|
FEMORAL HEAD HIP 28MM +12MM V40
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
HCPCS 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 +12MM V40
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8026261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$828.00 |
| 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: Aetna of IA Medicare |
$1,048.80
|
| Rate for Payer: Amerigroup Medicaid |
$1,061.31
|
| Rate for Payer: Amerigroup Medicare |
$836.28
|
| 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 |
$828.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,051.01
|
| Rate for Payer: Medical Associates Commercial |
$1,380.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$828.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,288.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,066.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$952.20
|
| 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
|
IP
|
$1,840.00
|
|
|
Service Code
|
HCPCS 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
|
HCPCS C1776
|
| Hospital Charge Code |
8026263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$828.00 |
| 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: Aetna of IA Medicare |
$1,048.80
|
| Rate for Payer: Amerigroup Medicaid |
$1,061.31
|
| Rate for Payer: Amerigroup Medicare |
$836.28
|
| 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 |
$828.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,051.01
|
| Rate for Payer: Medical Associates Commercial |
$1,380.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$828.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,288.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,066.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$952.20
|
| 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
|
HCPCS C1776
|
| Hospital Charge Code |
8026252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$828.00 |
| 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: Aetna of IA Medicare |
$1,048.80
|
| Rate for Payer: Amerigroup Medicaid |
$1,061.31
|
| Rate for Payer: Amerigroup Medicare |
$836.28
|
| 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 |
$828.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,051.01
|
| Rate for Payer: Medical Associates Commercial |
$1,380.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$828.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,288.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,066.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$952.20
|
| 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
|
HCPCS 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
|
OP
|
$1,905.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.25 |
| 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 |
$1,098.80
|
| Rate for Payer: Amerigroup Medicare |
$865.82
|
| 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 |
$857.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,088.14
|
| Rate for Payer: Medical Associates Commercial |
$1,428.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$857.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,333.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,104.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$985.84
|
| Rate for Payer: United Healthcare Commercial |
$1,714.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,123.95
|
|
|
FEMORAL HEAD HIP 32MM +8MM V40
|
Facility
|
IP
|
$1,905.00
|
|
|
Service Code
|
HCPCS 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
|
HCPCS L8699
|
| Hospital Charge Code |
8026276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,927.35 |
| 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 |
$2,470.43
|
| Rate for Payer: Amerigroup Medicare |
$1,946.62
|
| 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 |
$1,927.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,446.45
|
| Rate for Payer: Medical Associates Commercial |
$3,212.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,927.35
|
| Rate for Payer: Midlands Choice Commercial |
$2,998.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,482.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,216.45
|
| 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
|
HCPCS 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
|
HCPCS 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
|
HCPCS C1776
|
| Hospital Charge Code |
8026256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,574.55 |
| 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 |
$2,018.22
|
| Rate for Payer: Amerigroup Medicare |
$1,590.30
|
| 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 |
$1,574.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,998.63
|
| Rate for Payer: Medical Associates Commercial |
$2,624.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,574.55
|
| Rate for Payer: Midlands Choice Commercial |
$2,449.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,028.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,810.73
|
| 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
|
HCPCS C1776
|
| Hospital Charge Code |
8026260
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,574.55 |
| 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 |
$2,018.22
|
| Rate for Payer: Amerigroup Medicare |
$1,590.30
|
| 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 |
$1,574.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,998.63
|
| Rate for Payer: Medical Associates Commercial |
$2,624.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,574.55
|
| Rate for Payer: Midlands Choice Commercial |
$2,449.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,028.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,810.73
|
| 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
|
HCPCS 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
|
IP
|
$3,431.00
|
|
|
Service Code
|
HCPCS 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
|
$3,431.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8026258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.95 |
| 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 |
$1,979.00
|
| Rate for Payer: Amerigroup Medicare |
$1,559.39
|
| 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 |
$1,543.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,959.79
|
| Rate for Payer: Medical Associates Commercial |
$2,573.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,543.95
|
| Rate for Payer: Midlands Choice Commercial |
$2,401.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,988.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,775.54
|
| 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
|
OP
|
$3,499.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8026253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,574.55 |
| 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 |
$2,018.22
|
| Rate for Payer: Amerigroup Medicare |
$1,590.30
|
| 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 |
$1,574.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,998.63
|
| Rate for Payer: Medical Associates Commercial |
$2,624.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,574.55
|
| Rate for Payer: Midlands Choice Commercial |
$2,449.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,028.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,810.73
|
| 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
|
HCPCS 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
|
OP
|
$4,150.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,867.50 |
| 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 |
$2,393.72
|
| Rate for Payer: Amerigroup Medicare |
$1,886.18
|
| 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 |
$1,867.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,370.48
|
| Rate for Payer: Medical Associates Commercial |
$3,112.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,867.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,905.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,405.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,147.62
|
| Rate for Payer: United Healthcare Commercial |
$3,735.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,448.50
|
|
|
FEMORAL HEAD HIP 36MM +5MM V40 CERAMIC
|
Facility
|
IP
|
$4,150.00
|
|
|
Service Code
|
HCPCS 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 X +2.5MM
|
Facility
|
IP
|
$4,419.00
|
|
|
Service Code
|
HCPCS 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
|
HCPCS L8699
|
| Hospital Charge Code |
8046944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,988.55 |
| 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 |
$2,548.88
|
| Rate for Payer: Amerigroup Medicare |
$2,008.44
|
| 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 |
$1,988.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,524.13
|
| Rate for Payer: Medical Associates Commercial |
$3,314.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,988.55
|
| Rate for Payer: Midlands Choice Commercial |
$3,093.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,561.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,286.83
|
| 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
|
HCPCS 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 HEAD HIP CERAMIC V40 36MMX-5MM
|
Facility
|
OP
|
$4,419.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046942
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,988.55 |
| 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 |
$2,548.88
|
| Rate for Payer: Amerigroup Medicare |
$2,008.44
|
| 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 |
$1,988.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,524.13
|
| Rate for Payer: Medical Associates Commercial |
$3,314.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,988.55
|
| Rate for Payer: Midlands Choice Commercial |
$3,093.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,561.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,286.83
|
| Rate for Payer: United Healthcare Commercial |
$3,977.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,607.21
|
|
|
FEMORAL POSTERIOR STABILIZED
|
Facility
|
OP
|
$7,173.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,227.85 |
| 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 |
$4,137.39
|
| Rate for Payer: Amerigroup Medicare |
$3,260.13
|
| 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 |
$3,227.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,097.22
|
| Rate for Payer: Medical Associates Commercial |
$5,379.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,227.85
|
| Rate for Payer: Midlands Choice Commercial |
$5,021.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,157.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,712.03
|
| Rate for Payer: United Healthcare Commercial |
$6,455.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,232.07
|
|
