|
IMPLANT INSERT TIBIAL SIZE #6 CS 16MM
|
Facility
IP
|
$5,651.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8046875
|
|
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 #7 CS 11MM
|
Facility
IP
|
$5,651.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8026184
|
|
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 #7 CS 11MM
|
Facility
OP
|
$5,651.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8026184
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,824.37 |
| 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 |
$2,852.06
|
| Rate for Payer: Amerigroup Medicare |
$2,853.76
|
| 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 |
$2,825.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,824.37
|
| Rate for Payer: Medical Associates Commercial |
$4,238.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,825.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,955.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,867.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,238.25
|
| Rate for Payer: United Healthcare Commercial |
$5,085.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,334.09
|
|
|
IMPLANT INSERT TIBIAL SIZE #7 CS 13MM
|
Facility
IP
|
$5,651.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8026185
|
|
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 #7 CS 13MM
|
Facility
OP
|
$5,651.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8026185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,824.37 |
| 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 |
$2,852.06
|
| Rate for Payer: Amerigroup Medicare |
$2,853.76
|
| 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 |
$2,825.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,824.37
|
| Rate for Payer: Medical Associates Commercial |
$4,238.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,825.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,955.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,867.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,238.25
|
| Rate for Payer: United Healthcare Commercial |
$5,085.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,334.09
|
|
|
IMPLANT KNEE CRUCIATE RET FEMORAL SIZE 5
|
Facility
OP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,224.01 |
| 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 |
$6,285.03
|
| Rate for Payer: Amerigroup Medicare |
$6,288.76
|
| 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 |
$6,226.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,224.01
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$6,226.50
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,319.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$9,339.75
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT KNEE CRUCIATE RET FEMORAL SIZE 5
|
Facility
IP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046829
|
|
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 KNEE CRUCIATE RET FEMORAL SIZE 6
|
Facility
OP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,224.01 |
| 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 |
$6,285.03
|
| Rate for Payer: Amerigroup Medicare |
$6,288.76
|
| 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 |
$6,226.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,224.01
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$6,226.50
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,319.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$9,339.75
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT KNEE CRUCIATE RET FEMORAL SIZE 6
|
Facility
IP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046830
|
|
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 KNEE FEMORAL SIZE 4
|
Facility
IP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046827
|
|
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 KNEE FEMORAL SIZE 4
|
Facility
OP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,224.01 |
| 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 |
$6,285.03
|
| Rate for Payer: Amerigroup Medicare |
$6,288.76
|
| 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 |
$6,226.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,224.01
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$6,226.50
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,319.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$9,339.75
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT KNEE FEMORAL SIZE 5
|
Facility
IP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046835
|
|
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 KNEE FEMORAL SIZE 5
|
Facility
OP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,224.01 |
| 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 |
$6,285.03
|
| Rate for Payer: Amerigroup Medicare |
$6,288.76
|
| 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 |
$6,226.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,224.01
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$6,226.50
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,319.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$9,339.75
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT KNEE FEMORAL SIZE 6
|
Facility
OP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,224.01 |
| 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 |
$6,285.03
|
| Rate for Payer: Amerigroup Medicare |
$6,288.76
|
| 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 |
$6,226.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,224.01
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$6,226.50
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,319.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$9,339.75
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT KNEE FEMORAL SIZE 6
|
Facility
IP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046831
|
|
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 KNEE FEMORAL SIZE 7
|
Facility
OP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,224.01 |
| 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 |
$6,285.03
|
