|
IMPLANT KNEE TIBIAL BEARING INSERT 8X9
|
Facility
|
OP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,519.49 |
| Max. Negotiated Rate |
$4,536.90 |
| Rate for Payer: Aetna of IA Commercial |
$4,536.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,536.90
|
| Rate for Payer: Aetna of IA Medicare |
$2,873.37
|
| Rate for Payer: Amerigroup Medicaid |
$2,544.19
|
| Rate for Payer: Amerigroup Medicare |
$2,545.70
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,780.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,520.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,519.49
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,520.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,558.31
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$2,556.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$3,780.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,780.75
|
| Rate for Payer: United Healthcare Commercial |
$4,536.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,974.19
|
|
|
IMPLANT KNEE TIBIAL SIZE 6
|
Facility
|
IP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.70 |
| Max. Negotiated Rate |
$4,536.90 |
| Rate for Payer: Aetna of IA Commercial |
$4,536.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,536.90
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: United Healthcare Commercial |
$4,536.90
|
|
|
IMPLANT KNEE TIBIAL SIZE 6
|
Facility
|
OP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,519.49 |
| Max. Negotiated Rate |
$4,536.90 |
| Rate for Payer: Aetna of IA Commercial |
$4,536.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,536.90
|
| Rate for Payer: Aetna of IA Medicare |
$2,873.37
|
| Rate for Payer: Amerigroup Medicaid |
$2,544.19
|
| Rate for Payer: Amerigroup Medicare |
$2,545.70
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,780.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,520.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,519.49
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,520.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,558.31
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$2,556.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$3,780.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,780.75
|
| Rate for Payer: United Healthcare Commercial |
$4,536.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,974.19
|
|
|
IMPLANT KNEE TIBIAL SIZE 6-1
|
Facility
|
OP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,519.49 |
| Max. Negotiated Rate |
$4,536.90 |
| Rate for Payer: Aetna of IA Commercial |
$4,536.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,536.90
|
| Rate for Payer: Aetna of IA Medicare |
$2,873.37
|
| Rate for Payer: Amerigroup Medicaid |
$2,544.19
|
| Rate for Payer: Amerigroup Medicare |
$2,545.70
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,780.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,520.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,519.49
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,520.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,558.31
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$2,556.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$3,780.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,780.75
|
| Rate for Payer: United Healthcare Commercial |
$4,536.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,974.19
|
|
|
IMPLANT KNEE TIBIAL SIZE 6-1
|
Facility
|
IP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.70 |
| Max. Negotiated Rate |
$4,536.90 |
| Rate for Payer: Aetna of IA Commercial |
$4,536.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,536.90
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: United Healthcare Commercial |
$4,536.90
|
|
|
IMPLANT KNEE TIBIAL UNIV BASEPLT SZ 8
|
Facility
|
IP
|
$6,743.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,720.10 |
| Max. Negotiated Rate |
$6,068.70 |
| Rate for Payer: Aetna of IA Commercial |
$6,068.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,068.70
|
| Rate for Payer: Cash Price |
$5,394.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,057.25
|
| Rate for Payer: Medical Associates Commercial |
$5,057.25
|
| Rate for Payer: Midlands Choice Commercial |
$4,720.10
|
| Rate for Payer: United Healthcare Commercial |
$6,068.70
|
|
|
IMPLANT KNEE TIBIAL UNIV BASEPLT SZ 8
|
Facility
|
OP
|
$6,743.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,370.15 |
| Max. Negotiated Rate |
$6,068.70 |
| Rate for Payer: Aetna of IA Commercial |
$6,068.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,068.70
|
| Rate for Payer: Aetna of IA Medicare |
$3,843.51
|
| Rate for Payer: Amerigroup Medicaid |
$3,403.19
|
| Rate for Payer: Amerigroup Medicare |
$3,405.22
|
| Rate for Payer: Cash Price |
$5,394.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,057.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,371.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,370.15
|
| Rate for Payer: Medical Associates Commercial |
$5,057.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,371.50
|
| Rate for Payer: Midlands Choice Commercial |
$4,720.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,422.07
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$3,420.05
|
| Rate for Payer: Oscar Health of IA Commercial |
$5,057.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$5,057.25
|
| Rate for Payer: United Healthcare Commercial |
$6,068.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,978.37
|
|
|
IMPLANT LOCKING INSERT
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Aetna of IA Medicare |
$41.61
|
| Rate for Payer: Amerigroup Medicaid |
$36.84
|
| Rate for Payer: Amerigroup Medicare |
$36.86
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.49
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.50
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.05
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$37.03
|
| Rate for Payer: Oscar Health of IA Commercial |
$54.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.75
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.07
|
|
|
IMPLANT LOCKING INSERT
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
|
|
IMPLANT LOCK SCREW KNEE 5X25 FULL TH
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.44 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Aetna of IA Commercial |
