|
IMPLANT KNEE PATELLA A38 11MM
|
Facility
OP
|
$2,986.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026198
|
|
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 A38 11MM
|
Facility
IP
|
$2,986.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026198
|
|
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 A40 11MM
|
Facility
IP
|
$2,986.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046883
|
|
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 A40 11MM
|
Facility
OP
|
$2,986.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046883
|
|
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 TIBAL BASEPLATE #8
|
Facility
IP
|
$8,004.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,602.80 |
| Max. Negotiated Rate |
$7,203.60 |
| Rate for Payer: Aetna of IA Commercial |
$7,203.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,203.60
|
| Rate for Payer: Cash Price |
$6,403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,003.00
|
| Rate for Payer: Medical Associates Commercial |
$6,003.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,602.80
|
| Rate for Payer: United Healthcare Commercial |
$7,203.60
|
|
|
IMPLANT KNEE TIBAL BASEPLATE #8
|
Facility
OP
|
$8,004.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,000.40 |
| Max. Negotiated Rate |
$7,203.60 |
| Rate for Payer: Aetna of IA Commercial |
$7,203.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,203.60
|
| Rate for Payer: Aetna of IA Medicare |
$4,562.28
|
| Rate for Payer: Amerigroup Medicaid |
$4,039.62
|
| Rate for Payer: Amerigroup Medicare |
$4,042.02
|
| Rate for Payer: Cash Price |
$6,403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,003.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4,002.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,000.40
|
| Rate for Payer: Medical Associates Commercial |
$6,003.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$4,002.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,602.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,062.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,003.00
|
| Rate for Payer: United Healthcare Commercial |
$7,203.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,722.36
|
|
|
IMPLANT KNEE TIBIAL AUGMENT HALF BLOCK
|
Facility
OP
|
$2,723.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,360.96 |
| Max. Negotiated Rate |
$2,450.70 |
| Rate for Payer: Aetna of IA Commercial |
$2,450.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,450.70
|
| Rate for Payer: Aetna of IA Medicare |
$1,552.11
|
| Rate for Payer: Amerigroup Medicaid |
$1,374.30
|
| Rate for Payer: Amerigroup Medicare |
$1,375.12
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,042.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,361.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,360.96
|
| Rate for Payer: Medical Associates Commercial |
$2,042.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,361.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,906.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,381.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,042.25
|
| Rate for Payer: United Healthcare Commercial |
$2,450.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,606.57
|
|
|
IMPLANT KNEE TIBIAL AUGMENT HALF BLOCK
|
Facility
IP
|
$2,723.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,906.10 |
| Max. Negotiated Rate |
$2,450.70 |
| Rate for Payer: Aetna of IA Commercial |
$2,450.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,450.70
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,042.25
|
| Rate for Payer: Medical Associates Commercial |
$2,042.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,906.10
|
| Rate for Payer: United Healthcare Commercial |
$2,450.70
|
|
|
IMPLANT KNEE TIBIAL BASEPLATE
|
Facility
IP
|
$8,004.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,602.80 |
| Max. Negotiated Rate |
$7,203.60 |
| Rate for Payer: Aetna of IA Commercial |
$7,203.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,203.60
|
| Rate for Payer: Cash Price |
$6,403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,003.00
|
| Rate for Payer: Medical Associates Commercial |
$6,003.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,602.80
|
| Rate for Payer: United Healthcare Commercial |
$7,203.60
|
|
|
IMPLANT KNEE TIBIAL BASEPLATE
|
Facility
OP
|
$8,004.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,000.40 |
| Max. Negotiated Rate |
$7,203.60 |
| Rate for Payer: Aetna of IA Commercial |
$7,203.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,203.60
|
| Rate for Payer: Aetna of IA Medicare |
$4,562.28
|
| Rate for Payer: Amerigroup Medicaid |
$4,039.62
|
| Rate for Payer: Amerigroup Medicare |
$4,042.02
|
| Rate for Payer: Cash Price |
$6,403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,003.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4,002.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,000.40
|
| Rate for Payer: Medical Associates Commercial |
$6,003.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$4,002.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,602.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,062.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,003.00
|
| Rate for Payer: United Healthcare Commercial |
$7,203.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,722.36
|
|
|
IMPLANT KNEE TIBIAL BASEPLATE #3
|
Facility
OP
|
$8,004.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046840
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,000.40 |
| Max. Negotiated Rate |
$7,203.60 |
| Rate for Payer: Aetna of IA Commercial |
$7,203.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,203.60
|
