|
IMPLANT FEMMORAL POSTERIOR STABILIZED
|
Facility
|
IP
|
$7,173.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,021.10 |
| Max. Negotiated Rate |
$6,455.70 |
| Rate for Payer: Aetna of IA Commercial |
$6,455.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,455.70
|
| Rate for Payer: Cash Price |
$5,738.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,379.75
|
| Rate for Payer: Medical Associates Commercial |
$5,379.75
|
| Rate for Payer: Midlands Choice Commercial |
$5,021.10
|
| Rate for Payer: United Healthcare Commercial |
$6,455.70
|
|
|
IMPLANT FEMMORAL POSTERIOR STABILIZED
|
Facility
|
OP
|
$7,173.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,585.07 |
| Max. Negotiated Rate |
$6,455.70 |
| Rate for Payer: Aetna of IA Commercial |
$6,455.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,455.70
|
| Rate for Payer: Aetna of IA Medicare |
$4,088.61
|
| Rate for Payer: Amerigroup Medicaid |
$3,620.21
|
| Rate for Payer: Amerigroup Medicare |
$3,622.36
|
| Rate for Payer: Cash Price |
$5,738.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,379.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,586.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,585.07
|
| Rate for Payer: Medical Associates Commercial |
$5,379.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,586.50
|
| Rate for Payer: Midlands Choice Commercial |
$5,021.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,640.30
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$3,638.15
|
| Rate for Payer: Oscar Health of IA Commercial |
$5,379.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$5,379.75
|
| Rate for Payer: United Healthcare Commercial |
$6,455.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,232.07
|
|
|
IMPLANT FIBERLOOP
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of IA Commercial |
$73.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.50
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
|
|
IMPLANT FIBERLOOP
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of IA Commercial |
$73.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.80
|
| Rate for Payer: Aetna of IA Medicare |
$46.74
|
| Rate for Payer: Amerigroup Medicaid |
$41.39
|
| Rate for Payer: Amerigroup Medicare |
$41.41
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$41.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.98
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$41.00
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.62
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$41.59
|
| Rate for Payer: Oscar Health of IA Commercial |
$61.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$61.50
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.38
|
|
|
IMPLANT FIBERSTICK
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna of IA Commercial |
$74.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$74.70
|
| Rate for Payer: Aetna of IA Medicare |
$47.31
|
| Rate for Payer: Amerigroup Medicaid |
$41.89
|
| Rate for Payer: Amerigroup Medicare |
$41.92
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$62.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$41.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.48
|
| Rate for Payer: Medical Associates Commercial |
$62.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$41.50
|
| Rate for Payer: Midlands Choice Commercial |
$58.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.12
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$42.10
|
| Rate for Payer: Oscar Health of IA Commercial |
$62.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$62.25
|
| Rate for Payer: United Healthcare Commercial |
$74.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.97
|
|
|
IMPLANT FIBERSTICK
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna of IA Commercial |
$74.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$74.70
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$62.25
|
| Rate for Payer: Medical Associates Commercial |
$62.25
|
| Rate for Payer: Midlands Choice Commercial |
$58.10
|
| Rate for Payer: United Healthcare Commercial |
$74.70
|
|
|
IMPLANT HIP BIPOLAR COMP. UNIV. HEAD
|
Facility
|
IP
|
$2,655.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,858.50 |
| Max. Negotiated Rate |
$2,389.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,389.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,389.50
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,991.25
|
| Rate for Payer: Medical Associates Commercial |
$1,991.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,858.50
|
| Rate for Payer: United Healthcare Commercial |
$2,389.50
|
|
|
IMPLANT HIP BIPOLAR COMP. UNIV. HEAD
|
Facility
|
OP
|
$2,655.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,326.97 |
| Max. Negotiated Rate |
$2,389.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,389.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,389.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,513.35
|
| Rate for Payer: Amerigroup Medicaid |
$1,339.98
|
| Rate for Payer: Amerigroup Medicare |
$1,340.78
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,991.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,327.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,326.97
|
| Rate for Payer: Medical Associates Commercial |
$1,991.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,327.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,858.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,347.41
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,346.62
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,991.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,991.25
|
| Rate for Payer: United Healthcare Commercial |
$2,389.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,566.45
|
|
|
IMPLANT HIP BONE PLUG ARTISAN SIZE L
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$193.90 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: Aetna of IA Commercial |
$249.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$249.30
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$207.75
|
| Rate for Payer: Medical Associates Commercial |
$207.75
|
| Rate for Payer: Midlands Choice Commercial |
$193.90
|
| Rate for Payer: United Healthcare Commercial |
$249.30
|
|
|
IMPLANT HIP BONE PLUG ARTISAN SIZE L
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.44 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: Aetna of IA Commercial |
$249.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$249.30
|
| Rate for Payer: Aetna of IA Medicare |
