|
IMPLANT CEMENT SPACER
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
8046309
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.40 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Aetna of IA Commercial |
$262.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$262.80
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$219.00
|
| Rate for Payer: Medical Associates Commercial |
$219.00
|
| Rate for Payer: Midlands Choice Commercial |
$204.40
|
| Rate for Payer: United Healthcare Commercial |
$262.80
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL
|
Facility
|
OP
|
$12,453.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,603.85 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Aetna of IA Medicare |
$7,098.21
|
| Rate for Payer: Amerigroup Medicaid |
$7,182.89
|
| Rate for Payer: Amerigroup Medicare |
$5,659.89
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5,603.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,113.15
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$5,603.85
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,217.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,444.43
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL
|
Facility
|
IP
|
$12,453.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,717.10 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #2 RT
|
Facility
|
OP
|
$12,453.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,603.85 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Aetna of IA Medicare |
$7,098.21
|
| Rate for Payer: Amerigroup Medicaid |
$7,182.89
|
| Rate for Payer: Amerigroup Medicare |
$5,659.89
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5,603.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,113.15
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$5,603.85
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,217.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,444.43
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #2 RT
|
Facility
|
IP
|
$12,453.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,717.10 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #3 LF
|
Facility
|
OP
|
$12,453.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,603.85 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Aetna of IA Medicare |
$7,098.21
|
| Rate for Payer: Amerigroup Medicaid |
$7,182.89
|
| Rate for Payer: Amerigroup Medicare |
$5,659.89
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5,603.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,113.15
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$5,603.85
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,217.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,444.43
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #3 LF
|
Facility
|
IP
|
$12,453.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,717.10 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #3 RT
|
Facility
|
OP
|
$12,453.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,603.85 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Aetna of IA Medicare |
$7,098.21
|
| Rate for Payer: Amerigroup Medicaid |
$7,182.89
|
| Rate for Payer: Amerigroup Medicare |
$5,659.89
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5,603.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,113.15
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$5,603.85
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,217.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,444.43
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #3 RT
|
Facility
|
IP
|
$12,453.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,717.10 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #8 LF
|
Facility
|
IP
|
$12,453.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,717.10 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #8 LF
|
Facility
|
OP
|
$12,453.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,603.85 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Aetna of IA Medicare |
$7,098.21
|
| Rate for Payer: Amerigroup Medicaid |
$7,182.89
|
| Rate for Payer: Amerigroup Medicare |
$5,659.89
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5,603.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,113.15
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$5,603.85
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,217.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,444.43
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #8 RT
|
Facility
|
OP
|
$12,453.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,603.85 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Aetna of IA Medicare |
$7,098.21
|
| Rate for Payer: Amerigroup Medicaid |
$7,182.89
|
| Rate for Payer: Amerigroup Medicare |
$5,659.89
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5,603.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,113.15
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$5,603.85
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,217.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,444.43
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT CRUCIATE RETAINING FEMORAL #8 RT
|
Facility
|
IP
|
$12,453.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,717.10 |
| Max. Negotiated Rate |
$11,207.70 |
| Rate for Payer: Aetna of IA Commercial |
$11,207.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11,207.70
|
| Rate for Payer: Cash Price |
$9,962.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
|
|
IMPLANT END CAP +10MM
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$303.80 |
| Max. Negotiated Rate |
$390.60 |
| Rate for Payer: Aetna of IA Commercial |
$390.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$390.60
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$325.50
|
| Rate for Payer: Medical Associates Commercial |
$325.50
|
| Rate for Payer: Midlands Choice Commercial |
$303.80
|
| Rate for Payer: United Healthcare Commercial |
$390.60
|
|
|
IMPLANT END CAP +10MM
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$390.60 |
| Rate for Payer: Aetna of IA Commercial |
$390.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$390.60
|
| Rate for Payer: Aetna of IA Medicare |
$247.38
|
| Rate for Payer: Amerigroup Medicaid |
$250.33
|
| Rate for Payer: Amerigroup Medicare |
$197.25
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$325.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$195.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$247.90
|
| Rate for Payer: Medical Associates Commercial |
$325.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$195.30
|
| Rate for Payer: Midlands Choice Commercial |
$303.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$251.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$224.60
|
| Rate for Payer: United Healthcare Commercial |
