|
SCREW LOCKING AXSOS 5.0MM X L65 MM
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046672
|
|
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 L65 MM
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046672
|
|
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 L70MM
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046673
|
|
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 L70MM
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046673
|
|
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 L75
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046674
|
|
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 L75
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046674
|
|
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 L80
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046675
|
|
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 L80
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046675
|
|
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 L85MM
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046676
|
|
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 L85MM
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046676
|
|
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 L90MM
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046677
|
|
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 L90MM
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046677
|
|
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 L95MM
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046678
|
|
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 L95MM
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046678
|
|
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 SOS 3.0XL10MM
|
Facility
OP
|
$99.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.48 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Aetna of IA Medicare |
$56.43
|
| Rate for Payer: Amerigroup Medicaid |
$49.97
|
| Rate for Payer: Amerigroup Medicare |
$50.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.48
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.25
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.41
|
|
|
SCREW LOCKING SOS 3.0XL10MM
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
|
|
SCREW LOCKING SOS 3.0XL12MM
|
Facility
IP
|
$110.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
|
|
SCREW LOCKING SOS 3.0XL12MM
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.98 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Aetna of IA Medicare |
$62.70
|
| Rate for Payer: Amerigroup Medicaid |
$55.52
|
| Rate for Payer: Amerigroup Medicare |
$55.55
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.98
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.00
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.90
|
|
|
SCREW LOCKING SOS 3.0XL14MM
|
Facility
OP
|
$122.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.98 |
| 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 |
$61.57
|
| Rate for Payer: Amerigroup Medicare |
$61.61
|
| 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 |
$61.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$60.98
|
| Rate for Payer: Medical Associates Commercial |
$91.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$61.00
|
| Rate for Payer: Midlands Choice Commercial |
$85.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$61.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$91.50
|
| Rate for Payer: United Healthcare Commercial |
$109.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$71.98
|
|
|
SCREW LOCKING SOS 3.0XL14MM
|
Facility
IP
|
$122.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046642
|
|
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 LOCKING SOS 3.0XL16MM
|
Facility
IP
|
$110.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
|
|
SCREW LOCKING SOS 3.0XL16MM
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.98 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Aetna of IA Medicare |
$62.70
|
| Rate for Payer: Amerigroup Medicaid |
$55.52
|
| Rate for Payer: Amerigroup Medicare |
$55.55
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.98
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.00
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.90
|
|
|
SCREW LOCKING SOS 3.0XL18MM
|
Facility
OP
|
$99.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.48 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Aetna of IA Medicare |
$56.43
|
| Rate for Payer: Amerigroup Medicaid |
$49.97
|
| Rate for Payer: Amerigroup Medicare |
$50.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.48
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.25
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.41
|
|
|
SCREW LOCKING SOS 3.0XL18MM
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
|
|
SCREW LOCKING SOS 3.0XL22MM
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
|
