|
SCREW LOCKING AXSOS 5.0MM X L34MM
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046661
|
|
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 L36MM
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046662
|
|
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: Molina Healthcare Managed Medicare |
$80.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$119.25
|
| 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 L36MM
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046662
|
|
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 L40
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046664
|
|
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: Molina Healthcare Managed Medicare |
$80.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$119.25
|
| 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 L40
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046664
|
|
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 L42
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046665
|
|
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: Molina Healthcare Managed Medicare |
$80.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$119.25
|
| 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 L42
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046665
|
|
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 L44
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046666
|
|
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: Molina Healthcare Managed Medicare |
$80.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$119.25
|
| 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 L44
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046666
|
|
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 L46MM
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046667
|
|
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: Molina Healthcare Managed Medicare |
$80.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$119.25
|
| 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 L46MM
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046667
|
|
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 L48MM
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046668
|
|
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 L48MM
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046668
|
|
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: Molina Healthcare Managed Medicare |
$80.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$119.25
|
| 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 L50MM
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046669
|
|
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 L50MM
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046669
|
|
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: Molina Healthcare Managed Medicare |
$80.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$119.25
|
| 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 L55MM
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046670
|
|
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 L55MM
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046670
|
|
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: Molina Healthcare Managed Medicare |
$80.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$119.25
|
| 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 L60MM
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046671
|
|
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 L60MM
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046671
|
|
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: Molina Healthcare Managed Medicare |
$80.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$119.25
|
| 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 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: Molina Healthcare Managed Medicare |
$80.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$119.25
|
| 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: Medical Associates Commercial |
$119.25
|
| 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: 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: Molina Healthcare Managed Medicare |
$80.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$119.25
|
| 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 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: Molina Healthcare Managed Medicare |
$80.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$119.25
|
| 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
|
|
