|
Immunofixation Urine DMCL
|
Facility
IP
|
$182.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
8037717
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna of IA Commercial |
$163.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$163.80
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$136.50
|
| Rate for Payer: Medical Associates Commercial |
$136.50
|
| Rate for Payer: Midlands Choice Commercial |
$127.40
|
| Rate for Payer: United Healthcare Commercial |
$163.80
|
|
|
Immunofixation Urine DMCL
|
Facility
OP
|
$182.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
8037717
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna of IA Commercial |
$163.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$163.80
|
| Rate for Payer: Aetna of IA Medicare |
$103.74
|
| Rate for Payer: Amerigroup Medicaid |
$91.86
|
| Rate for Payer: Amerigroup Medicare |
$91.91
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$136.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$91.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.96
|
| Rate for Payer: Medical Associates Commercial |
$136.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$91.00
|
| Rate for Payer: Midlands Choice Commercial |
$127.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$136.50
|
| Rate for Payer: United Healthcare Commercial |
$163.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$107.38
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Immunoglobulin E DMCL
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
8037718
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Immunoglobulin E DMCL
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
8037718
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
IMMUNOGLOBULIN FREE LT CHAIN
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
8093938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of IA Commercial |
$117.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.00
|
| Rate for Payer: Aetna of IA Medicare |
$74.10
|
| Rate for Payer: Amerigroup Medicaid |
$65.61
|
| Rate for Payer: Amerigroup Medicare |
$65.65
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$97.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$65.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.97
|
| Rate for Payer: Medical Associates Commercial |
$97.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$65.00
|
| Rate for Payer: Midlands Choice Commercial |
$91.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$65.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$97.50
|
| Rate for Payer: United Healthcare Commercial |
$117.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.70
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
IMMUNOGLOBULIN FREE LT CHAIN
|
Facility
IP
|
$130.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
8093938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of IA Commercial |
$117.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$97.50
|
| Rate for Payer: Medical Associates Commercial |
$97.50
|
| Rate for Payer: Midlands Choice Commercial |
$91.00
|
| Rate for Payer: United Healthcare Commercial |
$117.00
|
|
|
IMMUNOGLOBULIN IGA, IGD, IGG, IGM EACH
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
8093939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
IMMUNOGLOBULIN IGA, IGD, IGG, IGM EACH
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
8093939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
Immunoglobulin Panel IgG IgA IgM DMCL
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
8037719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
Immunoglobulin Panel IgG IgA IgM DMCL
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
8037719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
IMPLANT ANCHOR-JUGGERKNOT 1.4MM SHORT
|
Facility
OP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.36 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna of IA Commercial |
$607.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$607.50
|
| Rate for Payer: Aetna of IA Medicare |
$384.75
|
| Rate for Payer: Amerigroup Medicaid |
$340.67
|
| Rate for Payer: Amerigroup Medicare |
$340.88
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$506.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$337.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$337.36
|
| Rate for Payer: Medical Associates Commercial |
$506.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$337.50
|
| Rate for Payer: Midlands Choice Commercial |
$472.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$342.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$506.25
|
| Rate for Payer: United Healthcare Commercial |
$607.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$398.25
|
|
|
IMPLANT ANCHOR-JUGGERKNOT 1.4MM SHORT
|
Facility
IP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.50 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna of IA Commercial |
$607.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$607.50
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$506.25
|
| Rate for Payer: Medical Associates Commercial |
$506.25
|
| Rate for Payer: Midlands Choice Commercial |
$472.50
|
| Rate for Payer: United Healthcare Commercial |
$607.50
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 26MMX41MM
|
Facility
OP
|
$2,487.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.00 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,255.19
|
| Rate for Payer: Amerigroup Medicare |
$1,255.94
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,243.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,243.00
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,243.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,262.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,865.25
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 26MMX41MM
|
Facility
IP
|
$2,487.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 26MMX42MM
|
Facility
OP
|
$2,487.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.00 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,255.19
|
| Rate for Payer: Amerigroup Medicare |
$1,255.94
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,243.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,243.00
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,243.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,262.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,865.25
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 26MMX42MM
|
Facility
IP
|
$2,487.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 26MMX43MM
|
Facility
IP
|
$2,487.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 26MMX43MM
|
Facility
OP
|
$2,487.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.00 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,255.19
|
| Rate for Payer: Amerigroup Medicare |
$1,255.94
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,243.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,243.00
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,243.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,262.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,865.25
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX44MM
|
Facility
IP
|
$2,487.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX44MM
|
Facility
OP
|
$2,487.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.00 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,255.19
|
| Rate for Payer: Amerigroup Medicare |
$1,255.94
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,243.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,243.00
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,243.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,262.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,865.25
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX45MM
|
Facility
OP
|
$2,487.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.00 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,255.19
|
| Rate for Payer: Amerigroup Medicare |
$1,255.94
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,243.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,243.00
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,243.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,262.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,865.25
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX45MM
|
Facility
IP
|
$2,487.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX46MM
|
Facility
IP
|
$2,487.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX46MM
|
Facility
OP
|
$2,487.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.00 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,255.19
|
| Rate for Payer: Amerigroup Medicare |
$1,255.94
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,243.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,243.00
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,243.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,262.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,865.25
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX47MM
|
Facility
OP
|
$2,487.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.00 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,255.19
|
| Rate for Payer: Amerigroup Medicare |
$1,255.94
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,243.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,243.00
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,243.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,262.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,865.25
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
