|
Abortion Without D&C
|
Facility
IP
|
$4,832.62
|
|
|
Service Code
|
MS-DRG 779
|
| Hospital Charge Code |
524
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$4,832.62 |
| Rate for Payer: Amerigroup Medicaid |
$4,809.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,762.58
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,832.62
|
|
|
acarbose 100 mg Tab
|
Facility
IP
|
$2.09
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700154
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna of IA Commercial |
$1.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.88
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.57
|
| Rate for Payer: Medical Associates Commercial |
$1.57
|
| Rate for Payer: Midlands Choice Commercial |
$1.46
|
| Rate for Payer: United Healthcare Commercial |
$1.88
|
|
|
acarbose 100 mg Tab
|
Facility
OP
|
$2.09
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700154
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna of IA Commercial |
$1.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.88
|
| Rate for Payer: Aetna of IA Medicare |
$1.19
|
| Rate for Payer: Amerigroup Medicaid |
$1.05
|
| Rate for Payer: Amerigroup Medicare |
$1.06
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.57
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.04
|
| Rate for Payer: Medical Associates Commercial |
$1.57
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.04
|
| Rate for Payer: Midlands Choice Commercial |
$1.46
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.57
|
| Rate for Payer: United Healthcare Commercial |
$1.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.23
|
|
|
ACCESSORY KIT FOR INTELLIS ADAPTIVESTIM
|
Facility
OP
|
$94.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8557556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of IA Commercial |
$84.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$84.60
|
| Rate for Payer: Aetna of IA Medicare |
$53.58
|
| Rate for Payer: Amerigroup Medicaid |
$47.44
|
| Rate for Payer: Amerigroup Medicare |
$47.47
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$70.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$47.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$46.98
|
| Rate for Payer: Medical Associates Commercial |
$70.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.00
|
| Rate for Payer: Midlands Choice Commercial |
$65.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$47.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$70.50
|
| Rate for Payer: United Healthcare Commercial |
$84.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$55.46
|
|
|
ACCESSORY KIT FOR INTELLIS ADAPTIVESTIM
|
Facility
IP
|
$94.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8557556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of IA Commercial |
$84.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$84.60
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$70.50
|
| Rate for Payer: Medical Associates Commercial |
$70.50
|
| Rate for Payer: Midlands Choice Commercial |
$65.80
|
| Rate for Payer: United Healthcare Commercial |
$84.60
|
|
|
acellular dermal graft 15mm x 140mm x1.5
|
Facility
IP
|
$3,859.00
|
|
|
Service Code
|
CPT Q4100
|
| Hospital Charge Code |
8832409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,701.30 |
| Max. Negotiated Rate |
$3,473.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,473.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,473.10
|
| Rate for Payer: Cash Price |
$3,087.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,894.25
|
| Rate for Payer: Medical Associates Commercial |
$2,894.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,701.30
|
| Rate for Payer: United Healthcare Commercial |
$3,473.10
|
|
|
acellular dermal graft 15mm x 140mm x1.5
|
Facility
OP
|
$3,859.00
|
|
|
Service Code
|
CPT Q4100
|
| Hospital Charge Code |
8832409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,881.08 |
| Max. Negotiated Rate |
$3,473.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,473.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,473.10
|
| Rate for Payer: Aetna of IA Medicare |
$2,199.63
|
| Rate for Payer: Amerigroup Medicaid |
$1,947.64
|
| Rate for Payer: Amerigroup Medicare |
$1,948.80
|
| Rate for Payer: Cash Price |
$3,087.20
|
| Rate for Payer: Cash Price |
$3,087.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,894.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,929.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,928.73
|
| Rate for Payer: Medical Associates Commercial |
$2,894.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,929.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,701.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,958.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,894.25
|
| Rate for Payer: United Healthcare Commercial |