| Rate for Payer: Amerigroup Medicare |
$6,288.76
|
| 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 |
$6,226.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,224.01
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$6,226.50
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,319.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$9,339.75
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT KNEE FEMORAL SIZE 7
|
Facility
IP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046832
|
|
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 KNEE FEMORAL SIZE 7 LFT
|
Facility
OP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,224.01 |
| 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 |
$6,285.03
|
| Rate for Payer: Amerigroup Medicare |
$6,288.76
|
| 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 |
$6,226.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,224.01
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$6,226.50
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,319.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$9,339.75
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT KNEE FEMORAL SIZE 7 LFT
|
Facility
IP
|
$12,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026179
|
|
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 KNEE PATELLA A29
|
Facility
OP
|
$2,986.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,492.40 |
| Max. Negotiated Rate |
$2,687.40 |
| Rate for Payer: Aetna of IA Commercial |
$2,687.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,687.40
|
| Rate for Payer: Aetna of IA Medicare |
$1,702.02
|
| Rate for Payer: Amerigroup Medicaid |
$1,507.03
|
| Rate for Payer: Amerigroup Medicare |
$1,507.93
|
| Rate for Payer: Cash Price |
$2,388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,239.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,493.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,492.40
|
| Rate for Payer: Medical Associates Commercial |
$2,239.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,493.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,090.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,515.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,239.50
|
| Rate for Payer: United Healthcare Commercial |
$2,687.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,761.74
|
|
|
IMPLANT KNEE PATELLA A29
|
Facility
IP
|
$2,986.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.20 |
| Max. Negotiated Rate |
$2,687.40 |
| Rate for Payer: Aetna of IA Commercial |
$2,687.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,687.40
|
| Rate for Payer: Cash Price |
$2,388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,239.50
|
| Rate for Payer: Medical Associates Commercial |
$2,239.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,090.20
|
| Rate for Payer: United Healthcare Commercial |
$2,687.40
|
|
|
IMPLANT KNEE PATELLA A32
|
Facility
IP
|
$2,986.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.20 |
| Max. Negotiated Rate |
$2,687.40 |
| Rate for Payer: Aetna of IA Commercial |
$2,687.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,687.40
|
| Rate for Payer: Cash Price |
$2,388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,239.50
|
| Rate for Payer: Medical Associates Commercial |
$2,239.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,090.20
|
| Rate for Payer: United Healthcare Commercial |
$2,687.40
|
|
|
IMPLANT KNEE PATELLA A32
|
Facility
OP
|
$2,986.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,492.40 |
| Max. Negotiated Rate |
$2,687.40 |
| Rate for Payer: Aetna of IA Commercial |
$2,687.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,687.40
|
| Rate for Payer: Aetna of IA Medicare |
$1,702.02
|
| Rate for Payer: Amerigroup Medicaid |
$1,507.03
|
| Rate for Payer: Amerigroup Medicare |
$1,507.93
|
| Rate for Payer: Cash Price |
$2,388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,239.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,493.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,492.40
|
| Rate for Payer: Medical Associates Commercial |
$2,239.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,493.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,090.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,515.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,239.50
|
| Rate for Payer: United Healthcare Commercial |
$2,687.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,761.74
|
|
|
IMPLANT KNEE PATELLA A35
|
Facility
OP
|
$2,986.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,492.40 |
| Max. Negotiated Rate |
$2,687.40 |
| Rate for Payer: Aetna of IA Commercial |
$2,687.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,687.40
|
| Rate for Payer: Aetna of IA Medicare |
$1,702.02
|
| Rate for Payer: Amerigroup Medicaid |
$1,507.03
|
| Rate for Payer: Amerigroup Medicare |
$1,507.93
|
| Rate for Payer: Cash Price |
$2,388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,239.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,493.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,492.40
|
| Rate for Payer: Medical Associates Commercial |
$2,239.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,493.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,090.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,515.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,239.50
|
| Rate for Payer: United Healthcare Commercial |
$2,687.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,761.74
|
|
|
IMPLANT KNEE PATELLA A35
|
Facility
IP
|
$2,986.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.20 |
| Max. Negotiated Rate |
$2,687.40 |
| Rate for Payer: Aetna of IA Commercial |
$2,687.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,687.40
|
| Rate for Payer: Cash Price |
$2,388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,239.50
|
| Rate for Payer: Medical Associates Commercial |
$2,239.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,090.20
|
| Rate for Payer: United Healthcare Commercial |
$2,687.40
|
|
