|
HUMERAL HEAD 44MM X 19MM
|
Facility
|
IP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,205.00 |
| Max. Negotiated Rate |
$2,835.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,835.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,362.50
|
| Rate for Payer: Medical Associates Commercial |
$2,362.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,205.00
|
| Rate for Payer: United Healthcare Commercial |
$2,835.00
|
|
|
HUMERAL HEAD 46MM X 18MM
|
Facility
|
IP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,205.00 |
| Max. Negotiated Rate |
$2,835.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,835.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,362.50
|
| Rate for Payer: Medical Associates Commercial |
$2,362.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,205.00
|
| Rate for Payer: United Healthcare Commercial |
$2,835.00
|
|
|
HUMERAL HEAD 46MM X 18MM
|
Facility
|
OP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$2,835.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,835.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,835.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,795.50
|
| Rate for Payer: Amerigroup Medicaid |
$1,816.92
|
| Rate for Payer: Amerigroup Medicare |
$1,431.68
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,362.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,417.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,799.28
|
| Rate for Payer: Medical Associates Commercial |
$2,362.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,417.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,205.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,825.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,630.12
|
| Rate for Payer: United Healthcare Commercial |
$2,835.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,858.50
|
|
|
HUMERAL HEAD 48MM X 19MM
|
Facility
|
IP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,205.00 |
| Max. Negotiated Rate |
$2,835.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,835.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,362.50
|
| Rate for Payer: Medical Associates Commercial |
$2,362.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,205.00
|
| Rate for Payer: United Healthcare Commercial |
$2,835.00
|
|
|
HUMERAL HEAD 48MM X 19MM
|
Facility
|
OP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$2,835.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,835.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,835.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,795.50
|
| Rate for Payer: Amerigroup Medicaid |
$1,816.92
|
| Rate for Payer: Amerigroup Medicare |
$1,431.68
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,362.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,417.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,799.28
|
| Rate for Payer: Medical Associates Commercial |
$2,362.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,417.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,205.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,825.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,630.12
|
| Rate for Payer: United Healthcare Commercial |
$2,835.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,858.50
|
|
|
HUMERAL HEAD 48MM X 21MM
|
Facility
|
OP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$2,835.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,835.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,835.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,795.50
|
| Rate for Payer: Amerigroup Medicaid |
$1,816.92
|
| Rate for Payer: Amerigroup Medicare |
$1,431.68
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,362.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,417.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,799.28
|
| Rate for Payer: Medical Associates Commercial |
$2,362.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,417.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,205.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,825.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,630.12
|
| Rate for Payer: United Healthcare Commercial |
$2,835.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,858.50
|
|
|
HUMERAL HEAD 48MM X 21MM
|
Facility
|
IP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,205.00 |
| Max. Negotiated Rate |
$2,835.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,835.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,362.50
|
| Rate for Payer: Medical Associates Commercial |
$2,362.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,205.00
|
| Rate for Payer: United Healthcare Commercial |
$2,835.00
|
|
|
HUMERAL HEAD 50MM X 19MM
|
Facility
|
OP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$2,835.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,835.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,835.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,795.50
|
| Rate for Payer: Amerigroup Medicaid |
$1,816.92
|
| Rate for Payer: Amerigroup Medicare |
$1,431.68
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,362.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,417.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,799.28
|
| Rate for Payer: Medical Associates Commercial |
$2,362.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,417.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,205.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,825.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,630.12
|
| Rate for Payer: United Healthcare Commercial |
$2,835.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,858.50
|
|
|
HUMERAL HEAD 50MM X 19MM
|
Facility
|
IP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,205.00 |
| Max. Negotiated Rate |
$2,835.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,835.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,362.50
|
| Rate for Payer: Medical Associates Commercial |
$2,362.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,205.00
|
| Rate for Payer: United Healthcare Commercial |
$2,835.00
|
|
|
HUMERAL HEAD 52MM X 20MM
