|
IMPLANT HIP BONE PLUG ARTISAN SIZE M
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna of IA Commercial |
$259.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$259.20
|
| Rate for Payer: Aetna of IA Medicare |
$164.16
|
| Rate for Payer: Amerigroup Medicaid |
$166.12
|
| Rate for Payer: Amerigroup Medicare |
$130.90
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$216.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$129.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$164.51
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$129.60
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$166.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$149.04
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$169.92
|
|
|
IMPLANT HIP BONE PLUG ARTISAN SIZE M
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna of IA Commercial |
$259.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$259.20
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$216.00
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
|
|
IMPLANT HIP BONE PLUG HOWMEDICA
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8026246
|
|
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
|
|
|
IMPLANT HIP BONE PLUG HOWMEDICA
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8026246
|
|
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 HOWMEDICA SMALL
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8026245
|
|
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 HOWMEDICA SMALL
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8026245
|
|
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
|
|
|
IMPLANT HIP CEMENTED STEM
|
Facility
|
OP
|
$7,722.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,474.90 |
| Max. Negotiated Rate |
$6,949.80 |
| Rate for Payer: Aetna of IA Commercial |
$6,949.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,949.80
|
| Rate for Payer: Aetna of IA Medicare |
$4,401.54
|
| Rate for Payer: Amerigroup Medicaid |
$4,454.05
|
| Rate for Payer: Amerigroup Medicare |
$3,509.65
|
| Rate for Payer: Cash Price |
$6,177.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,791.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,474.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,410.81
|
| Rate for Payer: Medical Associates Commercial |
$5,791.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,474.90
|
| Rate for Payer: Midlands Choice Commercial |
$5,405.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,475.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,996.14
|
| Rate for Payer: United Healthcare Commercial |
$6,949.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,555.98
|
|
|
IMPLANT HIP CEMENTED STEM
|
Facility
|
IP
|
$7,722.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,405.40 |
| Max. Negotiated Rate |
$6,949.80 |
| Rate for Payer: Aetna of IA Commercial |
$6,949.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,949.80
|
| Rate for Payer: Cash Price |
$6,177.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,791.50
|
| Rate for Payer: Medical Associates Commercial |
$5,791.50
|
| Rate for Payer: Midlands Choice Commercial |
$5,405.40
|
| Rate for Payer: United Healthcare Commercial |
$6,949.80
|
|
|
IMPLANT HIP CEMENTED STEM ACCOLADE 132
|
Facility
|
OP
|
$7,227.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.15 |
| Max. Negotiated Rate |
$6,504.30 |
| Rate for Payer: Aetna of IA Commercial |
$6,504.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,504.30
|
| Rate for Payer: Aetna of IA Medicare |
$4,119.39
|
| Rate for Payer: Amerigroup Medicaid |
$4,168.53
|
| Rate for Payer: Amerigroup Medicare |
$3,284.67
|
| Rate for Payer: Cash Price |
$5,781.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,420.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,252.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,128.06
|
| Rate for Payer: Medical Associates Commercial |
$5,420.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,252.15
|
| Rate for Payer: Midlands Choice Commercial |
$5,058.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,188.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,739.97
|
| Rate for Payer: United Healthcare Commercial |
$6,504.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,263.93
|
|
|
IMPLANT HIP CEMENTED STEM ACCOLADE 132
|
Facility
|
IP
|
$7,227.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,058.90 |
| Max. Negotiated Rate |
$6,504.30 |
| Rate for Payer: Aetna of IA Commercial |
$6,504.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,504.30
|
| Rate for Payer: Cash Price |
$5,781.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,420.25
|
| Rate for Payer: Medical Associates Commercial |
$5,420.25
|
| Rate for Payer: Midlands Choice Commercial |
$5,058.90
|
| Rate for Payer: United Healthcare Commercial |
$6,504.30
|
|
|
IMPLANT HIP COCR LFIT HEAD 26MM/-3
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8026251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$828.00 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,656.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,656.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,048.80
|
| Rate for Payer: Amerigroup Medicaid |
$1,061.31
|
| Rate for Payer: Amerigroup Medicare |
$836.28
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,380.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$828.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,051.01
|
| Rate for Payer: Medical Associates Commercial |
$1,380.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$828.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,288.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,066.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$952.20