$270.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$270.90
|
| Rate for Payer: Aetna of IA Medicare |
$171.57
|
| Rate for Payer: Amerigroup Medicaid |
$151.91
|
| Rate for Payer: Amerigroup Medicare |
$152.00
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$225.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$150.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$150.44
|
| Rate for Payer: Medical Associates Commercial |
$225.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$150.50
|
| Rate for Payer: Midlands Choice Commercial |
$210.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$152.76
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$152.67
|
| Rate for Payer: Oscar Health of IA Commercial |
$225.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$225.75
|
| Rate for Payer: United Healthcare Commercial |
$270.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$177.59
|
|
|
IMPLANT LOCK SCREW KNEE 5X25 FULL TH
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.70 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Aetna of IA Commercial |
$270.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$270.90
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$225.75
|
| Rate for Payer: Medical Associates Commercial |
$225.75
|
| Rate for Payer: Midlands Choice Commercial |
$210.70
|
| Rate for Payer: United Healthcare Commercial |
$270.90
|
|
|
IMPLANT LOCK SCREW KNEE 5X30 FULL TH
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.70 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Aetna of IA Commercial |
$270.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$270.90
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$225.75
|
| Rate for Payer: Medical Associates Commercial |
$225.75
|
| Rate for Payer: Midlands Choice Commercial |
$210.70
|
| Rate for Payer: United Healthcare Commercial |
$270.90
|
|
|
IMPLANT LOCK SCREW KNEE 5X30 FULL TH
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.44 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Aetna of IA Commercial |
$270.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$270.90
|
| Rate for Payer: Aetna of IA Medicare |
$171.57
|
| Rate for Payer: Amerigroup Medicaid |
$151.91
|
| Rate for Payer: Amerigroup Medicare |
$152.00
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$225.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$150.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$150.44
|
| Rate for Payer: Medical Associates Commercial |
$225.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$150.50
|
| Rate for Payer: Midlands Choice Commercial |
$210.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$152.76
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$152.67
|
| Rate for Payer: Oscar Health of IA Commercial |
$225.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$225.75
|
| Rate for Payer: United Healthcare Commercial |
$270.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$177.59
|
|
|
IMPLANT LOCK SCREW KNEE 5X35 FULL TH
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.44 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Aetna of IA Commercial |
$270.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$270.90
|
| Rate for Payer: Aetna of IA Medicare |
$171.57
|
| Rate for Payer: Amerigroup Medicaid |
$151.91
|
| Rate for Payer: Amerigroup Medicare |
$152.00
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$225.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$150.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$150.44
|
| Rate for Payer: Medical Associates Commercial |
$225.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$150.50
|
| Rate for Payer: Midlands Choice Commercial |
$210.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$152.76
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$152.67
|
| Rate for Payer: Oscar Health of IA Commercial |
$225.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$225.75
|
| Rate for Payer: United Healthcare Commercial |
$270.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$177.59
|
|
|
IMPLANT LOCK SCREW KNEE 5X35 FULL TH
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.70 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Aetna of IA Commercial |
$270.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$270.90
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$225.75
|
| Rate for Payer: Medical Associates Commercial |
$225.75
|
| Rate for Payer: Midlands Choice Commercial |
$210.70
|
| Rate for Payer: United Healthcare Commercial |
$270.90
|
|
|
IMPLANT LOCK SCREW KNEE 5X40 FULL TH
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.70 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Aetna of IA Commercial |
$270.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$270.90
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$225.75
|
| Rate for Payer: Medical Associates Commercial |
$225.75
|
| Rate for Payer: Midlands Choice Commercial |
$210.70
|
| Rate for Payer: United Healthcare Commercial |
$270.90
|
|
|
IMPLANT LOCK SCREW KNEE 5X40 FULL TH
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.44 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Aetna of IA Commercial |
$270.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$270.90
|
| Rate for Payer: Aetna of IA Medicare |
$171.57
|
| Rate for Payer: Amerigroup Medicaid |
$151.91
|
| Rate for Payer: Amerigroup Medicare |
$152.00
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$225.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$150.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$150.44
|
| Rate for Payer: Medical Associates Commercial |
$225.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$150.50
|
| Rate for Payer: Midlands Choice Commercial |
$210.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$152.76
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$152.67
|
| Rate for Payer: Oscar Health of IA Commercial |
$225.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$225.75
|
| Rate for Payer: United Healthcare Commercial |
$270.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$177.59
|
|
|
IMPLANT LOCK SCREW T7 2.3X20MM
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Aetna of IA Commercial |
