|
IMPLANT PLATE LEFT SMALL
|
Facility
|
IP
|
$1,919.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,343.30 |
| Max. Negotiated Rate |
$1,727.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,727.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,727.10
|
| Rate for Payer: Cash Price |
$1,535.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,439.25
|
| Rate for Payer: Medical Associates Commercial |
$1,439.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,343.30
|
| Rate for Payer: United Healthcare Commercial |
$1,727.10
|
|
|
IMPLANT PLATE LEFT SMALL
|
Facility
|
OP
|
$1,919.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.12 |
| Max. Negotiated Rate |
$1,727.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,727.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,727.10
|
| Rate for Payer: Aetna of IA Medicare |
$1,093.83
|
| Rate for Payer: Amerigroup Medicaid |
$968.52
|
| Rate for Payer: Amerigroup Medicare |
$969.10
|
| Rate for Payer: Cash Price |
$1,535.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,439.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$959.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$959.12
|
| Rate for Payer: Medical Associates Commercial |
$1,439.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$959.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,343.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$973.89
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$973.32
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,439.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,439.25
|
| Rate for Payer: United Healthcare Commercial |
$1,727.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,132.21
|
|
|
IMPLANT PLATE RIGHT SMALL
|
Facility
|
OP
|
$1,919.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.12 |
| Max. Negotiated Rate |
$1,727.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,727.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,727.10
|
| Rate for Payer: Aetna of IA Medicare |
$1,093.83
|
| Rate for Payer: Amerigroup Medicaid |
$968.52
|
| Rate for Payer: Amerigroup Medicare |
$969.10
|
| Rate for Payer: Cash Price |
$1,535.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,439.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$959.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$959.12
|
| Rate for Payer: Medical Associates Commercial |
$1,439.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$959.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,343.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$973.89
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$973.32
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,439.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,439.25
|
| Rate for Payer: United Healthcare Commercial |
$1,727.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,132.21
|
|
|
IMPLANT PLATE RIGHT SMALL
|
Facility
|
IP
|
$1,919.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,343.30 |
| Max. Negotiated Rate |
$1,727.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,727.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,727.10
|
| Rate for Payer: Cash Price |
$1,535.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,439.25
|
| Rate for Payer: Medical Associates Commercial |
$1,439.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,343.30
|
| Rate for Payer: United Healthcare Commercial |
$1,727.10
|
|
|
IMPLANT PUSHLOCK 2.9 BIO
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.80 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna of IA Commercial |
$615.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$615.60
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$513.00
|
| Rate for Payer: Medical Associates Commercial |
$513.00
|
| Rate for Payer: Midlands Choice Commercial |
$478.80
|
| Rate for Payer: United Healthcare Commercial |
$615.60
|
|
|
IMPLANT PUSHLOCK 2.9 BIO
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.86 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna of IA Commercial |
$615.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$615.60
|
| Rate for Payer: Aetna of IA Medicare |
$389.88
|
| Rate for Payer: Amerigroup Medicaid |
$345.21
|
| Rate for Payer: Amerigroup Medicare |
$345.42
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$513.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$342.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$341.86
|
| Rate for Payer: Medical Associates Commercial |
$513.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$342.00
|
| Rate for Payer: Midlands Choice Commercial |
$478.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$347.13
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$346.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$513.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$513.00
|
| Rate for Payer: United Healthcare Commercial |
$615.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$403.56
|
|
|
IMPLANT PUSHLOCK 4.5MM
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna of IA Commercial |
$621.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$621.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$517.50
|
| Rate for Payer: Medical Associates Commercial |
$517.50
|
| Rate for Payer: Midlands Choice Commercial |
$483.00
|
| Rate for Payer: United Healthcare Commercial |
$621.00
|
|
|
IMPLANT PUSHLOCK 4.5MM
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$344.86 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna of IA Commercial |
$621.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$621.00
|
| Rate for Payer: Aetna of IA Medicare |
$393.30
|
| Rate for Payer: Amerigroup Medicaid |
$348.24
|
| Rate for Payer: Amerigroup Medicare |
$348.45
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$517.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$345.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$344.86
|
| Rate for Payer: Medical Associates Commercial |
$517.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$345.00
|
| Rate for Payer: Midlands Choice Commercial |
$483.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$350.18
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$349.97
|
| Rate for Payer: Oscar Health of IA Commercial |
$517.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$517.50
|
