|
IMPLANT BIPOLAR COMP UNIV HEAD 26MMX41MM
|
Facility
|
OP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.15 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,434.50
|
| Rate for Payer: Amerigroup Medicare |
$1,130.34
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,119.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,420.57
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,119.15
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,441.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,287.02
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 26MMX42MM
|
Facility
|
OP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.15 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,434.50
|
| Rate for Payer: Amerigroup Medicare |
$1,130.34
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,119.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,420.57
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,119.15
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,441.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,287.02
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 26MMX42MM
|
Facility
|
IP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 26MMX43MM
|
Facility
|
IP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 26MMX43MM
|
Facility
|
OP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.15 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,434.50
|
| Rate for Payer: Amerigroup Medicare |
$1,130.34
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,119.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,420.57
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,119.15
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,441.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,287.02
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX44MM
|
Facility
|
IP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX44MM
|
Facility
|
OP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.15 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,434.50
|
| Rate for Payer: Amerigroup Medicare |
$1,130.34
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,119.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,420.57
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,119.15
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,441.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,287.02
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX45MM
|
Facility
|
IP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX45MM
|
Facility
|
OP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.15 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,434.50
|
| Rate for Payer: Amerigroup Medicare |
$1,130.34
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,119.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,420.57
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,119.15
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,441.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,287.02
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX46MM
|
Facility
|
IP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX46MM
|
Facility
|
OP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.15 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,434.50
|
| Rate for Payer: Amerigroup Medicare |
$1,130.34
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,119.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,420.57
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,119.15
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,441.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,287.02
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX47MM
|
Facility
|
OP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.15 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,434.50
|
| Rate for Payer: Amerigroup Medicare |
$1,130.34
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,119.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,420.57
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,119.15
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,441.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,287.02
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX47MM
|
Facility
|
IP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX48MM
|
Facility
|
IP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX48MM
|
Facility
|
OP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.15 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,434.50
|
| Rate for Payer: Amerigroup Medicare |
$1,130.34
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,119.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,420.57
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,119.15
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,441.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,287.02
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX49MM
|
Facility
|
IP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX49MM
|
Facility
|
OP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.15 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,434.50
|
| Rate for Payer: Amerigroup Medicare |
$1,130.34
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,119.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,420.57
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,119.15
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,441.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,287.02
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX50MM
|
Facility
|
OP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.15 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,434.50
|
| Rate for Payer: Amerigroup Medicare |
$1,130.34
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,119.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,420.57
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,119.15
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,441.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,287.02
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX50MM
|
Facility
|
IP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX51MM
|
Facility
|
IP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX51MM
|
Facility
|
OP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.15 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,434.50
|
| Rate for Payer: Amerigroup Medicare |
$1,130.34
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,119.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,420.57
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,119.15
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,441.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,287.02
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX52MM
|
Facility
|
OP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.15 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,434.50
|
| Rate for Payer: Amerigroup Medicare |
$1,130.34
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,119.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,420.57
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,119.15
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,441.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,287.02
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX52MM
|
Facility
|
IP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX53MM
|
Facility
|
OP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.15 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,417.59
|
| Rate for Payer: Amerigroup Medicaid |
$1,434.50
|
| Rate for Payer: Amerigroup Medicare |
$1,130.34
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,119.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,420.57
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,119.15
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,441.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,287.02
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,467.33
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 28MMX53MM
|
Facility
|
IP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
