|
IMPLANT INSERT TIBIAL #6
|
Facility
|
OP
|
$3,864.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,931.23 |
| 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 |
$1,950.16
|
| Rate for Payer: Amerigroup Medicare |
$1,951.32
|
| 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 |
$1,932.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,931.23
|
| Rate for Payer: Medical Associates Commercial |
$2,898.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,932.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,704.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,960.98
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,959.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,898.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,898.00
|
| Rate for Payer: United Healthcare Commercial |
$3,477.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,279.76
|
|
|
IMPLANT INSERT TIBIAL SIZE #3
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
CPT 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
|
CPT C1778
|
| Hospital Charge Code |
8046866
|
|
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: Molina Healthcare Managed Medicare |
$2,866.19
|
| Rate for Payer: Oscar Health of IA Commercial |
$4,238.25
|
| 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 #3 13MM
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8046867
|
|
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: Molina Healthcare Managed Medicare |
$2,866.19
|
| Rate for Payer: Oscar Health of IA Commercial |
$4,238.25
|
| 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 #3 13MM
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
CPT 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
|
OP
|
$5,651.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8046868
|
|
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: Molina Healthcare Managed Medicare |
$2,866.19
|
| Rate for Payer: Oscar Health of IA Commercial |
$4,238.25
|
| 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 #3 16MM
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
CPT 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 #4 13MM
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
CPT 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
|
CPT C1778
|
| Hospital Charge Code |
8046870
|
|
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: Molina Healthcare Managed Medicare |
$2,866.19
|
| Rate for Payer: Oscar Health of IA Commercial |
$4,238.25
|
| 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 #4 16MM
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8046871
|
|
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: Molina Healthcare Managed Medicare |
$2,866.19
|
| Rate for Payer: Oscar Health of IA Commercial |
$4,238.25
|
| 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 #4 16MM
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
CPT 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
|
|
|
IMPLANT INSERT TIBIAL SIZE #4 9MM
|
Facility
|
OP
|
$5,476.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8046869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,736.90 |
| Max. Negotiated Rate |
$4,928.40 |
| Rate for Payer: Aetna of IA Commercial |
$4,928.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,928.40
|
| Rate for Payer: Aetna of IA Medicare |
$3,121.32
|
| Rate for Payer: Amerigroup Medicaid |
$2,763.74
|
| Rate for Payer: Amerigroup Medicare |
$2,765.38
|
| Rate for Payer: Cash Price |
$4,380.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,107.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,738.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,736.90
|
| Rate for Payer: Medical Associates Commercial |
$4,107.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,738.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,833.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,779.07
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$2,777.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$4,107.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,107.00
|
| Rate for Payer: United Healthcare Commercial |
$4,928.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,230.84
|
|
|
IMPLANT INSERT TIBIAL SIZE #4 9MM
|
Facility
|
IP
|
$5,476.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8046869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,833.20 |
| Max. Negotiated Rate |
$4,928.40 |
| Rate for Payer: Aetna of IA Commercial |
$4,928.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,928.40
|
| Rate for Payer: Cash Price |
$4,380.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,107.00
|
| Rate for Payer: Medical Associates Commercial |
$4,107.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,833.20
|
| Rate for Payer: United Healthcare Commercial |
$4,928.40
|
|
|
IMPLANT INSERT TIBIAL SIZE #5
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046865
|
|
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 #5
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046865
|
|
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: Molina Healthcare Managed Medicare |
$2,866.19
|
| Rate for Payer: Oscar Health of IA Commercial |
$4,238.25
|
| 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 #5 CS 11MM
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8046872
|
|
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: Molina Healthcare Managed Medicare |
$2,866.19
|
| Rate for Payer: Oscar Health of IA Commercial |
$4,238.25
|
| 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 #5 CS 11MM
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8046872
|
|
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 #5 CS 16MM
|
Facility
|
OP
|
$5,476.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8046873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,736.90 |
| Max. Negotiated Rate |
$4,928.40 |
| Rate for Payer: Aetna of IA Commercial |
$4,928.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,928.40
|
| Rate for Payer: Aetna of IA Medicare |
$3,121.32
|
| Rate for Payer: Amerigroup Medicaid |
$2,763.74
|
| Rate for Payer: Amerigroup Medicare |
$2,765.38
|
| Rate for Payer: Cash Price |
$4,380.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,107.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,738.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,736.90
|
| Rate for Payer: Medical Associates Commercial |
$4,107.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,738.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,833.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,779.07
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$2,777.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$4,107.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,107.00
|
| Rate for Payer: United Healthcare Commercial |
$4,928.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,230.84
|
|
|
IMPLANT INSERT TIBIAL SIZE #5 CS 16MM
|
Facility
|
IP
|
$5,476.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8046873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,833.20 |
| Max. Negotiated Rate |
$4,928.40 |
| Rate for Payer: Aetna of IA Commercial |
$4,928.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,928.40
|
| Rate for Payer: Cash Price |
$4,380.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,107.00
|
| Rate for Payer: Medical Associates Commercial |
$4,107.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,833.20
|
| Rate for Payer: United Healthcare Commercial |
$4,928.40
|
|
|
IMPLANT INSERT TIBIAL SIZE #6 CS 11MM
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8046874
|
|
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 #6 CS 11MM
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8046874
|
|
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: Molina Healthcare Managed Medicare |
$2,866.19
|
| Rate for Payer: Oscar Health of IA Commercial |
$4,238.25
|
| 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 #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 #6 CS 16MM
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
8046875
|
|
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: Molina Healthcare Managed Medicare |
$2,866.19
|
| Rate for Payer: Oscar Health of IA Commercial |
$4,238.25
|
| 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 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: Molina Healthcare Managed Medicare |
$2,866.19
|
| Rate for Payer: Oscar Health of IA Commercial |
$4,238.25
|
| 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 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
|
|
