|
Factor X Assay DMCL
|
Facility
IP
|
$129.00
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
8037845
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
|
|
Factor X Assay DMCL
|
Facility
OP
|
$129.00
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
8037845
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$56.42 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Aetna of IA Medicare |
$73.53
|
| Rate for Payer: Amerigroup Medicaid |
$65.11
|
| Rate for Payer: Amerigroup Medicare |
$65.14
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.47
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$65.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$96.75
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.11
|
| Rate for Payer: Wellmark IA HMO |
$56.42
|
| Rate for Payer: Wellmark IA PPO |
$62.06
|
|
|
famotidine 10 mg/mL 2 ml IV Sol
|
Facility
OP
|
$22.50
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43733270
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Aetna of IA Commercial |
$20.25
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.25
|
| Rate for Payer: Aetna of IA Medicare |
$12.82
|
| Rate for Payer: Amerigroup Medicaid |
$11.36
|
| Rate for Payer: Amerigroup Medicare |
$11.36
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.88
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.25
|
| Rate for Payer: Medical Associates Commercial |
$16.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.25
|
| Rate for Payer: Midlands Choice Commercial |
$15.75
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.88
|
| Rate for Payer: United Healthcare Commercial |
$20.25
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.28
|
|
|
famotidine 10 mg/mL 2 ml IV Sol
|
Facility
IP
|
$22.50
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43733270
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Aetna of IA Commercial |
$20.25
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.25
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.88
|
| Rate for Payer: Medical Associates Commercial |
$16.88
|
| Rate for Payer: Midlands Choice Commercial |
$15.75
|
| Rate for Payer: United Healthcare Commercial |
$20.25
|
|
|
famotidine 20 mg Tab
|
Facility
IP
|
$1.29
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of IA Commercial |
$1.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.16
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.97
|
| Rate for Payer: Medical Associates Commercial |
$0.97
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.16
|
|
|
famotidine 20 mg Tab
|
Facility
OP
|
$1.29
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of IA Commercial |
$1.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.16
|
| Rate for Payer: Aetna of IA Medicare |
$0.74
|
| Rate for Payer: Amerigroup Medicaid |
$0.65
|
| Rate for Payer: Amerigroup Medicare |
$0.65
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.64
|
| Rate for Payer: Medical Associates Commercial |
$0.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.65
|
| Rate for Payer: Midlands Choice Commercial |
$0.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.97
|
| Rate for Payer: United Healthcare Commercial |
$1.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.76
|
|
|
febuxostat 40 mg Tab
|
Facility
IP
|
$2.68
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna of IA Commercial |
$2.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.41
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.01
|
| Rate for Payer: Medical Associates Commercial |
$2.01
|
| Rate for Payer: Midlands Choice Commercial |
$1.88
|
| Rate for Payer: United Healthcare Commercial |
$2.41
|
|
|
febuxostat 40 mg Tab
|
Facility
OP
|
$2.68
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna of IA Commercial |
$2.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.41
|
| Rate for Payer: Aetna of IA Medicare |
$1.53
|
| Rate for Payer: Amerigroup Medicaid |
$1.35
|
| Rate for Payer: Amerigroup Medicare |
$1.35
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.01
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.34
|
| Rate for Payer: Medical Associates Commercial |
$2.01
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.34
|
| Rate for Payer: Midlands Choice Commercial |
$1.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.01
|
| Rate for Payer: United Healthcare Commercial |
$2.41
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.58
|
|
|
felodipine 5 mg ER Tab
|
Facility
OP
|
$1.44
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702670
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna of IA Commercial |
$1.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.30
|
| Rate for Payer: Aetna of IA Medicare |
$0.82
|
| Rate for Payer: Amerigroup Medicaid |
$0.73
|
| Rate for Payer: Amerigroup Medicare |
$0.73
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.08
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.72
|
| Rate for Payer: Medical Associates Commercial |
$1.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.72
|
| Rate for Payer: Midlands Choice Commercial |
$1.01
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.85
|
|
|
felodipine 5 mg ER Tab
|
Facility
IP
|
$1.44
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702670
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna of IA Commercial |
$1.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.30
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.08
|
| Rate for Payer: Medical Associates Commercial |
$1.08
|
| Rate for Payer: Midlands Choice Commercial |
$1.01
|
| Rate for Payer: United Healthcare Commercial |
$1.30
|
|
|
Female Reproductive System Reconstructive Procedures
|
Facility
IP
|
$10,429.02
|
|
|
Service Code
|
MS-DRG 748
|
| Hospital Charge Code |
509
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$10,429.02 |
| Rate for Payer: Amerigroup Medicaid |
$10,378.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10,277.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,429.02
|
|
|
FEMORAL DISTAL FIXATION PEG
|
Facility
IP
|
$1,013.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.10 |
| Max. Negotiated Rate |
$911.70 |
| Rate for Payer: Aetna of IA Commercial |
$911.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$911.70
|
| Rate for Payer: Cash Price |
$810.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$759.75
|
| Rate for Payer: Medical Associates Commercial |
$759.75
|
| Rate for Payer: Midlands Choice Commercial |
$709.10
|
| Rate for Payer: United Healthcare Commercial |
$911.70
|
|
|
FEMORAL DISTAL FIXATION PEG
|
Facility
OP
|
$1,013.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.30 |
| Max. Negotiated Rate |
$911.70 |
| Rate for Payer: Aetna of IA Commercial |
$911.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$911.70
|
| Rate for Payer: Aetna of IA Medicare |
$577.41
|
| Rate for Payer: Amerigroup Medicaid |
$511.26
|
| Rate for Payer: Amerigroup Medicare |
$511.56
|
| Rate for Payer: Cash Price |
$810.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$759.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$506.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$506.30
|
| Rate for Payer: Medical Associates Commercial |
$759.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$506.50
|
| Rate for Payer: Midlands Choice Commercial |
$709.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$514.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$759.75
|
| Rate for Payer: United Healthcare Commercial |
$911.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$597.67
|
|
|
FEMORAL HEAD 28
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.63 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,656.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,656.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,048.80
|
| Rate for Payer: Amerigroup Medicaid |
$928.65
|
| Rate for Payer: Amerigroup Medicare |
$929.20
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,380.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$920.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$919.63
|
| Rate for Payer: Medical Associates Commercial |
