Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

felodipine 5 mg ER Tab [VDMC]

Facility

$1.44

Service Code	HCPCS A9270
Hospital Charge Code	10388157
Hospital Revenue Code	259
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

$10,429.02

Service Code	MS-DRG 748
Hospital Charge Code	509
Min. Negotiated Rate	$10,277.88
Max. Negotiated Rate	$10,429.02
Rate for Payer: Amerigroup Medicaid	$10,378.64
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

$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

$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: Molina Healthcare Managed Medicare	$513.79
Rate for Payer: Oscar Health of IA Commercial	$759.75
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

$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: Molina Healthcare Managed Medicare	$933.25
Rate for Payer: Oscar Health of IA Commercial	$1,380.00
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

$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

$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: Molina Healthcare Managed Medicare	$2,319.43
Rate for Payer: Oscar Health of IA Commercial	$3,429.75
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 C-TAPER 36MM +5MM C-TPR

Facility

$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 HIP 26MM+0MM

Facility

$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+0MM

Facility

$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: Molina Healthcare Managed Medicare	$933.25
Rate for Payer: Oscar Health of IA Commercial	$1,380.00
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

$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 +12MM V40

Facility

$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: Molina Healthcare Managed Medicare	$933.25
Rate for Payer: Oscar Health of IA Commercial	$1,380.00
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

$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: Molina Healthcare Managed Medicare	$933.25
Rate for Payer: Oscar Health of IA Commercial	$1,380.00
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

$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

$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

$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: Molina Healthcare Managed Medicare	$933.25
Rate for Payer: Oscar Health of IA Commercial	$1,380.00
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+0MM

Facility

$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

$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: Molina Healthcare Managed Medicare	$933.25
Rate for Payer: Oscar Health of IA Commercial	$1,380.00
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

$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: Molina Healthcare Managed Medicare	$933.25
Rate for Payer: Oscar Health of IA Commercial	$1,380.00
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

$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

$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: Molina Healthcare Managed Medicare	$933.25
Rate for Payer: Oscar Health of IA Commercial	$1,380.00
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

Facility

$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 V40

Facility

$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: Molina Healthcare Managed Medicare	$933.25
Rate for Payer: Oscar Health of IA Commercial	$1,380.00
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

$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

$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

Know your out-of-pocket cost for care.

All Charges