| Rate for Payer: Aetna of IA Medicare |
$4,562.28
|
| Rate for Payer: Amerigroup Medicaid |
$4,039.62
|
| Rate for Payer: Amerigroup Medicare |
$4,042.02
|
| Rate for Payer: Cash Price |
$6,403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,003.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4,002.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,000.40
|
| Rate for Payer: Medical Associates Commercial |
$6,003.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$4,002.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,602.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,062.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,003.00
|
| Rate for Payer: United Healthcare Commercial |
$7,203.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,722.36
|
|
|
IMPLANT KNEE TIBIAL BASEPLATE #3
|
Facility
IP
|
$8,004.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046840
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,602.80 |
| Max. Negotiated Rate |
$7,203.60 |
| Rate for Payer: Aetna of IA Commercial |
$7,203.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,203.60
|
| Rate for Payer: Cash Price |
$6,403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,003.00
|
| Rate for Payer: Medical Associates Commercial |
$6,003.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,602.80
|
| Rate for Payer: United Healthcare Commercial |
$7,203.60
|
|
|
IMPLANT KNEE TIBIAL BASEPLATE #4
|
Facility
OP
|
$8,004.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,000.40 |
| Max. Negotiated Rate |
$7,203.60 |
| Rate for Payer: Aetna of IA Commercial |
$7,203.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,203.60
|
| Rate for Payer: Aetna of IA Medicare |
$4,562.28
|
| Rate for Payer: Amerigroup Medicaid |
$4,039.62
|
| Rate for Payer: Amerigroup Medicare |
$4,042.02
|
| Rate for Payer: Cash Price |
$6,403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,003.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4,002.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,000.40
|
| Rate for Payer: Medical Associates Commercial |
$6,003.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$4,002.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,602.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,062.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,003.00
|
| Rate for Payer: United Healthcare Commercial |
$7,203.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,722.36
|
|
|
IMPLANT KNEE TIBIAL BASEPLATE #4
|
Facility
IP
|
$8,004.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,602.80 |
| Max. Negotiated Rate |
$7,203.60 |
| Rate for Payer: Aetna of IA Commercial |
$7,203.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,203.60
|
| Rate for Payer: Cash Price |
$6,403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,003.00
|
| Rate for Payer: Medical Associates Commercial |
$6,003.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,602.80
|
| Rate for Payer: United Healthcare Commercial |
$7,203.60
|
|
|
IMPLANT KNEE TIBIAL BASEPLATE #6
|
Facility
OP
|
$8,004.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,000.40 |
| Max. Negotiated Rate |
$7,203.60 |
| Rate for Payer: Aetna of IA Commercial |
$7,203.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,203.60
|
| Rate for Payer: Aetna of IA Medicare |
$4,562.28
|
| Rate for Payer: Amerigroup Medicaid |
$4,039.62
|
| Rate for Payer: Amerigroup Medicare |
$4,042.02
|
| Rate for Payer: Cash Price |
$6,403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,003.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4,002.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,000.40
|
| Rate for Payer: Medical Associates Commercial |
$6,003.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$4,002.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,602.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,062.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,003.00
|
| Rate for Payer: United Healthcare Commercial |
$7,203.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,722.36
|
|
|
IMPLANT KNEE TIBIAL BASEPLATE #6
|
Facility
IP
|
$8,004.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,602.80 |
| Max. Negotiated Rate |
$7,203.60 |
| Rate for Payer: Aetna of IA Commercial |
$7,203.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,203.60
|
| Rate for Payer: Cash Price |
$6,403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,003.00
|
| Rate for Payer: Medical Associates Commercial |
$6,003.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,602.80
|
| Rate for Payer: United Healthcare Commercial |
$7,203.60
|
|
|
IMPLANT KNEE TIBIAL BASEPLATE PRIMARY #7
|
Facility
IP
|
$8,004.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,602.80 |
| Max. Negotiated Rate |
$7,203.60 |
| Rate for Payer: Aetna of IA Commercial |
$7,203.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,203.60
|
| Rate for Payer: Cash Price |
$6,403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,003.00
|
| Rate for Payer: Medical Associates Commercial |
$6,003.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,602.80
|
| Rate for Payer: United Healthcare Commercial |
$7,203.60
|
|
|
IMPLANT KNEE TIBIAL BASEPLATE PRIMARY #7
|
Facility
OP
|
$8,004.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,000.40 |
| Max. Negotiated Rate |
$7,203.60 |
| Rate for Payer: Aetna of IA Commercial |
$7,203.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,203.60
|
| Rate for Payer: Aetna of IA Medicare |
$4,562.28
|
| Rate for Payer: Amerigroup Medicaid |
$4,039.62
|
| Rate for Payer: Amerigroup Medicare |
$4,042.02
|
| Rate for Payer: Cash Price |
