|
SCREW LOCKING AXSOS 4.0XL18MM
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046681
|
|
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: Molina Healthcare Managed Medicare |
$75.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$111.75
|
| 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 4.0XL20MM
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046682
|
|
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: Molina Healthcare Managed Medicare |
$75.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$111.75
|
| 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 4.0XL20MM
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046682
|
|
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 4.0XL22MM
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046683
|
|
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 4.0XL22MM
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046683
|
|
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: Molina Healthcare Managed Medicare |
$75.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$111.75
|
| 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 4.0XL24MM
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046684
|
|
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: Molina Healthcare Managed Medicare |
$75.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$111.75
|
| 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 4.0XL24MM
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046684
|
|
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 4.0XL26MM
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046685
|
|
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 4.0XL26MM
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046685
|
|
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: Molina Healthcare Managed Medicare |
$75.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$111.75
|
| 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 4.0XL28MM
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046686
|
|
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 4.0XL28MM
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046686
|
|
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: Molina Healthcare Managed Medicare |
$75.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$111.75
|
| 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 4.0XL30MM
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046687
|
|
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: Molina Healthcare Managed Medicare |
$75.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$111.75
|
| 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 4.0XL30MM
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046687
|
|
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 4.0XL32MM
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046688
|
|
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: Molina Healthcare Managed Medicare |
$75.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$111.75
|
| 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 4.0XL32MM
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046688
|
|
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 4.0XL34MM
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046689
|
|
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: Molina Healthcare Managed Medicare |
$75.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$111.75
|
| 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 4.0XL34MM
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046689
|
|
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 4.0XL36MM
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046690
|
|
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: Molina Healthcare Managed Medicare |
$75.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$111.75
|
| 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 4.0XL36MM
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046690
|
|
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 4.0XL38MM
|
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: Molina Healthcare Managed Medicare |
$75.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$111.75
|
| 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
|
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: Molina Healthcare Managed Medicare |
$75.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$111.75
|
| 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 4.0XL40MM
|
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 4.0XL42MM
|
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: Molina Healthcare Managed Medicare |
$75.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$111.75
|
| 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
|
|
