|
FEMORAL HEAD HIP 28MM+0MM
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026255
|
|
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 28MM+0MM
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026255
|
|
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 28MM +12MM V40
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026261
|
|
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 28MM +12MM V40
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026261
|
|
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 28MM/+4MM
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026263
|
|
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 28MM/+4MM
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026263
|
|
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 28MM -4MM V40
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026252
|
|
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 28MM -4MM V40
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026252
|
|
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 32MM +8MM V40
|
Facility
IP
|
$1,905.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,333.50 |
| Max. Negotiated Rate |
$1,714.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,714.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,714.50
|
| Rate for Payer: Cash Price |
$1,524.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,428.75
|
| Rate for Payer: Medical Associates Commercial |
$1,428.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,333.50
|
| Rate for Payer: United Healthcare Commercial |
$1,714.50
|
|
|
FEMORAL HEAD HIP 32MM +8MM V40
|
Facility
OP
|
$1,905.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$952.12 |
| Max. Negotiated Rate |
$1,714.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,714.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,714.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,085.85
|
| Rate for Payer: Amerigroup Medicaid |
$961.45
|
| Rate for Payer: Amerigroup Medicare |
$962.02
|
| Rate for Payer: Cash Price |
$1,524.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,428.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$952.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$952.12
|
| Rate for Payer: Medical Associates Commercial |
$1,428.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$952.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,333.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$966.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,428.75
|
| Rate for Payer: United Healthcare Commercial |
$1,714.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,123.95
|
|
|
FEMORAL HEAD HIP 36MM
|
Facility
OP
|
$4,283.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,140.64 |
| Max. Negotiated Rate |
$3,854.70 |
| Rate for Payer: Aetna of IA Commercial |
$3,854.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,854.70
|
| Rate for Payer: Aetna of IA Medicare |
$2,441.31
|
| Rate for Payer: Amerigroup Medicaid |
$2,161.63
|
| Rate for Payer: Amerigroup Medicare |
$2,162.92
|
| Rate for Payer: Cash Price |
$3,426.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,212.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,141.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,140.64
|
| Rate for Payer: Medical Associates Commercial |
$3,212.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,141.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,998.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,173.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,212.25
|
| Rate for Payer: United Healthcare Commercial |
$3,854.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,526.97
|
|
|
FEMORAL HEAD HIP 36MM
|
Facility
IP
|
$4,283.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8026276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,998.10 |
| Max. Negotiated Rate |
$3,854.70 |
| Rate for Payer: Aetna of IA Commercial |
$3,854.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,854.70
|
| Rate for Payer: Cash Price |
$3,426.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,212.25
|
| Rate for Payer: Medical Associates Commercial |
$3,212.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,998.10
|
| Rate for Payer: United Healthcare Commercial |
$3,854.70
|
|
|
FEMORAL HEAD HIP 36MM +0MM V40
|
Facility
IP
|
$3,499.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,449.30 |
| Max. Negotiated Rate |
$3,149.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,149.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,149.10
|
| Rate for Payer: Cash Price |
$2,799.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,624.25
|
| Rate for Payer: Medical Associates Commercial |
$2,624.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,449.30
|
| Rate for Payer: United Healthcare Commercial |
$3,149.10
|
|
|
FEMORAL HEAD HIP 36MM +0MM V40
|
Facility
OP
|
$3,499.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,748.80 |
| Max. Negotiated Rate |
$3,149.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,149.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,149.10
|
| Rate for Payer: Aetna of IA Medicare |
$1,994.43
|
| Rate for Payer: Amerigroup Medicaid |
$1,765.95
|
| Rate for Payer: Amerigroup Medicare |
$1,767.00
|
| Rate for Payer: Cash Price |
$2,799.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,624.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,749.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,748.80
|
| Rate for Payer: Medical Associates Commercial |
$2,624.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,749.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,449.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,775.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,624.25
|
| Rate for Payer: United Healthcare Commercial |
$3,149.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,064.41
|
|
|
FEMORAL HEAD HIP 36MM +10MM V40
|
Facility
OP
|
$3,499.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026260
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,748.80 |
| Max. Negotiated Rate |
$3,149.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,149.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,149.10
|
| Rate for Payer: Aetna of IA Medicare |
$1,994.43
|
| Rate for Payer: Amerigroup Medicaid |
$1,765.95
|
| Rate for Payer: Amerigroup Medicare |
$1,767.00
|
| Rate for Payer: Cash Price |
$2,799.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,624.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,749.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,748.80
|
| Rate for Payer: Medical Associates Commercial |
$2,624.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,749.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,449.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,775.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,624.25
|
| Rate for Payer: United Healthcare Commercial |
$3,149.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,064.41
|
|
|
FEMORAL HEAD HIP 36MM +10MM V40
|
Facility
IP
|
$3,499.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026260
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,449.30 |
| Max. Negotiated Rate |
$3,149.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,149.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,149.10
|