$6,403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,003.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4,002.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,000.40
|
| Rate for Payer: Medical Associates Commercial |
$6,003.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$4,002.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,602.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,062.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,003.00
|
| Rate for Payer: United Healthcare Commercial |
$7,203.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,722.36
|
|
|
IMPLANT KNEE TIBIAL BEARING 7
|
Facility
OP
|
$4,892.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,445.02 |
| Max. Negotiated Rate |
$4,402.80 |
| Rate for Payer: Aetna of IA Commercial |
$4,402.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,402.80
|
| Rate for Payer: Aetna of IA Medicare |
$2,788.44
|
| Rate for Payer: Amerigroup Medicaid |
$2,468.99
|
| Rate for Payer: Amerigroup Medicare |
$2,470.46
|
| Rate for Payer: Cash Price |
$3,913.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,669.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,446.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,445.02
|
| Rate for Payer: Medical Associates Commercial |
$3,669.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,446.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,424.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,482.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,669.00
|
| Rate for Payer: United Healthcare Commercial |
$4,402.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,886.28
|
|
|
IMPLANT KNEE TIBIAL BEARING 7
|
Facility
IP
|
$4,892.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,424.40 |
| Max. Negotiated Rate |
$4,402.80 |
| Rate for Payer: Aetna of IA Commercial |
$4,402.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,402.80
|
| Rate for Payer: Cash Price |
$3,913.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,669.00
|
| Rate for Payer: Medical Associates Commercial |
$3,669.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,424.40
|
| Rate for Payer: United Healthcare Commercial |
$4,402.80
|
|
|
IMPLANT KNEE TIBIAL BEARING INSERT
|
Facility
IP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.70 |
| Max. Negotiated Rate |
$4,536.90 |
| Rate for Payer: Aetna of IA Commercial |
$4,536.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,536.90
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: United Healthcare Commercial |
$4,536.90
|
|
|
IMPLANT KNEE TIBIAL BEARING INSERT
|
Facility
OP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,519.49 |
| Max. Negotiated Rate |
$4,536.90 |
| Rate for Payer: Aetna of IA Commercial |
$4,536.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,536.90
|
| Rate for Payer: Aetna of IA Medicare |
$2,873.37
|
| Rate for Payer: Amerigroup Medicaid |
$2,544.19
|
| Rate for Payer: Amerigroup Medicare |
$2,545.70
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,780.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,520.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,519.49
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,520.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,558.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,780.75
|
| Rate for Payer: United Healthcare Commercial |
$4,536.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,974.19
|
|
|
IMPLANT KNEE TIBIAL BEARING INSERT-309
|
Facility
OP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,519.49 |
| Max. Negotiated Rate |
$4,536.90 |
| Rate for Payer: Aetna of IA Commercial |
$4,536.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,536.90
|
| Rate for Payer: Aetna of IA Medicare |
$2,873.37
|
| Rate for Payer: Amerigroup Medicaid |
$2,544.19
|
| Rate for Payer: Amerigroup Medicare |
$2,545.70
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,780.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,520.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,519.49
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,520.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,558.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,780.75
|
| Rate for Payer: United Healthcare Commercial |
$4,536.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,974.19
|
|
|
IMPLANT KNEE TIBIAL BEARING INSERT-309
|
Facility
IP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.70 |
| Max. Negotiated Rate |
$4,536.90 |
| Rate for Payer: Aetna of IA Commercial |
$4,536.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,536.90
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: United Healthcare Commercial |
$4,536.90
|
|
|
IMPLANT KNEE TIBIAL BEARING INSERT #3X11
|
Facility
OP
|
$4,892.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,445.02 |
| Max. Negotiated Rate |
$4,402.80 |
| Rate for Payer: Aetna of IA Commercial |
$4,402.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,402.80
|
| Rate for Payer: Aetna of IA Medicare |
$2,788.44
|
| Rate for Payer: Amerigroup Medicaid |
$2,468.99
|
| Rate for Payer: Amerigroup Medicare |
$2,470.46
|
| Rate for Payer: Cash Price |
$3,913.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,669.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,446.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,445.02
|
| Rate for Payer: Medical Associates Commercial |
$3,669.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,446.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,424.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,482.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,669.00
|
| Rate for Payer: United Healthcare Commercial |
$4,402.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,886.28
|
|