|
Facility
|
OP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$2,835.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,835.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,835.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,795.50
|
| Rate for Payer: Amerigroup Medicaid |
$1,816.92
|
| Rate for Payer: Amerigroup Medicare |
$1,431.68
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,362.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,417.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,799.28
|
| Rate for Payer: Medical Associates Commercial |
$2,362.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,417.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,205.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,825.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,630.12
|
| Rate for Payer: United Healthcare Commercial |
$2,835.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,858.50
|
|
|
HUMERAL HEAD 52MM X 20MM
|
Facility
|
IP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,205.00 |
| Max. Negotiated Rate |
$2,835.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,835.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,362.50
|
| Rate for Payer: Medical Associates Commercial |
$2,362.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,205.00
|
| Rate for Payer: United Healthcare Commercial |
$2,835.00
|
|
|
HUMERAL HEAD 52MM X 22MM
|
Facility
|
IP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,205.00 |
| Max. Negotiated Rate |
$2,835.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,835.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,362.50
|
| Rate for Payer: Medical Associates Commercial |
$2,362.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,205.00
|
| Rate for Payer: United Healthcare Commercial |
$2,835.00
|
|
|
HUMERAL HEAD 52MM X 22MM
|
Facility
|
OP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$2,835.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,835.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,835.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,795.50
|
| Rate for Payer: Amerigroup Medicaid |
$1,816.92
|
| Rate for Payer: Amerigroup Medicare |
$1,431.68
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,362.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,417.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,799.28
|
| Rate for Payer: Medical Associates Commercial |
$2,362.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,417.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,205.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,825.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,630.12
|
| Rate for Payer: United Healthcare Commercial |
$2,835.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,858.50
|
|
|
HUMERAL HEAD 54MM X 23MM
|
Facility
|
IP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,205.00 |
| Max. Negotiated Rate |
$2,835.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,835.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,362.50
|
| Rate for Payer: Medical Associates Commercial |
$2,362.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,205.00
|
| Rate for Payer: United Healthcare Commercial |
$2,835.00
|
|
|
HUMERAL HEAD 54MM X 23MM
|
Facility
|
OP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$2,835.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,835.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,835.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,795.50
|
| Rate for Payer: Amerigroup Medicaid |
$1,816.92
|
| Rate for Payer: Amerigroup Medicare |
$1,431.68
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,362.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,417.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,799.28
|
| Rate for Payer: Medical Associates Commercial |
$2,362.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,417.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,205.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,825.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,630.12
|
| Rate for Payer: United Healthcare Commercial |
$2,835.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,858.50
|
|
|
HUMERAL METAPHYSIS CEMENTED
|
Facility
|
IP
|
$4,052.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,836.40 |
| Max. Negotiated Rate |
$3,646.80 |
| Rate for Payer: Aetna of IA Commercial |
$3,646.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,646.80
|
| Rate for Payer: Cash Price |
$3,241.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,039.00
|
| Rate for Payer: Medical Associates Commercial |
$3,039.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,836.40
|
| Rate for Payer: United Healthcare Commercial |
$3,646.80
|
|
|
HUMERAL METAPHYSIS CEMENTED
|
Facility
|
OP
|
$4,052.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,823.40 |
| Max. Negotiated Rate |
$3,646.80 |
| Rate for Payer: Aetna of IA Commercial |
$3,646.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,646.80
|
| Rate for Payer: Aetna of IA Medicare |
$2,309.64
|
| Rate for Payer: Amerigroup Medicaid |
$2,337.19
|
| Rate for Payer: Amerigroup Medicare |
$1,841.63
|
| Rate for Payer: Cash Price |
$3,241.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,039.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,823.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,314.50
|
| Rate for Payer: Medical Associates Commercial |
$3,039.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,823.40
|
| Rate for Payer: Midlands Choice Commercial |
$2,836.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,348.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,096.91
|
| Rate for Payer: United Healthcare Commercial |
$3,646.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,390.68
|
|
|
HUMERAL STEM 10MM X 148MM
|
Facility
|
IP
|
$6,615.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,630.50 |
| Max. Negotiated Rate |
$5,953.50 |
| Rate for Payer: Aetna of IA Commercial |
$5,953.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,953.50
|
| Rate for Payer: Cash Price |