$180.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$180.90
|
| Rate for Payer: Aetna of IA Medicare |
$114.57
|
| Rate for Payer: Amerigroup Medicaid |
$101.44
|
| Rate for Payer: Amerigroup Medicare |
$101.50
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$150.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$100.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.46
|
| Rate for Payer: Medical Associates Commercial |
$150.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$100.50
|
| Rate for Payer: Midlands Choice Commercial |
$140.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.01
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$101.95
|
| Rate for Payer: Oscar Health of IA Commercial |
$150.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$150.75
|
| Rate for Payer: United Healthcare Commercial |
$180.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$118.59
|
|
|
IMPLANT LOCK SCREW T7 2.3X20MM
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.70 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Aetna of IA Commercial |
$180.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$180.90
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$150.75
|
| Rate for Payer: Medical Associates Commercial |
$150.75
|
| Rate for Payer: Midlands Choice Commercial |
$140.70
|
| Rate for Payer: United Healthcare Commercial |
$180.90
|
|
|
IMPLANT LOCK SCREW T7 2.3X22MM
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046808
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Aetna of IA Commercial |
$180.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$180.90
|
| Rate for Payer: Aetna of IA Medicare |
$114.57
|
| Rate for Payer: Amerigroup Medicaid |
$101.44
|
| Rate for Payer: Amerigroup Medicare |
$101.50
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$150.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$100.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.46
|
| Rate for Payer: Medical Associates Commercial |
$150.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$100.50
|
| Rate for Payer: Midlands Choice Commercial |
$140.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.01
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$101.95
|
| Rate for Payer: Oscar Health of IA Commercial |
$150.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$150.75
|
| Rate for Payer: United Healthcare Commercial |
$180.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$118.59
|
|
|
IMPLANT LOCK SCREW T7 2.3X22MM
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046808
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.70 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Aetna of IA Commercial |
$180.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$180.90
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$150.75
|
| Rate for Payer: Medical Associates Commercial |
$150.75
|
| Rate for Payer: Midlands Choice Commercial |
$140.70
|
| Rate for Payer: United Healthcare Commercial |
$180.90
|
|
|
IMPLANT MONOTUBE TRIAX WRIST KT
|
Facility
|
IP
|
$3,987.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,790.90 |
| Max. Negotiated Rate |
$3,588.30 |
| Rate for Payer: Aetna of IA Commercial |
$3,588.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,588.30
|
| Rate for Payer: Cash Price |
$3,189.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,990.25
|
| Rate for Payer: Medical Associates Commercial |
$2,990.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,790.90
|
| Rate for Payer: United Healthcare Commercial |
$3,588.30
|
|
|
IMPLANT MONOTUBE TRIAX WRIST KT
|
Facility
|
OP
|
$3,987.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,992.70 |
| Max. Negotiated Rate |
$3,588.30 |
| Rate for Payer: Aetna of IA Commercial |
$3,588.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,588.30
|
| Rate for Payer: Aetna of IA Medicare |
$2,272.59
|
| Rate for Payer: Amerigroup Medicaid |
$2,012.24
|
| Rate for Payer: Amerigroup Medicare |
$2,013.44
|
| Rate for Payer: Cash Price |
$3,189.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,990.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,993.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,992.70
|
| Rate for Payer: Medical Associates Commercial |
$2,990.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,993.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,790.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,023.40
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$2,022.21
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,990.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,990.25
|
| Rate for Payer: United Healthcare Commercial |
$3,588.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,352.33
|
|
|
IMPLANT PIN KIT
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.70 |
| Max. Negotiated Rate |
$315.90 |
| Rate for Payer: Aetna of IA Commercial |
$315.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.90
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$263.25
|
| Rate for Payer: Medical Associates Commercial |
$263.25
|
| Rate for Payer: Midlands Choice Commercial |
$245.70
|
| Rate for Payer: United Healthcare Commercial |
$315.90
|
|
|
IMPLANT PIN KIT
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.43 |
| Max. Negotiated Rate |
$315.90 |
| Rate for Payer: Aetna of IA Commercial |
$315.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.90
|
| Rate for Payer: Aetna of IA Medicare |
$200.07
|
| Rate for Payer: Amerigroup Medicaid |
$177.15
|
| Rate for Payer: Amerigroup Medicare |
$177.26
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$263.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$175.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$175.43
|
| Rate for Payer: Medical Associates Commercial |
$263.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$175.50
|
| Rate for Payer: Midlands Choice Commercial |
$245.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$178.13
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$178.03
|
| Rate for Payer: Oscar Health of IA Commercial |
$263.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$263.25
|
| Rate for Payer: United Healthcare Commercial |
$315.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$207.09
|
|