$3,473.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,276.81
|
| Rate for Payer: Wellmark IA HMO |
$1,881.08
|
| Rate for Payer: Wellmark IA PPO |
$2,069.19
|
|
|
ACETABULAR DOME HOLE PLUG
|
Facility
OP
|
$269.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.45 |
| Max. Negotiated Rate |
$242.10 |
| Rate for Payer: Aetna of IA Commercial |
$242.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$242.10
|
| Rate for Payer: Aetna of IA Medicare |
$153.33
|
| Rate for Payer: Amerigroup Medicaid |
$135.76
|
| Rate for Payer: Amerigroup Medicare |
$135.84
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$201.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$134.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$134.45
|
| Rate for Payer: Medical Associates Commercial |
$201.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$134.50
|
| Rate for Payer: Midlands Choice Commercial |
$188.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$136.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$201.75
|
| Rate for Payer: United Healthcare Commercial |
$242.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$158.71
|
|
|
ACETABULAR DOME HOLE PLUG
|
Facility
IP
|
$269.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.30 |
| Max. Negotiated Rate |
$242.10 |
| Rate for Payer: Aetna of IA Commercial |
$242.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$242.10
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$201.75
|
| Rate for Payer: Medical Associates Commercial |
$201.75
|
| Rate for Payer: Midlands Choice Commercial |
$188.30
|
| Rate for Payer: United Healthcare Commercial |
$242.10
|
|
|
ACETABULAR SHELL 54MM
|
Facility
IP
|
$4,358.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,050.60 |
| Max. Negotiated Rate |
$3,922.20 |
| Rate for Payer: Aetna of IA Commercial |
$3,922.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,922.20
|
| Rate for Payer: Cash Price |
$3,486.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,268.50
|
| Rate for Payer: Medical Associates Commercial |
$3,268.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,050.60
|
| Rate for Payer: United Healthcare Commercial |
$3,922.20
|
|
|
ACETABULAR SHELL 54MM
|
Facility
OP
|
$4,358.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,178.13 |
| Max. Negotiated Rate |
$3,922.20 |
| Rate for Payer: Aetna of IA Commercial |
$3,922.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,922.20
|
| Rate for Payer: Aetna of IA Medicare |
$2,484.06
|
| Rate for Payer: Amerigroup Medicaid |
$2,199.48
|
| Rate for Payer: Amerigroup Medicare |
$2,200.79
|
| Rate for Payer: Cash Price |
$3,486.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,268.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,179.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,178.13
|
| Rate for Payer: Medical Associates Commercial |
$3,268.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,179.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,050.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,211.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,268.50
|
| Rate for Payer: United Healthcare Commercial |
$3,922.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,571.22
|
|
|
ACETABULAR SHELL 54MM CLUSTER F
|
Facility
OP
|
$4,334.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046820
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,166.13 |
| Max. Negotiated Rate |
$3,900.60 |
| Rate for Payer: Aetna of IA Commercial |
$3,900.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,900.60
|
| Rate for Payer: Aetna of IA Medicare |
$2,470.38
|
| Rate for Payer: Amerigroup Medicaid |
$2,187.37
|
| Rate for Payer: Amerigroup Medicare |
$2,188.67
|
| Rate for Payer: Cash Price |
$3,467.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,250.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,167.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,166.13
|
| Rate for Payer: Medical Associates Commercial |
$3,250.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,167.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,033.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,199.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,250.50
|
| Rate for Payer: United Healthcare Commercial |
$3,900.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,557.06
|
|
|
ACETABULAR SHELL 54MM CLUSTER F
|
Facility
IP
|
$4,334.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046820
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,033.80 |
| Max. Negotiated Rate |
$3,900.60 |
| Rate for Payer: Aetna of IA Commercial |
$3,900.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,900.60
|
| Rate for Payer: Cash Price |
$3,467.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,250.50
|
| Rate for Payer: Medical Associates Commercial |