|
| Rate for Payer: United Healthcare Commercial |
$1,656.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,085.60
|
|
|
IMPLANT HIP COCR LFIT HEAD 26MM/-3
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8026251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,288.00 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,656.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,656.00
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,380.00
|
| Rate for Payer: Medical Associates Commercial |
$1,380.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,288.00
|
| Rate for Payer: United Healthcare Commercial |
$1,656.00
|
|
|
IMPLANT HUMERAL NAIL CANNULA
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,620.00 |
| Max. Negotiated Rate |
$3,240.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,240.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,240.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,052.00
|
| Rate for Payer: Amerigroup Medicaid |
$2,076.48
|
| Rate for Payer: Amerigroup Medicare |
$1,636.20
|
| Rate for Payer: Cash Price |
$2,880.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,700.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,620.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,056.32
|
| Rate for Payer: Medical Associates Commercial |
$2,700.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,620.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,520.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,086.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,863.00
|
| Rate for Payer: United Healthcare Commercial |
$3,240.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,124.00
|
|
|
IMPLANT HUMERAL NAIL CANNULA
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8026237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,520.00 |
| Max. Negotiated Rate |
$3,240.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,240.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,240.00
|
| Rate for Payer: Cash Price |
$2,880.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,700.00
|
| Rate for Payer: Medical Associates Commercial |
$2,700.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,520.00
|
| Rate for Payer: United Healthcare Commercial |
$3,240.00
|
|
|
IMPLANT INSERT TIBIAL #6
|
Facility
|
OP
|
$3,864.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,738.80 |
| Max. Negotiated Rate |
$3,477.60 |
| Rate for Payer: Aetna of IA Commercial |
$3,477.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,477.60
|
| Rate for Payer: Aetna of IA Medicare |
$2,202.48
|
| Rate for Payer: Amerigroup Medicaid |
$2,228.76
|
| Rate for Payer: Amerigroup Medicare |
$1,756.19
|
| Rate for Payer: Cash Price |
$3,091.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,898.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,738.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,207.12
|
| Rate for Payer: Medical Associates Commercial |
$2,898.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,738.80
|
| Rate for Payer: Midlands Choice Commercial |
$2,704.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,239.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,999.62
|
| Rate for Payer: United Healthcare Commercial |
$3,477.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,279.76
|
|
|
IMPLANT INSERT TIBIAL #6
|
Facility
|
IP
|
$3,864.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,704.80 |
| Max. Negotiated Rate |
$3,477.60 |
| Rate for Payer: Aetna of IA Commercial |
$3,477.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,477.60
|
| Rate for Payer: Cash Price |
$3,091.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,898.00
|
| Rate for Payer: Medical Associates Commercial |
$2,898.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,704.80
|
| Rate for Payer: United Healthcare Commercial |
$3,477.60
|
|
|
IMPLANT INSERT TIBIAL SIZE #3
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
8046866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,955.70 |
| Max. Negotiated Rate |
$5,085.90 |
| Rate for Payer: Aetna of IA Commercial |
$5,085.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,085.90
|
| Rate for Payer: Cash Price |
$4,520.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,238.25
|
| Rate for Payer: Medical Associates Commercial |
$4,238.25
|
| Rate for Payer: Midlands Choice Commercial |
$3,955.70
|
| Rate for Payer: United Healthcare Commercial |
$5,085.90
|
|
|
IMPLANT INSERT TIBIAL SIZE #3
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
8046866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.95 |
| Max. Negotiated Rate |
$5,085.90 |
| Rate for Payer: Aetna of IA Commercial |
$5,085.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,085.90
|
| Rate for Payer: Aetna of IA Medicare |
$3,221.07
|
| Rate for Payer: Amerigroup Medicaid |
$3,259.50
|
| Rate for Payer: Amerigroup Medicare |
$2,568.38
|
| Rate for Payer: Cash Price |
$4,520.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,238.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,542.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,227.85
|
| Rate for Payer: Medical Associates Commercial |
$4,238.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,542.95
|
| Rate for Payer: Midlands Choice Commercial |
$3,955.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,275.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,924.39
|
| Rate for Payer: United Healthcare Commercial |
$5,085.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,334.09
|
|
|