$157.89
|
| Rate for Payer: Amerigroup Medicaid |
$139.80
|
| Rate for Payer: Amerigroup Medicare |
$139.88
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$207.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$138.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$138.44
|
| Rate for Payer: Medical Associates Commercial |
$207.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$138.50
|
| Rate for Payer: Midlands Choice Commercial |
$193.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$140.58
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$140.49
|
| Rate for Payer: Oscar Health of IA Commercial |
$207.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$207.75
|
| Rate for Payer: United Healthcare Commercial |
$249.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$163.43
|
|
|
IMPLANT HIP BONE PLUG ARTISAN SIZE M
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna of IA Commercial |
$259.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$259.20
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$216.00
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
|
|
IMPLANT HIP BONE PLUG ARTISAN SIZE M
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.94 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna of IA Commercial |
$259.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$259.20
|
| Rate for Payer: Aetna of IA Medicare |
$164.16
|
| Rate for Payer: Amerigroup Medicaid |
$145.35
|
| Rate for Payer: Amerigroup Medicare |
$145.44
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$216.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$144.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$143.94
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$144.00
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$146.16
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$146.07
|
| Rate for Payer: Oscar Health of IA Commercial |
$216.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$216.00
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$169.92
|
|
|
IMPLANT HIP BONE PLUG HOWMEDICA
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$193.90 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: Aetna of IA Commercial |
$249.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$249.30
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$207.75
|
| Rate for Payer: Medical Associates Commercial |
$207.75
|
| Rate for Payer: Midlands Choice Commercial |
$193.90
|
| Rate for Payer: United Healthcare Commercial |
$249.30
|
|
|
IMPLANT HIP BONE PLUG HOWMEDICA
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.44 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: Aetna of IA Commercial |
$249.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$249.30
|
| Rate for Payer: Aetna of IA Medicare |
$157.89
|
| Rate for Payer: Amerigroup Medicaid |
$139.80
|
| Rate for Payer: Amerigroup Medicare |
$139.88
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$207.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$138.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$138.44
|
| Rate for Payer: Medical Associates Commercial |
$207.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$138.50
|
| Rate for Payer: Midlands Choice Commercial |
$193.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$140.58
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$140.49
|
| Rate for Payer: Oscar Health of IA Commercial |
$207.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$207.75
|
| Rate for Payer: United Healthcare Commercial |
$249.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$163.43
|
|
|
IMPLANT HIP BONE PLUG HOWMEDICA SMALL
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$193.90 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: Aetna of IA Commercial |
$249.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$249.30
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$207.75
|
| Rate for Payer: Medical Associates Commercial |
$207.75
|
| Rate for Payer: Midlands Choice Commercial |
$193.90
|
| Rate for Payer: United Healthcare Commercial |
$249.30
|
|
|
IMPLANT HIP BONE PLUG HOWMEDICA SMALL
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.44 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: Aetna of IA Commercial |
$249.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$249.30
|
| Rate for Payer: Aetna of IA Medicare |
$157.89
|
| Rate for Payer: Amerigroup Medicaid |
$139.80
|
| Rate for Payer: Amerigroup Medicare |
$139.88
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$207.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$138.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$138.44
|
| Rate for Payer: Medical Associates Commercial |
$207.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$138.50
|
| Rate for Payer: Midlands Choice Commercial |
$193.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$140.58
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$140.49
|
| Rate for Payer: Oscar Health of IA Commercial |
$207.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$207.75
|
| Rate for Payer: United Healthcare Commercial |
$249.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$163.43
|
|
|
IMPLANT HIP CEMENTED STEM
|
Facility
|
IP
|
$7,722.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,405.40 |
| Max. Negotiated Rate |
$6,949.80 |
| Rate for Payer: Aetna of IA Commercial |
$6,949.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,949.80
|
| Rate for Payer: Cash Price |
$6,177.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,791.50
|
| Rate for Payer: Medical Associates Commercial |
$5,791.50
|
| Rate for Payer: Midlands Choice Commercial |
$5,405.40
|
| Rate for Payer: United Healthcare Commercial |
$6,949.80
|
|
|
IMPLANT HIP CEMENTED STEM
|
Facility
|
OP
|
$7,722.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,859.46 |
| Max. Negotiated Rate |
$6,949.80 |
| Rate for Payer: Aetna of IA Commercial |
$6,949.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,949.80
|
| Rate for Payer: Aetna of IA Medicare |
$4,401.54
|
| Rate for Payer: Amerigroup Medicaid |
$3,897.29
|
| Rate for Payer: Amerigroup Medicare |
$3,899.61
|
| Rate for Payer: Cash Price |
$6,177.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,791.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,861.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,859.46
|
| Rate for Payer: Medical Associates Commercial |
$5,791.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,861.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,405.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,918.92