$390.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$256.06
|
|
|
IMPLANT FEMMORAL POSTERIOR STABILIZED
|
Facility
|
OP
|
$7,173.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,227.85 |
| Max. Negotiated Rate |
$6,455.70 |
| Rate for Payer: Aetna of IA Commercial |
$6,455.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,455.70
|
| Rate for Payer: Aetna of IA Medicare |
$4,088.61
|
| Rate for Payer: Amerigroup Medicaid |
$4,137.39
|
| Rate for Payer: Amerigroup Medicare |
$3,260.13
|
| Rate for Payer: Cash Price |
$5,738.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,379.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,227.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,097.22
|
| Rate for Payer: Medical Associates Commercial |
$5,379.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,227.85
|
| Rate for Payer: Midlands Choice Commercial |
$5,021.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,157.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,712.03
|
| Rate for Payer: United Healthcare Commercial |
$6,455.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,232.07
|
|
|
IMPLANT FEMMORAL POSTERIOR STABILIZED
|
Facility
|
IP
|
$7,173.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,021.10 |
| Max. Negotiated Rate |
$6,455.70 |
| Rate for Payer: Aetna of IA Commercial |
$6,455.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,455.70
|
| Rate for Payer: Cash Price |
$5,738.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,379.75
|
| Rate for Payer: Medical Associates Commercial |
$5,379.75
|
| Rate for Payer: Midlands Choice Commercial |
$5,021.10
|
| Rate for Payer: United Healthcare Commercial |
$6,455.70
|
|
|
IMPLANT FIBERLOOP
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of IA Commercial |
$73.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.80
|
| Rate for Payer: Aetna of IA Medicare |
$46.74
|
| Rate for Payer: Amerigroup Medicaid |
$47.30
|
| Rate for Payer: Amerigroup Medicare |
$37.27
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$46.84
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.90
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$47.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.44
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.38
|
|
|
IMPLANT FIBERLOOP
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of IA Commercial |
$73.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.50
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
|
|
IMPLANT FIBERSTICK
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna of IA Commercial |
$74.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$74.70
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$62.25
|
| Rate for Payer: Medical Associates Commercial |
$62.25
|
| Rate for Payer: Midlands Choice Commercial |
$58.10
|
| Rate for Payer: United Healthcare Commercial |
$74.70
|
|
|
IMPLANT FIBERSTICK
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.35 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna of IA Commercial |
$74.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$74.70
|
| Rate for Payer: Aetna of IA Medicare |
$47.31
|
| Rate for Payer: Amerigroup Medicaid |
$47.87
|
| Rate for Payer: Amerigroup Medicare |
$37.72
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$62.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$37.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.41
|
| Rate for Payer: Medical Associates Commercial |
$62.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.35
|
| Rate for Payer: Midlands Choice Commercial |
$58.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$48.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.95
|
| Rate for Payer: United Healthcare Commercial |
$74.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.97
|
|
|
IMPLANT HIP BIPOLAR COMP. UNIV. HEAD
|
Facility
|
OP
|
$2,655.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.75 |
| Max. Negotiated Rate |
$2,389.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,389.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,389.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,513.35
|
| Rate for Payer: Amerigroup Medicaid |
$1,531.40
|
| Rate for Payer: Amerigroup Medicare |
$1,206.70
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,991.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,194.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,516.54
|
| Rate for Payer: Medical Associates Commercial |
$1,991.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,194.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,858.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,538.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,373.96
|
| Rate for Payer: United Healthcare Commercial |
$2,389.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,566.45
|
|
|
IMPLANT HIP BIPOLAR COMP. UNIV. HEAD
|
Facility
|
IP
|
$2,655.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,858.50 |
| Max. Negotiated Rate |
$2,389.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,389.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,389.50
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,991.25
|
| Rate for Payer: Medical Associates Commercial |
$1,991.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,858.50
|
| Rate for Payer: United Healthcare Commercial |
$2,389.50
|
|
|
IMPLANT HIP BONE PLUG ARTISAN SIZE L
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$193.90 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: Aetna of IA Commercial |
$249.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$249.30
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$207.75
|
| Rate for Payer: Medical Associates Commercial |
$207.75
|
| Rate for Payer: Midlands Choice Commercial |
$193.90
|
| Rate for Payer: United Healthcare Commercial |
$249.30
|
|
|
IMPLANT HIP BONE PLUG ARTISAN SIZE L
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.65 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: Aetna of IA Commercial |
$249.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$249.30
|
| Rate for Payer: Aetna of IA Medicare |
$157.89
|
| Rate for Payer: Amerigroup Medicaid |
$159.77
|
| Rate for Payer: Amerigroup Medicare |
$125.90
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$207.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$124.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$158.22
|
| Rate for Payer: Medical Associates Commercial |
$207.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$124.65
|
| Rate for Payer: Midlands Choice Commercial |
$193.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$160.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$143.35
|
| Rate for Payer: United Healthcare Commercial |
$249.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$163.43
|
|