$3,250.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,033.80
|
| Rate for Payer: United Healthcare Commercial |
$3,900.60
|
|
|
ACETABULAR SHELL 56MM CLUSTER
|
Facility
IP
|
$4,334.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,033.80 |
| Max. Negotiated Rate |
$3,900.60 |
| Rate for Payer: Aetna of IA Commercial |
$3,900.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,900.60
|
| Rate for Payer: Cash Price |
$3,467.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,250.50
|
| Rate for Payer: Medical Associates Commercial |
$3,250.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,033.80
|
| Rate for Payer: United Healthcare Commercial |
$3,900.60
|
|
|
ACETABULAR SHELL 56MM CLUSTER
|
Facility
OP
|
$4,334.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,166.13 |
| Max. Negotiated Rate |
$3,900.60 |
| Rate for Payer: Aetna of IA Commercial |
$3,900.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,900.60
|
| Rate for Payer: Aetna of IA Medicare |
$2,470.38
|
| Rate for Payer: Amerigroup Medicaid |
$2,187.37
|
| Rate for Payer: Amerigroup Medicare |
$2,188.67
|
| Rate for Payer: Cash Price |
$3,467.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,250.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,167.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,166.13
|
| Rate for Payer: Medical Associates Commercial |
$3,250.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,167.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,033.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,199.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,250.50
|
| Rate for Payer: United Healthcare Commercial |
$3,900.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,557.06
|
|
|
ACETABULAR SHELL 58MM CLUSTER
|
Facility
OP
|
$4,334.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,166.13 |
| Max. Negotiated Rate |
$3,900.60 |
| Rate for Payer: Aetna of IA Commercial |
$3,900.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,900.60
|
| Rate for Payer: Aetna of IA Medicare |
$2,470.38
|
| Rate for Payer: Amerigroup Medicaid |
$2,187.37
|
| Rate for Payer: Amerigroup Medicare |
$2,188.67
|
| Rate for Payer: Cash Price |
$3,467.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,250.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,167.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,166.13
|
| Rate for Payer: Medical Associates Commercial |
$3,250.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,167.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,033.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,199.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,250.50
|
| Rate for Payer: United Healthcare Commercial |
$3,900.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,557.06
|
|
|
ACETABULAR SHELL 58MM CLUSTER
|
Facility
IP
|
$4,334.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,033.80 |
| Max. Negotiated Rate |
$3,900.60 |
| Rate for Payer: Aetna of IA Commercial |
$3,900.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,900.60
|
| Rate for Payer: Cash Price |
$3,467.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,250.50
|
| Rate for Payer: Medical Associates Commercial |
$3,250.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,033.80
|
| Rate for Payer: United Healthcare Commercial |
$3,900.60
|
|
|
ACETABULAR SHELL 60MM CLUSTER
|
Facility
OP
|
$4,473.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,235.61 |
| Max. Negotiated Rate |
$4,025.70 |
| Rate for Payer: Aetna of IA Commercial |
$4,025.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,025.70
|
| Rate for Payer: Aetna of IA Medicare |
$2,549.61
|
| Rate for Payer: Amerigroup Medicaid |
$2,257.52
|
| Rate for Payer: Amerigroup Medicare |
$2,258.86
|
| Rate for Payer: Cash Price |
$3,578.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,354.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,236.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,235.61
|
| Rate for Payer: Medical Associates Commercial |
$3,354.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,236.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,131.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,270.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,354.75
|
| Rate for Payer: United Healthcare Commercial |
$4,025.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,639.07
|
|
|
ACETABULAR SHELL 60MM CLUSTER
|
Facility
IP
|
$4,473.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,131.10 |
| Max. Negotiated Rate |
$4,025.70 |
| Rate for Payer: Aetna of IA Commercial |
$4,025.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,025.70
|
| Rate for Payer: Cash Price |
$3,578.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,354.75
|
| Rate for Payer: Medical Associates Commercial |
$3,354.75
|
| Rate for Payer: Midlands Choice Commercial |
$3,131.10
|
