|
IMPLANT KNEE TIBIAL BEARING INSERT #3X11
|
Facility
IP
|
$4,892.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046847
|
|
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 #3X13
|
Facility
IP
|
$4,892.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046848
|
|
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 #3X13
|
Facility
OP
|
$4,892.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046848
|
|
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 INSERT-409
|
Facility
OP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046849
|
|
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-409
|
Facility
IP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046849
|
|
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-409-1
|
Facility
OP
|
$5,227.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,612.45 |
| Max. Negotiated Rate |
$4,704.30 |
| Rate for Payer: Aetna of IA Commercial |
$4,704.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,704.30
|
| Rate for Payer: Aetna of IA Medicare |
$2,979.39
|
| Rate for Payer: Amerigroup Medicaid |
$2,638.07
|
| Rate for Payer: Amerigroup Medicare |
$2,639.64
|
| Rate for Payer: Cash Price |
$4,181.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,920.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,613.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,612.45
|
| Rate for Payer: Medical Associates Commercial |
$3,920.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,613.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,658.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,652.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,920.25
|
| Rate for Payer: United Healthcare Commercial |
$4,704.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,083.93
|
|
|
IMPLANT KNEE TIBIAL BEARING INSERT-409-1
|
Facility
IP
|
$5,227.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,658.90 |
| Max. Negotiated Rate |
$4,704.30 |
| Rate for Payer: Aetna of IA Commercial |
$4,704.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,704.30
|
| Rate for Payer: Cash Price |
$4,181.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,920.25
|
| Rate for Payer: Medical Associates Commercial |
$3,920.25
|
| Rate for Payer: Midlands Choice Commercial |
$3,658.90
|
| Rate for Payer: United Healthcare Commercial |
$4,704.30
|
|
|
IMPLANT KNEE TIBIAL BEARING INSERT-416
|
Facility
IP
|
$4,892.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046877
|
|
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-416
|
Facility
OP
|
$4,892.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046877
|
|
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 INSERT #5
|
Facility
IP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046853
|
|
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 #5
|
Facility
OP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046853
|
|
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-509
|
Facility
IP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046852
|
|
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-509
|
Facility
OP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046852
|
|
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 5X13M
|
Facility
IP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046854
|
|
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 5X13M
|
Facility
OP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046854
|
|
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 5X16
|
Facility
IP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046855
|
|
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 5X16
|
Facility
OP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046855
|
|
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 #6
|
Facility
OP
|
$4,892.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046858
|
|
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 INSERT #6
|
Facility
IP
|
$4,892.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046858
|
|
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 7X11
|
Facility
OP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046860
|
|
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 7X11
|
Facility
IP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046860
|
|
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 7X13
|
Facility
IP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046861
|
|
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 7X13
|
Facility
OP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046861
|
|
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 #8
|
Facility
OP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046878
|
|
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 #8
|
Facility
IP
|
$5,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046878
|
|
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
|
|
