|
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 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: Molina Healthcare Managed Medicare |
$2,172.34
|
| Rate for Payer: Oscar Health of IA Commercial |
$3,212.25
|
| 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
|
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: Molina Healthcare Managed Medicare |
$1,774.69
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,624.25
|
| 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 +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 +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: Medical Associates Commercial |
$2,624.25
|
| 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: Midlands Choice Commercial |
$2,449.30
|
| Rate for Payer: United Healthcare Commercial |
$3,149.10
|
|
|
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: Molina Healthcare Managed Medicare |
$1,774.69
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,624.25
|
| 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
|
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: Molina Healthcare Managed Medicare |
$1,740.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,573.25
|
| 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
|
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
|
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: Molina Healthcare Managed Medicare |
$1,774.69
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,624.25
|
| 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 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: Molina Healthcare Managed Medicare |
$2,104.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$3,112.50
|
| 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
|
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 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: Molina Healthcare Managed Medicare |
$2,241.32
|
| Rate for Payer: Oscar Health of IA Commercial |
$3,314.25
|
| 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 CERAMIC V40 36MMX-5MM
|
Facility
|
OP
|
$4,419.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046942
|
|
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: Molina Healthcare Managed Medicare |
$2,241.32
|
| Rate for Payer: Oscar Health of IA Commercial |
$3,314.25
|
| 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 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
|
|
|
FEMORAL POSTERIOR STABILIZED
|
Facility
|
OP
|
$7,173.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,585.07 |
| Max. Negotiated Rate |
$6,455.70 |
| Rate for Payer: Aetna of IA Commercial |
$6,455.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,455.70
|
| Rate for Payer: Aetna of IA Medicare |
$4,088.61
|
| Rate for Payer: Amerigroup Medicaid |
$3,620.21
|
| Rate for Payer: Amerigroup Medicare |
$3,622.36
|
| Rate for Payer: Cash Price |
$5,738.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,379.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,586.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,585.07
|
| Rate for Payer: Medical Associates Commercial |
$5,379.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,586.50
|
| Rate for Payer: Midlands Choice Commercial |
$5,021.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,640.30
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$3,638.15
|
| Rate for Payer: Oscar Health of IA Commercial |
$5,379.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$5,379.75
|
| Rate for Payer: United Healthcare Commercial |
$6,455.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,232.07
|
|
|
FEMORAL POSTERIOR STABILIZED
|
Facility
|
IP
|
$7,173.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,021.10 |
| Max. Negotiated Rate |
$6,455.70 |
| Rate for Payer: Aetna of IA Commercial |
$6,455.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,455.70
|
| Rate for Payer: Cash Price |
$5,738.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,379.75
|
| Rate for Payer: Medical Associates Commercial |
$5,379.75
|
| Rate for Payer: Midlands Choice Commercial |
$5,021.10
|
| Rate for Payer: United Healthcare Commercial |
$6,455.70
|
|
|
FEMORAL POSTERIOR STABILIZED #5
|
Facility
|
OP
|
$7,814.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,905.44 |
| Max. Negotiated Rate |
$7,032.60 |
| Rate for Payer: Aetna of IA Commercial |
$7,032.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,032.60
|
| Rate for Payer: Aetna of IA Medicare |
$4,453.98
|
| Rate for Payer: Amerigroup Medicaid |
$3,943.73
|
| Rate for Payer: Amerigroup Medicare |
$3,946.07
|
| Rate for Payer: Cash Price |
$6,251.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,860.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,907.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,905.44
|
| Rate for Payer: Medical Associates Commercial |
$5,860.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,907.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,469.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,965.60
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$3,963.26
|
| Rate for Payer: Oscar Health of IA Commercial |
$5,860.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$5,860.50
|
| Rate for Payer: United Healthcare Commercial |
$7,032.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,610.26
|
|
|
FEMORAL POSTERIOR STABILIZED #5
|
Facility
|
IP
|
$7,814.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,469.80 |
| Max. Negotiated Rate |
$7,032.60 |
| Rate for Payer: Aetna of IA Commercial |
$7,032.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,032.60
|
| Rate for Payer: Cash Price |
$6,251.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,860.50
|
| Rate for Payer: Medical Associates Commercial |
$5,860.50
|
| Rate for Payer: Midlands Choice Commercial |
$5,469.80
|
| Rate for Payer: United Healthcare Commercial |
$7,032.60
|
|
|
FEMORAL POSTERIOR STABILIZED #8 LFT
|
Facility
|
IP
|
$7,318.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,122.60 |
| Max. Negotiated Rate |
$6,586.20 |
| Rate for Payer: Aetna of IA Commercial |
$6,586.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,586.20
|
| Rate for Payer: Cash Price |
$5,854.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,488.50
|
| Rate for Payer: Medical Associates Commercial |
$5,488.50
|
| Rate for Payer: Midlands Choice Commercial |
$5,122.60
|
| Rate for Payer: United Healthcare Commercial |
$6,586.20
|
|
|
FEMORAL POSTERIOR STABILIZED #8 LFT
|
Facility
|
OP
|
$7,318.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,657.54 |
| Max. Negotiated Rate |
$6,586.20 |
| Rate for Payer: Aetna of IA Commercial |
$6,586.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,586.20
|
| Rate for Payer: Aetna of IA Medicare |
$4,171.26
|
| Rate for Payer: Amerigroup Medicaid |
$3,693.39
|
| Rate for Payer: Amerigroup Medicare |
$3,695.59
|
| Rate for Payer: Cash Price |
$5,854.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,488.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,659.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,657.54
|
| Rate for Payer: Medical Associates Commercial |
$5,488.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,659.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,122.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,713.88
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$3,711.69
|
| Rate for Payer: Oscar Health of IA Commercial |
$5,488.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$5,488.50
|
| Rate for Payer: United Healthcare Commercial |
$6,586.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,317.62
|
|
|
fenofibrate 145 mg Tab [VDMC]
|
Facility
|
OP
|
$1.56
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10607876
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of IA Commercial |
$1.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.40
|
| Rate for Payer: Aetna of IA Medicare |
$0.89
|
| Rate for Payer: Amerigroup Medicaid |
$0.79
|
| Rate for Payer: Amerigroup Medicare |
$0.79
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.17
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.78
|
| Rate for Payer: Medical Associates Commercial |
$1.17
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.78
|
| Rate for Payer: Midlands Choice Commercial |
$1.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.79
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.79
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.17
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.92
|
|
|
fenofibrate 145 mg Tab [VDMC]
|
Facility
|
IP
|
$1.56
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10607876
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of IA Commercial |
$1.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.40
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.17
|
| Rate for Payer: Medical Associates Commercial |
$1.17
|
| Rate for Payer: Midlands Choice Commercial |
$1.09
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
|