| Rate for Payer: United Healthcare Commercial |
$621.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$407.10
|
|
|
IMPLANT SUTURETAK 2.4MM
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.70 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Aetna of IA Commercial |
$531.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$531.90
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$443.25
|
| Rate for Payer: Medical Associates Commercial |
$443.25
|
| Rate for Payer: Midlands Choice Commercial |
$413.70
|
| Rate for Payer: United Healthcare Commercial |
$531.90
|
|
|
IMPLANT SUTURETAK 2.4MM
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$295.38 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Aetna of IA Commercial |
$531.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$531.90
|
| Rate for Payer: Aetna of IA Medicare |
$336.87
|
| Rate for Payer: Amerigroup Medicaid |
$298.28
|
| Rate for Payer: Amerigroup Medicare |
$298.46
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$443.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$295.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$295.38
|
| Rate for Payer: Medical Associates Commercial |
$443.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$295.50
|
| Rate for Payer: Midlands Choice Commercial |
$413.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$299.93
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$299.76
|
| Rate for Payer: Oscar Health of IA Commercial |
$443.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$443.25
|
| Rate for Payer: United Healthcare Commercial |
$531.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$348.69
|
|
|
IMPLANT SUTURETAK 2 FIBERWIRES
|
Facility
|
OP
|
$2,953.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,475.91 |
| Max. Negotiated Rate |
$2,657.70 |
| Rate for Payer: Aetna of IA Commercial |
$2,657.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,657.70
|
| Rate for Payer: Aetna of IA Medicare |
$1,683.21
|
| Rate for Payer: Amerigroup Medicaid |
$1,490.38
|
| Rate for Payer: Amerigroup Medicare |
$1,491.26
|
| Rate for Payer: Cash Price |
$2,362.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,214.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,476.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,475.91
|
| Rate for Payer: Medical Associates Commercial |
$2,214.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,476.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,067.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,498.65
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,497.76
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,214.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,214.75
|
| Rate for Payer: United Healthcare Commercial |
$2,657.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,742.27
|
|
|
IMPLANT SUTURETAK 2 FIBERWIRES
|
Facility
|
IP
|
$2,953.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.10 |
| Max. Negotiated Rate |
$2,657.70 |
| Rate for Payer: Aetna of IA Commercial |
$2,657.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,657.70
|
| Rate for Payer: Cash Price |
$2,362.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,214.75
|
| Rate for Payer: Medical Associates Commercial |
$2,214.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,067.10
|
| Rate for Payer: United Healthcare Commercial |
$2,657.70
|
|
|
IMPLANT SUTURETAK 3.0MM
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$388.50 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Aetna of IA Commercial |
$499.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$499.50
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$416.25
|
| Rate for Payer: Medical Associates Commercial |
$416.25
|
| Rate for Payer: Midlands Choice Commercial |
$388.50
|
| Rate for Payer: United Healthcare Commercial |
$499.50
|
|
|
IMPLANT SUTURETAK 3.0MM
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$277.39 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Aetna of IA Commercial |
$499.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$499.50
|
| Rate for Payer: Aetna of IA Medicare |
$316.35
|
| Rate for Payer: Amerigroup Medicaid |
$280.11
|
| Rate for Payer: Amerigroup Medicare |
$280.28
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$416.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$277.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$277.39
|
| Rate for Payer: Medical Associates Commercial |
$416.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$277.50
|
| Rate for Payer: Midlands Choice Commercial |
$388.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$281.66
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$281.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$416.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$416.25
|
| Rate for Payer: United Healthcare Commercial |
$499.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$327.45
|
|
|
IMPLANT SWIVELOCK (5 PER BOX)
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna of IA Commercial |
$648.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$648.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$540.00
|
| Rate for Payer: Medical Associates Commercial |
$540.00
|
| Rate for Payer: Midlands Choice Commercial |
$504.00
|
| Rate for Payer: United Healthcare Commercial |
$648.00
|
|
|
IMPLANT SWIVELOCK (5 PER BOX)
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8026421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.86 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna of IA Commercial |
$648.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$648.00
|
| Rate for Payer: Aetna of IA Medicare |
$410.40
|
| Rate for Payer: Amerigroup Medicaid |
$363.38
|
| Rate for Payer: Amerigroup Medicare |
$363.60
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$540.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$360.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$359.86
|
| Rate for Payer: Medical Associates Commercial |
$540.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$360.00
|
| Rate for Payer: Midlands Choice Commercial |
$504.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$365.40
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$365.18
|
| Rate for Payer: Oscar Health of IA Commercial |
$540.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$540.00
