|
IMPLANT KNEE TIBIAL BEARING INSERT 5X13M
|
Facility
|
OP
|
$5,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.45 |
| 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 |
$2,907.65
|
| Rate for Payer: Amerigroup Medicare |
$2,291.13
|
| 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 |
$2,268.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,879.42
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,268.45
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,921.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,608.72
|
| 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
|
HCPCS 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 5X16
|
Facility
|
IP
|
$5,041.00
|
|
|
Service Code
|
HCPCS 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
|
HCPCS C1776
|
| Hospital Charge Code |
8046855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.45 |
| 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 |
$2,907.65
|
| Rate for Payer: Amerigroup Medicare |
$2,291.13
|
| 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 |
$2,268.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,879.42
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,268.45
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,921.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,608.72
|
| 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
|
HCPCS C1776
|
| Hospital Charge Code |
8046858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,201.40 |
| 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: Aetna of IA Medicare |
$2,788.44
|
| Rate for Payer: Amerigroup Medicaid |
$2,821.71
|
| Rate for Payer: Amerigroup Medicare |
$2,223.41
|
| 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 |
$2,201.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,794.31
|
| Rate for Payer: Medical Associates Commercial |
$3,669.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,201.40
|
| Rate for Payer: Midlands Choice Commercial |
$3,424.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,835.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,531.61
|
| 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
|
HCPCS 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
|
HCPCS C1776
|
| Hospital Charge Code |
8046860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.45 |
| 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 |
$2,907.65
|
| Rate for Payer: Amerigroup Medicare |
$2,291.13
|
| 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 |
$2,268.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,879.42
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,268.45
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,921.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,608.72
|
| 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
|
HCPCS 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
|
OP
|
$5,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.45 |
| 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 |
$2,907.65
|
| Rate for Payer: Amerigroup Medicare |
$2,291.13
|
| 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 |
$2,268.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,879.42
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,268.45
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,921.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,608.72
|
| Rate for Payer: United Healthcare Commercial |
$4,536.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,974.19
|
|
|
IMPLANT KNEE TIBIAL BEARING INSERT 7X13
|
Facility
|
IP
|
$5,041.00
|
|
|
Service Code
|
HCPCS 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 #8
|
Facility
|
IP
|
$5,041.00
|
|
|
Service Code
|
HCPCS 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
|
|
|
IMPLANT KNEE TIBIAL BEARING INSERT #8
|
Facility
|
OP
|
$5,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.45 |
| 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 |
$2,907.65
|
| Rate for Payer: Amerigroup Medicare |
$2,291.13
|
| 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 |
$2,268.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,879.42
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,268.45
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,921.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,608.72
|
| Rate for Payer: United Healthcare Commercial |
$4,536.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,974.19
|
|
|
IMPLANT KNEE TIBIAL BEARING INSERT8X11
|
Facility
|
IP
|
$5,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8026183
|
|
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 INSERT8X11
|
Facility
|
OP
|
$5,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8026183
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.45 |
| 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 |
$2,907.65
|
| Rate for Payer: Amerigroup Medicare |
$2,291.13
|
| 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 |
$2,268.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,879.42
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,268.45
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,921.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,608.72
|
| Rate for Payer: United Healthcare Commercial |
$4,536.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,974.19
|
|
|
IMPLANT KNEE TIBIAL BEARING INSERT 8X9
|
Facility
|
IP
|
$5,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046862
|
|
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 8X9
|
Facility
|
OP
|
$5,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.45 |
| 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 |
$2,907.65
|
| Rate for Payer: Amerigroup Medicare |
$2,291.13
|
| 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 |
$2,268.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,879.42
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,268.45
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,921.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,608.72
|
| Rate for Payer: United Healthcare Commercial |
$4,536.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,974.19
|
|
|
IMPLANT KNEE TIBIAL SIZE 6
|
Facility
|
IP
|
$5,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046856
|
|
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 SIZE 6
|
Facility
|
OP
|
$5,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.45 |
| 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 |
$2,907.65
|
| Rate for Payer: Amerigroup Medicare |
$2,291.13
|
| 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 |
$2,268.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,879.42
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,268.45
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,921.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,608.72
|
| Rate for Payer: United Healthcare Commercial |
$4,536.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,974.19
|
|
|
IMPLANT KNEE TIBIAL SIZE 6-1
|
Facility
|
IP
|
$5,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046857
|
|
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 SIZE 6-1
|
Facility
|
OP
|
$5,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.45 |
| 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 |
$2,907.65
|
| Rate for Payer: Amerigroup Medicare |
$2,291.13
|
| 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 |
$2,268.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,879.42
|
| Rate for Payer: Medical Associates Commercial |
$3,780.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,268.45
|
| Rate for Payer: Midlands Choice Commercial |
$3,528.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,921.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,608.72
|
| Rate for Payer: United Healthcare Commercial |
$4,536.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,974.19
|
|
|
IMPLANT KNEE TIBIAL UNIV BASEPLT SZ 8
|
Facility
|
OP
|
$6,743.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8026182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,034.35 |
| Max. Negotiated Rate |
$6,068.70 |
| Rate for Payer: Aetna of IA Commercial |
$6,068.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,068.70
|
| Rate for Payer: Aetna of IA Medicare |
$3,843.51
|
| Rate for Payer: Amerigroup Medicaid |
$3,889.36
|
| Rate for Payer: Amerigroup Medicare |
$3,064.69
|
| Rate for Payer: Cash Price |
$5,394.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,057.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,034.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,851.60
|
| Rate for Payer: Medical Associates Commercial |
$5,057.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,034.35
|
| Rate for Payer: Midlands Choice Commercial |
$4,720.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,908.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,489.50
|
| Rate for Payer: United Healthcare Commercial |
$6,068.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,978.37
|
|
|
IMPLANT KNEE TIBIAL UNIV BASEPLT SZ 8
|
Facility
|
IP
|
$6,743.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8026182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,720.10 |
| Max. Negotiated Rate |
$6,068.70 |
| Rate for Payer: Aetna of IA Commercial |
$6,068.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,068.70
|
| Rate for Payer: Cash Price |
$5,394.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,057.25
|
| Rate for Payer: Medical Associates Commercial |
$5,057.25
|
| Rate for Payer: Midlands Choice Commercial |
$4,720.10
|
| Rate for Payer: United Healthcare Commercial |
$6,068.70
|
|
|
IMPLANT LOCKING INSERT
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Aetna of IA Medicare |
$41.61
|
| Rate for Payer: Amerigroup Medicaid |
$42.11
|
| Rate for Payer: Amerigroup Medicare |
$33.18
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.70
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.85
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$37.78
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.07
|
|
|
IMPLANT LOCKING INSERT
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
|
|
IMPLANT LOCK SCREW KNEE 5X25 FULL TH
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.45 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Aetna of IA Commercial |
$270.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$270.90
|
| Rate for Payer: Aetna of IA Medicare |
$171.57
|
| Rate for Payer: Amerigroup Medicaid |
$173.62
|
| Rate for Payer: Amerigroup Medicare |
$136.80
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$225.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$135.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$171.93
|
| Rate for Payer: Medical Associates Commercial |
$225.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$135.45
|
| Rate for Payer: Midlands Choice Commercial |
$210.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$174.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$155.77
|
| Rate for Payer: United Healthcare Commercial |
$270.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$177.59
|
|