| Rate for Payer: United Healthcare Commercial |
$4,025.70
|
|
|
ACETABULARSHELL SOLID BACK 58MM
|
Facility
IP
|
$4,358.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,050.60 |
| Max. Negotiated Rate |
$3,922.20 |
| Rate for Payer: Aetna of IA Commercial |
$3,922.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,922.20
|
| Rate for Payer: Cash Price |
$3,486.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,268.50
|
| Rate for Payer: Medical Associates Commercial |
$3,268.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,050.60
|
| Rate for Payer: United Healthcare Commercial |
$3,922.20
|
|
|
ACETABULARSHELL SOLID BACK 58MM
|
Facility
OP
|
$4,358.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,178.13 |
| Max. Negotiated Rate |
$3,922.20 |
| Rate for Payer: Aetna of IA Commercial |
$3,922.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,922.20
|
| Rate for Payer: Aetna of IA Medicare |
$2,484.06
|
| Rate for Payer: Amerigroup Medicaid |
$2,199.48
|
| Rate for Payer: Amerigroup Medicare |
$2,200.79
|
| Rate for Payer: Cash Price |
$3,486.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,268.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,179.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,178.13
|
| Rate for Payer: Medical Associates Commercial |
$3,268.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,179.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,050.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,211.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,268.50
|
| Rate for Payer: United Healthcare Commercial |
$3,922.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,571.22
|
|
|
ACETABULAR SHELL SYSTEM
|
Facility
IP
|
$4,230.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,961.00 |
| Max. Negotiated Rate |
$3,807.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,807.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,807.00
|
| Rate for Payer: Cash Price |
$3,384.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,172.50
|
| Rate for Payer: Medical Associates Commercial |
$3,172.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,961.00
|
| Rate for Payer: United Healthcare Commercial |
$3,807.00
|
|
|
ACETABULAR SHELL SYSTEM
|
Facility
OP
|
$4,230.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,114.15 |
| Max. Negotiated Rate |
$3,807.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,807.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,807.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,411.10
|
| Rate for Payer: Amerigroup Medicaid |
$2,134.88
|
| Rate for Payer: Amerigroup Medicare |
$2,136.15
|
| Rate for Payer: Cash Price |
$3,384.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,172.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,115.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,114.15
|
| Rate for Payer: Medical Associates Commercial |
$3,172.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,115.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,961.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,146.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,172.50
|
| Rate for Payer: United Healthcare Commercial |
$3,807.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,495.70
|
|
|
ACETABULAR SHELL SYSTEM-50E
|
Facility
OP
|
$4,358.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,178.13 |
| Max. Negotiated Rate |
$3,922.20 |
| Rate for Payer: Aetna of IA Commercial |
$3,922.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,922.20
|
| Rate for Payer: Aetna of IA Medicare |
$2,484.06
|
| Rate for Payer: Amerigroup Medicaid |
$2,199.48
|
| Rate for Payer: Amerigroup Medicare |
$2,200.79
|
| Rate for Payer: Cash Price |
$3,486.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,268.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,179.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,178.13
|
| Rate for Payer: Medical Associates Commercial |
$3,268.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,179.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,050.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,211.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,268.50
|
| Rate for Payer: United Healthcare Commercial |
$3,922.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,571.22
|
|
|
ACETABULAR SHELL SYSTEM-50E
|
Facility
IP
|
$4,358.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,050.60 |
| Max. Negotiated Rate |
$3,922.20 |
| Rate for Payer: Aetna of IA Commercial |
$3,922.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,922.20
|
| Rate for Payer: Cash Price |
$3,486.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,268.50
|
| Rate for Payer: Medical Associates Commercial |
$3,268.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,050.60
|
| Rate for Payer: United Healthcare Commercial |
$3,922.20
|
|
