|
IMPLANT INSERT TIBIAL SIZE #4 16MM
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
8046871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.95 |
| 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 |
$3,259.50
|
| Rate for Payer: Amerigroup Medicare |
$2,568.38
|
| 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 |
$2,542.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,227.85
|
| Rate for Payer: Medical Associates Commercial |
$4,238.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,542.95
|
| Rate for Payer: Midlands Choice Commercial |
$3,955.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,275.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,924.39
|
| Rate for Payer: United Healthcare Commercial |
$5,085.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,334.09
|
|
|
IMPLANT INSERT TIBIAL SIZE #4 9MM
|
Facility
|
OP
|
$5,476.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
8046869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,464.20 |
| 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: Aetna of IA Medicare |
$3,121.32
|
| Rate for Payer: Amerigroup Medicaid |
$3,158.56
|
| Rate for Payer: Amerigroup Medicare |
$2,488.84
|
| 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 |
$2,464.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,127.89
|
| Rate for Payer: Medical Associates Commercial |
$4,107.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,464.20
|
| Rate for Payer: Midlands Choice Commercial |
$3,833.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,173.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,833.83
|
| 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
|
HCPCS 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
|
OP
|
$5,651.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.95 |
| 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 |
$3,259.50
|
| Rate for Payer: Amerigroup Medicare |
$2,568.38
|
| 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 |
$2,542.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,227.85
|
| Rate for Payer: Medical Associates Commercial |
$4,238.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,542.95
|
| Rate for Payer: Midlands Choice Commercial |
$3,955.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,275.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,924.39
|
| Rate for Payer: United Healthcare Commercial |
$5,085.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,334.09
|
|
|
IMPLANT INSERT TIBIAL SIZE #5
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
HCPCS 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 CS 11MM
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
8046872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.95 |
| 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 |
$3,259.50
|
| Rate for Payer: Amerigroup Medicare |
$2,568.38
|
| 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 |
$2,542.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,227.85
|
| Rate for Payer: Medical Associates Commercial |
$4,238.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,542.95
|
| Rate for Payer: Midlands Choice Commercial |
$3,955.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,275.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,924.39
|
| 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
|
HCPCS 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
|
IP
|
$5,476.00
|
|
|
Service Code
|
HCPCS 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 #5 CS 16MM
|
Facility
|
OP
|
$5,476.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
8046873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,464.20 |
| 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: Aetna of IA Medicare |
$3,121.32
|
| Rate for Payer: Amerigroup Medicaid |
$3,158.56
|
| Rate for Payer: Amerigroup Medicare |
$2,488.84
|
| 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 |
$2,464.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,127.89
|
| Rate for Payer: Medical Associates Commercial |
$4,107.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,464.20
|
| Rate for Payer: Midlands Choice Commercial |
$3,833.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,173.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,833.83
|
| Rate for Payer: United Healthcare Commercial |
$4,928.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,230.84
|
|
|
IMPLANT INSERT TIBIAL SIZE #6 CS 11MM
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
HCPCS 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
|
HCPCS C1778
|
| Hospital Charge Code |
8046874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.95 |
| 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 |
$3,259.50
|
| Rate for Payer: Amerigroup Medicare |
$2,568.38
|
| 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 |
$2,542.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,227.85
|
| Rate for Payer: Medical Associates Commercial |
$4,238.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,542.95
|
| Rate for Payer: Midlands Choice Commercial |
$3,955.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,275.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,924.39
|
| 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
|
HCPCS 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
|
HCPCS C1778
|
| Hospital Charge Code |
8046875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.95 |
| 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 |
$3,259.50
|
| Rate for Payer: Amerigroup Medicare |
$2,568.38
|
| 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 |
$2,542.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,227.85
|
| Rate for Payer: Medical Associates Commercial |
$4,238.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,542.95
|
| Rate for Payer: Midlands Choice Commercial |
$3,955.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,275.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,924.39
|
| 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
|
HCPCS C1778
|
| Hospital Charge Code |
8026184
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.95 |
| 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 |
$3,259.50
|
| Rate for Payer: Amerigroup Medicare |
$2,568.38
|
| 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 |
$2,542.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,227.85
|
| Rate for Payer: Medical Associates Commercial |
$4,238.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,542.95
|
| Rate for Payer: Midlands Choice Commercial |
$3,955.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,275.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,924.39
|
| 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
|
HCPCS 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 13MM
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
8026185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.95 |
| 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 |
$3,259.50
|
| Rate for Payer: Amerigroup Medicare |
$2,568.38
|
| 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 |
$2,542.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,227.85
|
| Rate for Payer: Medical Associates Commercial |
$4,238.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,542.95
|
| Rate for Payer: Midlands Choice Commercial |
$3,955.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,275.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,924.39
|
| 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
|
HCPCS 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 KNEE CRUCIATE RET FEMORAL SIZE 5
|
Facility
|
OP
|
$12,453.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,603.85 |
| 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 |
$7,182.89
|
| Rate for Payer: Amerigroup Medicare |
$5,659.89
|
| 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 |
$5,603.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,113.15
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$5,603.85
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,217.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,444.43
|
| 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
|
HCPCS 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
|
HCPCS C1776
|
| Hospital Charge Code |
8046830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,603.85 |
| 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 |
$7,182.89
|
| Rate for Payer: Amerigroup Medicare |
$5,659.89
|
| 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 |
$5,603.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,113.15
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$5,603.85
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,217.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,444.43
|
| 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
|
HCPCS 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
|
OP
|
$12,453.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,603.85 |
| 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 |
$7,182.89
|
| Rate for Payer: Amerigroup Medicare |
$5,659.89
|
| 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 |
$5,603.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,113.15
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$5,603.85
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,217.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,444.43
|
| Rate for Payer: United Healthcare Commercial |
$11,207.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$7,347.27
|
|
|
IMPLANT KNEE FEMORAL SIZE 4
|
Facility
|
IP
|
$12,453.00
|
|
|
Service Code
|
HCPCS 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 5
|
Facility
|
OP
|
$12,453.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,603.85 |
| 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 |
$7,182.89
|
| Rate for Payer: Amerigroup Medicare |
$5,659.89
|
| 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 |
$5,603.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,113.15
|
| Rate for Payer: Medical Associates Commercial |
$9,339.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$5,603.85
|
| Rate for Payer: Midlands Choice Commercial |
$8,717.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,217.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,444.43
|
| 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
|
HCPCS 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
|
|