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$3,916.60
|
| Rate for Payer: Oscar Health of IA Commercial |
$5,791.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$5,791.50
|
| Rate for Payer: United Healthcare Commercial |
$6,949.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,555.98
|
|
|
IMPLANT HIP CEMENTED STEM ACCOLADE 132
|
Facility
|
IP
|
$7,227.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,058.90 |
| Max. Negotiated Rate |
$6,504.30 |
| Rate for Payer: Aetna of IA Commercial |
$6,504.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,504.30
|
| Rate for Payer: Cash Price |
$5,781.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,420.25
|
| Rate for Payer: Medical Associates Commercial |
$5,420.25
|
| Rate for Payer: Midlands Choice Commercial |
$5,058.90
|
| Rate for Payer: United Healthcare Commercial |
$6,504.30
|
|
|
IMPLANT HIP CEMENTED STEM ACCOLADE 132
|
Facility
|
OP
|
$7,227.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,612.05 |
| Max. Negotiated Rate |
$6,504.30 |
| Rate for Payer: Aetna of IA Commercial |
$6,504.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,504.30
|
| Rate for Payer: Aetna of IA Medicare |
$4,119.39
|
| Rate for Payer: Amerigroup Medicaid |
$3,647.47
|
| Rate for Payer: Amerigroup Medicare |
$3,649.64
|
| Rate for Payer: Cash Price |
$5,781.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,420.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,613.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,612.05
|
| Rate for Payer: Medical Associates Commercial |
$5,420.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,613.50
|
| Rate for Payer: Midlands Choice Commercial |
$5,058.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,667.70
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$3,665.53
|
| Rate for Payer: Oscar Health of IA Commercial |
$5,420.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$5,420.25
|
| Rate for Payer: United Healthcare Commercial |
$6,504.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,263.93
|
|
|
IMPLANT HIP COCR LFIT HEAD 26MM/-3
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,288.00 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,656.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,656.00
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,380.00
|
| Rate for Payer: Medical Associates Commercial |
$1,380.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,288.00
|
| Rate for Payer: United Healthcare Commercial |
$1,656.00
|
|
|
IMPLANT HIP COCR LFIT HEAD 26MM/-3
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.63 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,656.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,656.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,048.80
|
| Rate for Payer: Amerigroup Medicaid |
$928.65
|
| Rate for Payer: Amerigroup Medicare |
$929.20
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,380.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$920.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$919.63
|
| Rate for Payer: Medical Associates Commercial |
$1,380.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$920.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,288.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$933.80
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$933.25
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,380.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,380.00
|
| Rate for Payer: United Healthcare Commercial |
$1,656.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,085.60
|
|
|
IMPLANT HUMERAL NAIL CANNULA
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,520.00 |
| Max. Negotiated Rate |
$3,240.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,240.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,240.00
|
| Rate for Payer: Cash Price |
$2,880.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,700.00
|
| Rate for Payer: Medical Associates Commercial |
$2,700.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,520.00
|
| Rate for Payer: United Healthcare Commercial |
$3,240.00
|
|
|
IMPLANT HUMERAL NAIL CANNULA
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,799.28 |
| Max. Negotiated Rate |
$3,240.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,240.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,240.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,052.00
|
| Rate for Payer: Amerigroup Medicaid |
$1,816.92
|
| Rate for Payer: Amerigroup Medicare |
$1,818.00
|
| Rate for Payer: Cash Price |
$2,880.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,700.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,800.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,799.28
|
| Rate for Payer: Medical Associates Commercial |
$2,700.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,800.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,520.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,827.00
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,825.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,700.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,700.00
|
| Rate for Payer: United Healthcare Commercial |
$3,240.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,124.00
|
|
|
IMPLANT INSERT TIBIAL #6
|
Facility
|
OP
|
$3,864.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,931.23 |
| Max. Negotiated Rate |
$3,477.60 |
| Rate for Payer: Aetna of IA Commercial |
$3,477.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,477.60
|
| Rate for Payer: Aetna of IA Medicare |
$2,202.48
|
| Rate for Payer: Amerigroup Medicaid |
$1,950.16
|
| Rate for Payer: Amerigroup Medicare |
$1,951.32
|
| Rate for Payer: Cash Price |
$3,091.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,898.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,932.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,931.23
|
| Rate for Payer: Medical Associates Commercial |
$2,898.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,932.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,704.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,960.98
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,959.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,898.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,898.00
|
| Rate for Payer: United Healthcare Commercial |
$3,477.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,279.76
|
|
