|
IMPLANT BIPOLAR COMP. UNIV HEAD 46X26
|
Facility
IP
|
$2,438.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,706.60 |
| Max. Negotiated Rate |
$2,194.20 |
| Rate for Payer: Aetna of IA Commercial |
$2,194.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,194.20
|
| Rate for Payer: Cash Price |
$1,950.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,828.50
|
| Rate for Payer: Medical Associates Commercial |
$1,828.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,706.60
|
| Rate for Payer: United Healthcare Commercial |
$2,194.20
|
|
|
IMPLANT BIPOLAR COMP. UNIV HEAD 46X26
|
Facility
OP
|
$2,438.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.51 |
| Max. Negotiated Rate |
$2,194.20 |
| Rate for Payer: Aetna of IA Commercial |
$2,194.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,194.20
|
| Rate for Payer: Aetna of IA Medicare |
$1,389.66
|
| Rate for Payer: Amerigroup Medicaid |
$1,230.46
|
| Rate for Payer: Amerigroup Medicare |
$1,231.19
|
| Rate for Payer: Cash Price |
$1,950.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,828.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,219.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,218.51
|
| Rate for Payer: Medical Associates Commercial |
$1,828.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,219.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,706.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,237.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,828.50
|
| Rate for Payer: United Healthcare Commercial |
$2,194.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,438.42
|
|
|
IMPLANT CABLE PLUG 5.0
|
Facility
IP
|
$68.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna of IA Commercial |
$61.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$61.20
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.00
|
| Rate for Payer: Medical Associates Commercial |
$51.00
|
| Rate for Payer: Midlands Choice Commercial |
$47.60
|
| Rate for Payer: United Healthcare Commercial |
$61.20
|
|
|
IMPLANT CABLE PLUG 5.0
|
Facility
OP
|
$68.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna of IA Commercial |
$61.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$61.20
|
| Rate for Payer: Aetna of IA Medicare |
$38.76
|
| Rate for Payer: Amerigroup Medicaid |
$34.32
|
| Rate for Payer: Amerigroup Medicare |
$34.34
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.99
|
| Rate for Payer: Medical Associates Commercial |
$51.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.00
|
| Rate for Payer: Midlands Choice Commercial |
$47.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.00
|
| Rate for Payer: United Healthcare Commercial |
$61.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$40.12
|
|
|
IMPLANT CANCELLOUS SCREW 6.5MM X 20MM
|
Facility
OP
|
$293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.44 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Aetna of IA Commercial |
$263.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$263.70
|
| Rate for Payer: Aetna of IA Medicare |
$167.01
|
| Rate for Payer: Amerigroup Medicaid |
$147.88
|
| Rate for Payer: Amerigroup Medicare |
$147.96
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$219.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$146.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$146.44
|
| Rate for Payer: Medical Associates Commercial |
$219.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$146.50
|
| Rate for Payer: Midlands Choice Commercial |
$205.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$148.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$219.75
|
| Rate for Payer: United Healthcare Commercial |
$263.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$172.87
|
|
|
IMPLANT CANCELLOUS SCREW 6.5MM X 20MM
|
Facility
IP
|
$293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.10 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Aetna of IA Commercial |
$263.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$263.70
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$219.75
|
| Rate for Payer: Medical Associates Commercial |
$219.75
|
| Rate for Payer: Midlands Choice Commercial |
$205.10
|
| Rate for Payer: United Healthcare Commercial |
$263.70
|
|
|
IMPLANT CANCELLOUS SCREW 6.5MM X 24MM
|
Facility
IP
|
$293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.10 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Aetna of IA Commercial |
$263.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$263.70
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$219.75
|
| Rate for Payer: Medical Associates Commercial |
$219.75
|
| Rate for Payer: Midlands Choice Commercial |
$205.10
|
| Rate for Payer: United Healthcare Commercial |
$263.70
|
|
|
IMPLANT CANCELLOUS SCREW 6.5MM X 24MM
|
Facility
OP
|
$293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.44 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Aetna of IA Commercial |
$263.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$263.70
|
| Rate for Payer: Aetna of IA Medicare |
$167.01
|
| Rate for Payer: Amerigroup Medicaid |
$147.88
|
| Rate for Payer: Amerigroup Medicare |
$147.96
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$219.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$146.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$146.44
|
| Rate for Payer: Medical Associates Commercial |
$219.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$146.50
|
| Rate for Payer: Midlands Choice Commercial |
$205.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$148.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$219.75
|
| Rate for Payer: United Healthcare Commercial |
$263.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$172.87
|
|
|
IMPLANT CANCELLOUS SCREW 6.5MM X 30MM
|
Facility
IP
|
$293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.10 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Aetna of IA Commercial |
$263.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$263.70
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$219.75
|
| Rate for Payer: Medical Associates Commercial |
$219.75
|
| Rate for Payer: Midlands Choice Commercial |
$205.10
|
| Rate for Payer: United Healthcare Commercial |
$263.70
|
|
|
IMPLANT CANCELLOUS SCREW 6.5MM X 30MM
|
Facility
OP
|
$293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.44 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Aetna of IA Commercial |
$263.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$263.70
|
| Rate for Payer: Aetna of IA Medicare |
$167.01
|
| Rate for Payer: Amerigroup Medicaid |
$147.88
|
| Rate for Payer: Amerigroup Medicare |
$147.96
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$219.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$146.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$146.44
|
| Rate for Payer: Medical Associates Commercial |
$219.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$146.50
|
| Rate for Payer: Midlands Choice Commercial |
$205.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$148.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$219.75
|