| Rate for Payer: Cash Price |
$2,799.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,624.25
|
| Rate for Payer: Medical Associates Commercial |
$2,624.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,449.30
|
| Rate for Payer: United Healthcare Commercial |
$3,149.10
|
|
|
FEMORAL HEAD HIP 36MM +5MM V40
|
Facility
OP
|
$3,431.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.81 |
| Max. Negotiated Rate |
$3,087.90 |
| Rate for Payer: Aetna of IA Commercial |
$3,087.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,087.90
|
| Rate for Payer: Aetna of IA Medicare |
$1,955.67
|
| Rate for Payer: Amerigroup Medicaid |
$1,731.63
|
| Rate for Payer: Amerigroup Medicare |
$1,732.66
|
| Rate for Payer: Cash Price |
$2,744.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,573.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,715.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,714.81
|
| Rate for Payer: Medical Associates Commercial |
$2,573.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,715.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,401.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,741.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,573.25
|
| Rate for Payer: United Healthcare Commercial |
$3,087.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,024.29
|
|
|
FEMORAL HEAD HIP 36MM +5MM V40
|
Facility
IP
|
$3,431.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,401.70 |
| Max. Negotiated Rate |
$3,087.90 |
| Rate for Payer: Aetna of IA Commercial |
$3,087.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,087.90
|
| Rate for Payer: Cash Price |
$2,744.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,573.25
|
| Rate for Payer: Medical Associates Commercial |
$2,573.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,401.70
|
| Rate for Payer: United Healthcare Commercial |
$3,087.90
|
|
|
FEMORAL HEAD HIP 36MM -5MM V40
|
Facility
OP
|
$3,499.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,748.80 |
| Max. Negotiated Rate |
$3,149.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,149.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,149.10
|
| Rate for Payer: Aetna of IA Medicare |
$1,994.43
|
| Rate for Payer: Amerigroup Medicaid |
$1,765.95
|
| Rate for Payer: Amerigroup Medicare |
$1,767.00
|
| Rate for Payer: Cash Price |
$2,799.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,624.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,749.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,748.80
|
| Rate for Payer: Medical Associates Commercial |
$2,624.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,749.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,449.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,775.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,624.25
|
| Rate for Payer: United Healthcare Commercial |
$3,149.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,064.41
|
|
|
FEMORAL HEAD HIP 36MM -5MM V40
|
Facility
IP
|
$3,499.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,449.30 |
| Max. Negotiated Rate |
$3,149.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,149.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,149.10
|
| Rate for Payer: Cash Price |
$2,799.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,624.25
|
| Rate for Payer: Medical Associates Commercial |
$2,624.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,449.30
|
| Rate for Payer: United Healthcare Commercial |
$3,149.10
|
|
|
FEMORAL HEAD HIP 36MM +5MM V40 CERAMIC
|
Facility
IP
|
$4,150.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,905.00 |
| Max. Negotiated Rate |
$3,735.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,735.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,735.00
|
| Rate for Payer: Cash Price |
$3,320.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,112.50
|
| Rate for Payer: Medical Associates Commercial |
$3,112.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,905.00
|
| Rate for Payer: United Healthcare Commercial |
$3,735.00
|
|
|
FEMORAL HEAD HIP 36MM +5MM V40 CERAMIC
|
Facility
OP
|
$4,150.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,074.17 |
| Max. Negotiated Rate |
$3,735.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,735.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,735.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,365.50
|
| Rate for Payer: Amerigroup Medicaid |
$2,094.50
|
| Rate for Payer: Amerigroup Medicare |
$2,095.75
|
| Rate for Payer: Cash Price |
$3,320.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,112.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,075.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,074.17
|
| Rate for Payer: Medical Associates Commercial |
$3,112.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,075.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,905.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,106.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,112.50
|
| Rate for Payer: United Healthcare Commercial |
$3,735.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,448.50
|
|
|
FEMORAL HEAD HIP 36MM X +2.5MM
|
Facility
OP
|
$4,419.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,208.62 |
| Max. Negotiated Rate |
$3,977.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,977.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,977.10
|
| Rate for Payer: Aetna of IA Medicare |
$2,518.83
|
| Rate for Payer: Amerigroup Medicaid |
$2,230.27
|
| Rate for Payer: Amerigroup Medicare |
$2,231.60
|
| Rate for Payer: Cash Price |
$3,535.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,314.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,209.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,208.62
|
| Rate for Payer: Medical Associates Commercial |
$3,314.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,209.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,093.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,242.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,314.25
|
| Rate for Payer: United Healthcare Commercial |
$3,977.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,607.21
|
|
|
FEMORAL HEAD HIP 36MM X +2.5MM
|
Facility
IP
|
$4,419.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,093.30 |
| Max. Negotiated Rate |
$3,977.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,977.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,977.10
|
| Rate for Payer: Cash Price |
$3,535.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,314.25
|
| Rate for Payer: Medical Associates Commercial |
$3,314.25
|
| Rate for Payer: Midlands Choice Commercial |
$3,093.30
|
| Rate for Payer: United Healthcare Commercial |
$3,977.10
|
|
|
FEMORAL HEAD HIP CERAMIC V40 36MMX-5MM
|
Facility
IP
|
$4,419.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046942
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,093.30 |
| Max. Negotiated Rate |
$3,977.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,977.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,977.10
|
| Rate for Payer: Cash Price |
$3,535.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,314.25
|
| Rate for Payer: Medical Associates Commercial |
$3,314.25
|
| Rate for Payer: Midlands Choice Commercial |
$3,093.30
|
| Rate for Payer: United Healthcare Commercial |
$3,977.10
|
|
