKING AXSOS 4.0XL38MM
|
Facility
OP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.47 |
| 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 |
$75.20
|
| Rate for Payer: Amerigroup Medicare |
$75.24
|
| 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 |
$74.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.47
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$74.50
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.75
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.91
|
|
|
SCREW LOCKING AXSOS 4.0XL38MM
|
Facility
IP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046691
|
|
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 AXSOS 4.0XL40MM
|
Facility
IP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046692
|
|
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 AXSOS 4.0XL40MM
|
Facility
OP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.47 |
| 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 |
$75.20
|
| Rate for Payer: Amerigroup Medicare |
$75.24
|
| 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 |
$74.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.47
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$74.50
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.75
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.91
|
|
|
SCREW LOCKING AXSOS 4.0XL42MM
|
Facility
IP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046693
|
|
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 AXSOS 4.0XL42MM
|
Facility
OP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.47 |
| 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 |
$75.20
|
| Rate for Payer: Amerigroup Medicare |
$75.24
|
| 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 |
$74.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.47
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$74.50
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.75
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.91
|
|
|
SCREW LOCKING AXSOS 4.0XL44MM
|
Facility
IP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046694
|
|
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 AXSOS 4.0XL44MM
|
Facility
OP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.47 |
| 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 |
$75.20
|
| Rate for Payer: Amerigroup Medicare |
$75.24
|
| 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 |
$74.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.47
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$74.50
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.75
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.91
|
|
|
SCREW LOCKING AXSOS 5.0MM X 38 MM
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
|
|
SCREW LOCKING AXSOS 5.0MM X 38 MM
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.47 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Aetna of IA Medicare |
$90.63
|
| Rate for Payer: Amerigroup Medicaid |
$80.25
|
| Rate for Payer: Amerigroup Medicare |
$80.30
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$79.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.47
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$79.50
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$119.25
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.81
|
|
|
SCREW LOCKING AXSOS 5.0MM X 5.20
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
|
|
SCREW LOCKING AXSOS 5.0MM X 5.20
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.47 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Aetna of IA Medicare |
$90.63
|
| Rate for Payer: Amerigroup Medicaid |
$80.25
|
| Rate for Payer: Amerigroup Medicare |
$80.30
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$79.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.47
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$79.50
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$119.25
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.81
|
|
|
SCREW LOCKING AXSOS 5.0MM X L14MM
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.47 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Aetna of IA Medicare |
$90.63
|
| Rate for Payer: Amerigroup Medicaid |
$80.25
|
| Rate for Payer: Amerigroup Medicare |
$80.30
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$79.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.47
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$79.50
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$119.25
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.81
|
|
|
SCREW LOCKING AXSOS 5.0MM X L14MM
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
|
|
SCREW LOCKING AXSOS 5.0MM X L16MM
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
|
|
SCREW LOCKING AXSOS 5.0MM X L16MM
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.47 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Aetna of IA Medicare |
$90.63
|
| Rate for Payer: Amerigroup Medicaid |
$80.25
|
| Rate for Payer: Amerigroup Medicare |
$80.30
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$79.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.47
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$79.50
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$119.25
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.81
|
|
|
SCREW LOCKING AXSOS 5.0MM X L20MM
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.47 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Aetna of IA Medicare |
$90.63
|
| Rate for Payer: Amerigroup Medicaid |
$80.25
|
| Rate for Payer: Amerigroup Medicare |
$80.30
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$79.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.47
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$79.50
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$119.25
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.81
|
|
|
SCREW LOCKING AXSOS 5.0MM X L20MM
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
|
|
SCREW LOCKING AXSOS 5.0MM X L22MM
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
|
|
SCREW LOCKING AXSOS 5.0MM X L22MM
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.47 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Aetna of IA Medicare |
$90.63
|
| Rate for Payer: Amerigroup Medicaid |
$80.25
|
| Rate for Payer: Amerigroup Medicare |
$80.30
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$79.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.47
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$79.50
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$119.25
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.81
|
|
|
SCREW LOCKING AXSOS 5.0MM X L24MM
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
|
|
SCREW LOCKING AXSOS 5.0MM X L24MM
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.47 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Aetna of IA Medicare |
$90.63
|
| Rate for Payer: Amerigroup Medicaid |
$80.25
|
| Rate for Payer: Amerigroup Medicare |
$80.30
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$79.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.47
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$79.50
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$119.25
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.81
|
|
|
SCREW LOCKING AXSOS 5.0MM X L26MM
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
|
|
SCREW LOCKING AXSOS 5.0MM X L26MM
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.47 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Aetna of IA Medicare |
$90.63
|
| Rate for Payer: Amerigroup Medicaid |
$80.25
|
| Rate for Payer: Amerigroup Medicare |
$80.30
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$79.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.47
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$79.50
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$119.25
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.81
|
|
|
SCREW LOCKING AXSOS 5.0MM X L28MM
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.47 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Aetna of IA Medicare |
$90.63
|
| Rate for Payer: Amerigroup Medicaid |
$80.25
|
| Rate for Payer: Amerigroup Medicare |
$80.30
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$79.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.47
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$79.50
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$119.25
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.81
|
|
