|
SCREW LOCKING AXSOS 5.0MM X 5.20
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.55 |
| 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 |
$91.71
|
| Rate for Payer: Amerigroup Medicare |
$72.27
|
| 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 |
$71.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.82
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.55
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.28
|
| 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
|
HCPCS 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 L14MM
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
HCPCS 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 L14MM
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.55 |
| 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 |
$91.71
|
| Rate for Payer: Amerigroup Medicare |
$72.27
|
| 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 |
$71.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.82
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.55
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.28
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.81
|
|
|
SCREW LOCKING AXSOS 5.0MM X L16MM
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.55 |
| 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 |
$91.71
|
| Rate for Payer: Amerigroup Medicare |
$72.27
|
| 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 |
$71.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.82
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.55
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.28
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.81
|
|
|
SCREW LOCKING AXSOS 5.0MM X L16MM
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
HCPCS 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 L20MM
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.55 |
| 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 |
$91.71
|
| Rate for Payer: Amerigroup Medicare |
$72.27
|
| 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 |
$71.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.82
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.55
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.28
|
| 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
|
HCPCS 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
|
HCPCS 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
|
HCPCS C1713
|
| Hospital Charge Code |
8046655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.55 |
| 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 |
$91.71
|
| Rate for Payer: Amerigroup Medicare |
$72.27
|
| 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 |
$71.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.82
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.55
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.28
|
| 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
|
HCPCS 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
|
HCPCS C1713
|
| Hospital Charge Code |
8046656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.55 |
| 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 |
$91.71
|
| Rate for Payer: Amerigroup Medicare |
$72.27
|
| 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 |
$71.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.82
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.55
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.28
|
| 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
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.55 |
| 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 |
$91.71
|
| Rate for Payer: Amerigroup Medicare |
$72.27
|
| 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 |
$71.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.82
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.55
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.28
|
| 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
|
HCPCS 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 L28MM
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046658
|
|
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 L28MM
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.55 |
| 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 |
$91.71
|
| Rate for Payer: Amerigroup Medicare |
$72.27
|
| 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 |
$71.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.82
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.55
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.28
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.81
|
|
|
SCREW LOCKING AXSOS 5.0MM X L30MM
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046659
|
|
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 L30MM
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.55 |
| 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 |
$91.71
|
| Rate for Payer: Amerigroup Medicare |
$72.27
|
| 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 |
$71.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.82
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.55
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.28
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.81
|
|
|
SCREW LOCKING AXSOS 5.0MM X L32MM
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.55 |
| 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 |
$91.71
|
| Rate for Payer: Amerigroup Medicare |
$72.27
|
| 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 |
$71.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.82
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.55
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.28
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.81
|
|
|
SCREW LOCKING AXSOS 5.0MM X L32MM
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046660
|
|
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 L34MM
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
HCPCS 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 L34MM
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.55 |
| 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 |
$91.71
|
| Rate for Payer: Amerigroup Medicare |
$72.27
|
| 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 |
$71.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.82
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.55
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.28
|
| 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
|
HCPCS 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 L36MM
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.55 |
| 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 |
$91.71
|
| Rate for Payer: Amerigroup Medicare |
$72.27
|
| 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 |
$71.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.82
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.55
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.28
|
| 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
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.55 |
| 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 |
$91.71
|
| Rate for Payer: Amerigroup Medicare |
$72.27
|
| 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 |
$71.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.82
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.55
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.28
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.81
|
|