$1,380.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$920.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,288.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$933.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,380.00
|
| Rate for Payer: United Healthcare Commercial |
$1,656.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,085.60
|
|
|
FEMORAL HEAD 28
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,288.00 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,656.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,656.00
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,380.00
|
| Rate for Payer: Medical Associates Commercial |
$1,380.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,288.00
|
| Rate for Payer: United Healthcare Commercial |
$1,656.00
|
|
|
FEMORAL HEAD C-TAPER 36MM +5MM C-TPR
|
Facility
IP
|
$4,573.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8025964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,201.10 |
| Max. Negotiated Rate |
$4,115.70 |
| Rate for Payer: Aetna of IA Commercial |
$4,115.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,115.70
|
| Rate for Payer: Cash Price |
$3,658.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,429.75
|
| Rate for Payer: Medical Associates Commercial |
$3,429.75
|
| Rate for Payer: Midlands Choice Commercial |
$3,201.10
|
| Rate for Payer: United Healthcare Commercial |
$4,115.70
|
|
|
FEMORAL HEAD C-TAPER 36MM +5MM C-TPR
|
Facility
OP
|
$4,573.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8025964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,285.59 |
| Max. Negotiated Rate |
$4,115.70 |
| Rate for Payer: Aetna of IA Commercial |
$4,115.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,115.70
|
| Rate for Payer: Aetna of IA Medicare |
$2,606.61
|
| Rate for Payer: Amerigroup Medicaid |
$2,307.99
|
| Rate for Payer: Amerigroup Medicare |
$2,309.36
|
| Rate for Payer: Cash Price |
$3,658.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,429.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,286.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,285.59
|
| Rate for Payer: Medical Associates Commercial |
$3,429.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,286.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,201.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,320.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,429.75
|
| Rate for Payer: United Healthcare Commercial |
$4,115.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,698.07
|
|
|
FEMORAL HEAD HIP 26MM+0MM
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.63 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,656.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,656.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,048.80
|
| Rate for Payer: Amerigroup Medicaid |
$928.65
|
| Rate for Payer: Amerigroup Medicare |
$929.20
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,380.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$920.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$919.63
|
| Rate for Payer: Medical Associates Commercial |
$1,380.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$920.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,288.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$933.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,380.00
|
| Rate for Payer: United Healthcare Commercial |
$1,656.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,085.60
|
|
|
FEMORAL HEAD HIP 26MM+0MM
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,288.00 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,656.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,656.00
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,380.00
|
| Rate for Payer: Medical Associates Commercial |
$1,380.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,288.00
|
| Rate for Payer: United Healthcare Commercial |
$1,656.00
|
|
|
FEMORAL HEAD HIP 26MM +12MM V40
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046931
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.63 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,656.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,656.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,048.80
|
| Rate for Payer: Amerigroup Medicaid |
$928.65
|
| Rate for Payer: Amerigroup Medicare |
$929.20
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,380.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$920.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$919.63
|
| Rate for Payer: Medical Associates Commercial |
$1,380.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$920.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,288.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$933.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,380.00
|
| Rate for Payer: United Healthcare Commercial |
$1,656.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,085.60
|
|
|
FEMORAL HEAD HIP 26MM +12MM V40
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046931
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,288.00 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,656.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,656.00
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,380.00
|
| Rate for Payer: Medical Associates Commercial |
$1,380.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,288.00
|
| Rate for Payer: United Healthcare Commercial |
$1,656.00
|
|
|
FEMORAL HEAD HIP 26MM+4MM
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.63 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,656.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,656.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,048.80
|
| Rate for Payer: Amerigroup Medicaid |
$928.65
|
| Rate for Payer: Amerigroup Medicare |
$929.20
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,380.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$920.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$919.63
|
| Rate for Payer: Medical Associates Commercial |
$1,380.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$920.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,288.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$933.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,380.00
|
| Rate for Payer: United Healthcare Commercial |
$1,656.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,085.60
|
|
|
FEMORAL HEAD HIP 26MM+4MM
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,288.00 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,656.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,656.00
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,380.00
|
| Rate for Payer: Medical Associates Commercial |
$1,380.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,288.00
|
| Rate for Payer: United Healthcare Commercial |
$1,656.00
|
|
|
FEMORAL HEAD HIP 26MM +8MM V40
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,288.00 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,656.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,656.00
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,380.00
|
| Rate for Payer: Medical Associates Commercial |
$1,380.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,288.00
|
| Rate for Payer: United Healthcare Commercial |
$1,656.00
|
|
|
FEMORAL HEAD HIP 26MM +8MM V40
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.63 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,656.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,656.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,048.80
|
| Rate for Payer: Amerigroup Medicaid |
$928.65
|
| Rate for Payer: Amerigroup Medicare |
$929.20
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,380.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$920.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$919.63
|
| Rate for Payer: Medical Associates Commercial |
$1,380.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$920.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,288.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$933.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,380.00
|
| Rate for Payer: United Healthcare Commercial |
$1,656.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,085.60
|
|