| Rate for Payer: United Healthcare Commercial |
$263.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$172.87
|
|
|
IMPLANT CANCELLOUS SCREW 6.5MM X 35MM
|
Facility
OP
|
$293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.44 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Aetna of IA Commercial |
$263.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$263.70
|
| Rate for Payer: Aetna of IA Medicare |
$167.01
|
| Rate for Payer: Amerigroup Medicaid |
$147.88
|
| Rate for Payer: Amerigroup Medicare |
$147.96
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$219.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$146.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$146.44
|
| Rate for Payer: Medical Associates Commercial |
$219.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$146.50
|
| Rate for Payer: Midlands Choice Commercial |
$205.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$148.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$219.75
|
| Rate for Payer: United Healthcare Commercial |
$263.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$172.87
|
|
|
IMPLANT CANCELLOUS SCREW 6.5MM X 35MM
|
Facility
IP
|
$293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.10 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Aetna of IA Commercial |
$263.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$263.70
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$219.75
|
| Rate for Payer: Medical Associates Commercial |
$219.75
|
| Rate for Payer: Midlands Choice Commercial |
$205.10
|
| Rate for Payer: United Healthcare Commercial |
$263.70
|
|
|
IMPLANT CEMENT SPACER
|
Facility
IP
|
$292.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8046309
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.40 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Aetna of IA Commercial |
$262.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$262.80
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$219.00
|
| Rate for Payer: Medical Associates Commercial |
$219.00
|
| Rate for Payer: Midlands Choice Commercial |
$204.40
|
| Rate for Payer: United Healthcare Commercial |
$262.80
|
|
|
IMPLANT CEMENT SPACER
|
Facility
OP
|
$292.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
8046309
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.94 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Aetna of IA Commercial |
$262.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$262.80
|
| Rate for Payer: Aetna of IA Medicare |
$166.44
|
| Rate for Payer: Amerigroup Medicaid |
$147.37
|
| Rate for Payer: Amerigroup Medicare |
$147.46
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$219.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$146.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$145.94
|
| Rate for Payer: Medical Associates Commercial |
$219.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$146.00
|
| Rate for Payer: Midlands Choice Commercial |
$204.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$148.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$219.00
|
| Rate for Payer: United Healthcare Commercial |
$262.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$172.28
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL
|
Facility
OP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,224.01 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Aetna of IA Medicare |
$7,098.21
|
| Rate for Payer: Amerigroup Medicaid |
$6,285.03
|
| Rate for Payer: Amerigroup Medicare |
$6,288.76
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6,226.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,224.01
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$6,226.50
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,319.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$9,339.75
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL
|
Facility
IP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,717.10 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #2 RT
|
Facility
OP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,224.01 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Aetna of IA Medicare |
$7,098.21
|
| Rate for Payer: Amerigroup Medicaid |
$6,285.03
|
| Rate for Payer: Amerigroup Medicare |
$6,288.76
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6,226.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,224.01
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$6,226.50
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,319.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$9,339.75
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #2 RT
|
Facility
IP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,717.10 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #3 LF
|
Facility
OP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,224.01 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Aetna of IA Medicare |
$7,098.21
|
| Rate for Payer: Amerigroup Medicaid |
$6,285.03
|
| Rate for Payer: Amerigroup Medicare |
$6,288.76
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6,226.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,224.01
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$6,226.50
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,319.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$9,339.75
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #3 LF
|
Facility
IP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,717.10 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #3 RT
|
Facility
OP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,224.01 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Aetna of IA Medicare |
$7,098.21
|
| Rate for Payer: Amerigroup Medicaid |
$6,285.03
|
| Rate for Payer: Amerigroup Medicare |
$6,288.76
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6,226.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,224.01
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$6,226.50
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,319.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$9,339.75
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #3 RT
|
Facility
IP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,717.10 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #8 LF
|
Facility
OP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,224.01 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Aetna of IA Medicare |
$7,098.21
|
| Rate for Payer: Amerigroup Medicaid |
$6,285.03
|
| Rate for Payer: Amerigroup Medicare |
$6,288.76
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6,226.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,224.01
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$6,226.50
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,319.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$9,339.75
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #8 LF
|
Facility
IP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,717.10 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #8 RT
|
Facility
IP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,717.10 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
|