|
| Rate for Payer: United Healthcare Commercial |
$648.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$424.80
|
|
|
IMPLANT SYSTEM, CPR MINI SCORPION DX
|
Facility
|
OP
|
$2,817.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8757482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,407.94 |
| Max. Negotiated Rate |
$2,535.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,535.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,535.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,605.69
|
| Rate for Payer: Amerigroup Medicaid |
$1,421.74
|
| Rate for Payer: Amerigroup Medicare |
$1,422.58
|
| Rate for Payer: Cash Price |
$2,253.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,112.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,408.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,407.94
|
| Rate for Payer: Medical Associates Commercial |
$2,112.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,408.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,971.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,429.63
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,428.78
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,112.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,112.75
|
| Rate for Payer: United Healthcare Commercial |
$2,535.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,662.03
|
|
|
IMPLANT SYSTEM, CPR MINI SCORPION DX
|
Facility
|
IP
|
$2,817.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8757482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,971.90 |
| Max. Negotiated Rate |
$2,535.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,535.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,535.30
|
| Rate for Payer: Cash Price |
$2,253.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,112.75
|
| Rate for Payer: Medical Associates Commercial |
$2,112.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,971.90
|
| Rate for Payer: United Healthcare Commercial |
$2,535.30
|
|
|
IMPLANT SYSTEM, MPFL BIOCOMPOSITE
|
Facility
|
IP
|
$2,677.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,873.90 |
| Max. Negotiated Rate |
$2,409.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,409.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,409.30
|
| Rate for Payer: Cash Price |
$2,141.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,007.75
|
| Rate for Payer: Medical Associates Commercial |
$2,007.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,873.90
|
| Rate for Payer: United Healthcare Commercial |
$2,409.30
|
|
|
IMPLANT SYSTEM, MPFL BIOCOMPOSITE
|
Facility
|
OP
|
$2,677.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,337.96 |
| Max. Negotiated Rate |
$2,409.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,409.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,409.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,525.89
|
| Rate for Payer: Amerigroup Medicaid |
$1,351.08
|
| Rate for Payer: Amerigroup Medicare |
$1,351.88
|
| Rate for Payer: Cash Price |
$2,141.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,007.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,338.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,337.96
|
| Rate for Payer: Medical Associates Commercial |
$2,007.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,338.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,873.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,358.58
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,357.77
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,007.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,007.75
|
| Rate for Payer: United Healthcare Commercial |
$2,409.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,579.43
|
|
|
IMPLANT TIBIAL BEARING INSERT #4
|
Facility
|
IP
|
$4,892.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,424.40 |
| Max. Negotiated Rate |
$4,402.80 |
| Rate for Payer: Aetna of IA Commercial |
$4,402.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,402.80
|
| Rate for Payer: Cash Price |
$3,913.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,669.00
|
| Rate for Payer: Medical Associates Commercial |
$3,669.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,424.40
|
| Rate for Payer: United Healthcare Commercial |
$4,402.80
|
|
|
IMPLANT TIBIAL BEARING INSERT #4
|
Facility
|
OP
|
$4,892.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,445.02 |
| Max. Negotiated Rate |
$4,402.80 |
| Rate for Payer: Aetna of IA Commercial |
$4,402.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,402.80
|
| Rate for Payer: Aetna of IA Medicare |
$2,788.44
|
| Rate for Payer: Amerigroup Medicaid |
$2,468.99
|
| Rate for Payer: Amerigroup Medicare |
$2,470.46
|
| Rate for Payer: Cash Price |
$3,913.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,669.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,446.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,445.02
|
| Rate for Payer: Medical Associates Commercial |
$3,669.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,446.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,424.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,482.69
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$2,481.22
|
| Rate for Payer: Oscar Health of IA Commercial |
$3,669.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,669.00
|
| Rate for Payer: United Healthcare Commercial |
$4,402.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,886.28
|
|
|
IMPLANT TIBIAL BEARING INSERT CR 4X11MM
|
Facility
|
OP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046850
|
|
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 TIBIAL BEARING INSERT CR 4X11MM
|
Facility
|
IP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046850
|
|
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 TIBIAL NAIL STANDARD 11X315MM
|
Facility
|
IP
|
$3,449.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,414.30 |
| Max. Negotiated Rate |
$3,104.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,104.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,104.10
|
| Rate for Payer: Cash Price |
$2,759.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,586.75
|
| Rate for Payer: Medical Associates Commercial |
$2,586.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,414.30
|
| Rate for Payer: United Healthcare Commercial |
$3,104.10
|
|