IMPLANT INSERT TIBIAL SIZE #3 13MM
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
8046867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.95 |
| Max. Negotiated Rate |
$5,085.90 |
| Rate for Payer: Aetna of IA Commercial |
$5,085.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,085.90
|
| Rate for Payer: Aetna of IA Medicare |
$3,221.07
|
| Rate for Payer: Amerigroup Medicaid |
$3,259.50
|
| Rate for Payer: Amerigroup Medicare |
$2,568.38
|
| Rate for Payer: Cash Price |
$4,520.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,238.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,542.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,227.85
|
| Rate for Payer: Medical Associates Commercial |
$4,238.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,542.95
|
| Rate for Payer: Midlands Choice Commercial |
$3,955.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,275.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,924.39
|
| Rate for Payer: United Healthcare Commercial |
$5,085.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,334.09
|
|
|
IMPLANT INSERT TIBIAL SIZE #3 13MM
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
8046867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,955.70 |
| Max. Negotiated Rate |
$5,085.90 |
| Rate for Payer: Aetna of IA Commercial |
$5,085.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,085.90
|
| Rate for Payer: Cash Price |
$4,520.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,238.25
|
| Rate for Payer: Medical Associates Commercial |
$4,238.25
|
| Rate for Payer: Midlands Choice Commercial |
$3,955.70
|
| Rate for Payer: United Healthcare Commercial |
$5,085.90
|
|
|
IMPLANT INSERT TIBIAL SIZE #3 16MM
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
8046868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,955.70 |
| Max. Negotiated Rate |
$5,085.90 |
| Rate for Payer: Aetna of IA Commercial |
$5,085.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,085.90
|
| Rate for Payer: Cash Price |
$4,520.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,238.25
|
| Rate for Payer: Medical Associates Commercial |
$4,238.25
|
| Rate for Payer: Midlands Choice Commercial |
$3,955.70
|
| Rate for Payer: United Healthcare Commercial |
$5,085.90
|
|
|
IMPLANT INSERT TIBIAL SIZE #3 16MM
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
8046868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.95 |
| Max. Negotiated Rate |
$5,085.90 |
| Rate for Payer: Aetna of IA Commercial |
$5,085.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,085.90
|
| Rate for Payer: Aetna of IA Medicare |
$3,221.07
|
| Rate for Payer: Amerigroup Medicaid |
$3,259.50
|
| Rate for Payer: Amerigroup Medicare |
$2,568.38
|
| Rate for Payer: Cash Price |
$4,520.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,238.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,542.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,227.85
|
| Rate for Payer: Medical Associates Commercial |
$4,238.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,542.95
|
| Rate for Payer: Midlands Choice Commercial |
$3,955.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,275.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,924.39
|
| Rate for Payer: United Healthcare Commercial |
$5,085.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,334.09
|
|
|
IMPLANT INSERT TIBIAL SIZE #4 13MM
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
8046870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,955.70 |
| Max. Negotiated Rate |
$5,085.90 |
| Rate for Payer: Aetna of IA Commercial |
$5,085.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,085.90
|
| Rate for Payer: Cash Price |
$4,520.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,238.25
|
| Rate for Payer: Medical Associates Commercial |
$4,238.25
|
| Rate for Payer: Midlands Choice Commercial |
$3,955.70
|
| Rate for Payer: United Healthcare Commercial |
$5,085.90
|
|
|
IMPLANT INSERT TIBIAL SIZE #4 13MM
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
8046870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.95 |
| Max. Negotiated Rate |
$5,085.90 |
| Rate for Payer: Aetna of IA Commercial |
$5,085.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,085.90
|
| Rate for Payer: Aetna of IA Medicare |
$3,221.07
|
| Rate for Payer: Amerigroup Medicaid |
$3,259.50
|
| Rate for Payer: Amerigroup Medicare |
$2,568.38
|
| Rate for Payer: Cash Price |
$4,520.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,238.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,542.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,227.85
|
| Rate for Payer: Medical Associates Commercial |
$4,238.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,542.95
|
| Rate for Payer: Midlands Choice Commercial |
$3,955.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,275.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,924.39
|
| Rate for Payer: United Healthcare Commercial |
$5,085.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,334.09
|
|
|
IMPLANT INSERT TIBIAL SIZE #4 16MM
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
8046871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,955.70 |
| Max. Negotiated Rate |
$5,085.90 |
| Rate for Payer: Aetna of IA Commercial |
$5,085.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,085.90
|
| Rate for Payer: Cash Price |
$4,520.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,238.25
|
| Rate for Payer: Medical Associates Commercial |
$4,238.25
|
| Rate for Payer: Midlands Choice Commercial |
$3,955.70
|
| Rate for Payer: United Healthcare Commercial |
$5,085.90
|
|