$5,292.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,961.25
|
| Rate for Payer: Medical Associates Commercial |
$4,961.25
|
| Rate for Payer: Midlands Choice Commercial |
$4,630.50
|
| Rate for Payer: United Healthcare Commercial |
$5,953.50
|
|
|
HUMERAL STEM 10MM X 148MM
|
Facility
|
OP
|
$6,615.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,976.75 |
| Max. Negotiated Rate |
$5,953.50 |
| Rate for Payer: Aetna of IA Commercial |
$5,953.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,953.50
|
| Rate for Payer: Aetna of IA Medicare |
$3,770.55
|
| Rate for Payer: Amerigroup Medicaid |
$3,815.53
|
| Rate for Payer: Amerigroup Medicare |
$3,006.52
|
| Rate for Payer: Cash Price |
$5,292.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,961.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,976.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,778.49
|
| Rate for Payer: Medical Associates Commercial |
$4,961.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,976.75
|
| Rate for Payer: Midlands Choice Commercial |
$4,630.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,834.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,423.26
|
| Rate for Payer: United Healthcare Commercial |
$5,953.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,902.85
|
|
|
HUMERAL STEM 11MM X 151MM
|
Facility
|
IP
|
$6,615.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,630.50 |
| Max. Negotiated Rate |
$5,953.50 |
| Rate for Payer: Aetna of IA Commercial |
$5,953.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,953.50
|
| Rate for Payer: Cash Price |
$5,292.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,961.25
|
| Rate for Payer: Medical Associates Commercial |
$4,961.25
|
| Rate for Payer: Midlands Choice Commercial |
$4,630.50
|
| Rate for Payer: United Healthcare Commercial |
$5,953.50
|
|
|
HUMERAL STEM 11MM X 151MM
|
Facility
|
OP
|
$6,615.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,976.75 |
| Max. Negotiated Rate |
$5,953.50 |
| Rate for Payer: Aetna of IA Commercial |
$5,953.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,953.50
|
| Rate for Payer: Aetna of IA Medicare |
$3,770.55
|
| Rate for Payer: Amerigroup Medicaid |
$3,815.53
|
| Rate for Payer: Amerigroup Medicare |
$3,006.52
|
| Rate for Payer: Cash Price |
$5,292.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,961.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,976.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,778.49
|
| Rate for Payer: Medical Associates Commercial |
$4,961.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,976.75
|
| Rate for Payer: Midlands Choice Commercial |
$4,630.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,834.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,423.26
|
| Rate for Payer: United Healthcare Commercial |
$5,953.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,902.85
|
|
|
HUMERAL STEM 12MM X 151MM
|
Facility
|
IP
|
$6,615.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,630.50 |
| Max. Negotiated Rate |
$5,953.50 |
| Rate for Payer: Aetna of IA Commercial |
$5,953.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,953.50
|
| Rate for Payer: Cash Price |
$5,292.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,961.25
|
| Rate for Payer: Medical Associates Commercial |
$4,961.25
|
| Rate for Payer: Midlands Choice Commercial |
$4,630.50
|
| Rate for Payer: United Healthcare Commercial |
$5,953.50
|
|
|
HUMERAL STEM 12MM X 151MM
|
Facility
|
OP
|
$6,615.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,976.75 |
| Max. Negotiated Rate |
$5,953.50 |
| Rate for Payer: Aetna of IA Commercial |
$5,953.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,953.50
|
| Rate for Payer: Aetna of IA Medicare |
$3,770.55
|
| Rate for Payer: Amerigroup Medicaid |
$3,815.53
|
| Rate for Payer: Amerigroup Medicare |
$3,006.52
|
| Rate for Payer: Cash Price |
$5,292.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,961.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,976.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,778.49
|
| Rate for Payer: Medical Associates Commercial |
$4,961.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,976.75
|
| Rate for Payer: Midlands Choice Commercial |
$4,630.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,834.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,423.26
|
| Rate for Payer: United Healthcare Commercial |
$5,953.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,902.85
|
|
|
HUMERAL STEM 6MM X 115MM
|
Facility
|
OP
|
$6,615.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,976.75 |
| Max. Negotiated Rate |
$5,953.50 |
| Rate for Payer: Aetna of IA Commercial |
$5,953.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,953.50
|
| Rate for Payer: Aetna of IA Medicare |
$3,770.55
|
| Rate for Payer: Amerigroup Medicaid |
$3,815.53
|
| Rate for Payer: Amerigroup Medicare |
$3,006.52
|
| Rate for Payer: Cash Price |
$5,292.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,961.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,976.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,778.49
|
| Rate for Payer: Medical Associates Commercial |
$4,961.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,976.75
|
| Rate for Payer: Midlands Choice Commercial |
$4,630.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,834.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,423.26
|
| Rate for Payer: United Healthcare Commercial |
$5,953.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,902.85
|
|
|
HUMERAL STEM 6MM X 115MM
|
Facility
|
IP
|
$6,615.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,630.50 |
| Max. Negotiated Rate |
$5,953.50 |
| Rate for Payer: Aetna of IA Commercial |
$5,953.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,953.50
|
| Rate for Payer: Cash Price |
$5,292.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,961.25
|
| Rate for Payer: Medical Associates Commercial |
$4,961.25
|
| Rate for Payer: Midlands Choice Commercial |
$4,630.50
|
| Rate for Payer: United Healthcare Commercial |
$5,953.50
|
|
