|
Hgb A1C
|
Facility
IP
|
$77.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
1383763
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of IA Commercial |
$69.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.30
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.75
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
|
|
HHN/MDI DEMONSTRATE AND/OR EVAL
|
Facility
IP
|
$165.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
5338934
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna of IA Commercial |
$148.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$148.50
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$123.75
|
| Rate for Payer: Medical Associates Commercial |
$123.75
|
| Rate for Payer: Midlands Choice Commercial |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$148.50
|
|
|
HHN/MDI DEMONSTRATE AND/OR EVAL
|
Facility
OP
|
$165.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
5338934
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$82.47 |
| Max. Negotiated Rate |
$218.24 |
| Rate for Payer: Aetna of IA Commercial |
$148.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$148.50
|
| Rate for Payer: Aetna of IA Medicare |
$94.05
|
| Rate for Payer: Amerigroup Medicaid |
$83.28
|
| Rate for Payer: Amerigroup Medicare |
$83.32
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$123.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$82.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$82.47
|
| Rate for Payer: Medical Associates Commercial |
$123.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$82.50
|
| Rate for Payer: Midlands Choice Commercial |
$115.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$83.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$123.75
|
| Rate for Payer: United Healthcare Commercial |
$148.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$97.35
|
| Rate for Payer: Wellmark IA HMO |
$198.40
|
| Rate for Payer: Wellmark IA PPO |
$218.24
|
|
|
Hip and Femur Procedures Except Major Joint With CC
|
Facility
IP
|
$20,104.12
|
|
|
Service Code
|
MS-DRG 481
|
| Hospital Charge Code |
301
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$20,104.12 |
| Rate for Payer: Amerigroup Medicaid |
$20,007.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19,812.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20,104.12
|
|
|
Hip and Femur Procedures Except Major Joint With MCC
|
Facility
IP
|
$27,465.26
|
|
|
Service Code
|
MS-DRG 480
|
| Hospital Charge Code |
300
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$27,465.26 |
| Rate for Payer: Amerigroup Medicaid |
$27,332.57
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27,067.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27,465.26
|
|
|
Hip and Femur Procedures Except Major Joint Without CC/MCC
|
Facility
IP
|
$14,166.19
|
|
|
Service Code
|
MS-DRG 482
|
| Hospital Charge Code |
302
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$14,166.19 |
| Rate for Payer: Amerigroup Medicaid |
$14,097.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13,960.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14,166.19
|
|
|
HIP FEMORAL HEAD 32MM
|
Facility
OP
|
$1,510.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8025900
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$754.70 |
| Max. Negotiated Rate |
$1,359.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,359.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,359.00
|
| Rate for Payer: Aetna of IA Medicare |
$860.70
|
| Rate for Payer: Amerigroup Medicaid |
$762.10
|
| Rate for Payer: Amerigroup Medicare |
$762.55
|
| Rate for Payer: Cash Price |
$1,208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,132.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$755.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$754.70
|
| Rate for Payer: Medical Associates Commercial |
$1,132.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$755.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,057.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$766.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,132.50
|
| Rate for Payer: United Healthcare Commercial |
$1,359.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$890.90
|
|
|
HIP FEMORAL HEAD 32MM
|
Facility
IP
|
$1,510.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8025900
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,057.00 |
| Max. Negotiated Rate |
$1,359.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,359.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,132.50
|
| Rate for Payer: Medical Associates Commercial |
$1,132.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,057.00
|
| Rate for Payer: United Healthcare Commercial |
$1,359.00
|
|
|
HIP REPLACEMENT
|
Facility
IP
|
$3,945.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.50 |
| Max. Negotiated Rate |
$3,550.50 |
| Rate for Payer: Aetna of IA Commercial |
$3,550.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,550.50
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,958.75
|
| Rate for Payer: Medical Associates Commercial |
$2,958.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,761.50
|
| Rate for Payer: United Healthcare Commercial |
$3,550.50
|
|
|
HIP REPLACEMENT
|
Facility
OP
|
$3,945.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,971.71 |
| Max. Negotiated Rate |
$3,550.50 |
| Rate for Payer: Aetna of IA Commercial |
$3,550.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,550.50
|
| Rate for Payer: Aetna of IA Medicare |
$2,248.65
|
| Rate for Payer: Amerigroup Medicaid |
$1,991.04
|
| Rate for Payer: Amerigroup Medicare |
$1,992.22
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,958.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,972.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,971.71
|
| Rate for Payer: Medical Associates Commercial |
$2,958.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,972.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,761.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,002.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,958.75
|
| Rate for Payer: United Healthcare Commercial |
$3,550.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,327.55
|
|
|
HIP REPLACEMENT INSERT 32MM 0 POLYETHYL
|
Facility
OP
|
$3,739.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,868.75 |
| Max. Negotiated Rate |
$3,365.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,365.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,365.10
|
| Rate for Payer: Aetna of IA Medicare |
$2,131.23
|
| Rate for Payer: Amerigroup Medicaid |
$1,887.07
|
| Rate for Payer: Amerigroup Medicare |
$1,888.20
|
| Rate for Payer: Cash Price |
$2,991.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,804.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,869.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,868.75
|
| Rate for Payer: Medical Associates Commercial |
$2,804.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,869.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,617.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,897.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,804.25
|
| Rate for Payer: United Healthcare Commercial |
$3,365.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,206.01
|
|
|
HIP REPLACEMENT INSERT 32MM 0 POLYETHYL
|
Facility
IP
|
$3,739.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.30 |
| Max. Negotiated Rate |
$3,365.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,365.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,365.10
|
| Rate for Payer: Cash Price |
$2,991.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,804.25
|
| Rate for Payer: Medical Associates Commercial |
$2,804.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,617.30
|
| Rate for Payer: United Healthcare Commercial |
$3,365.10
|
|
|
HIP REPLACEMENT INSERT-36D
|
Facility
IP
|
$3,830.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.00 |
| Max. Negotiated Rate |
$3,447.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,447.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,447.00
|
| Rate for Payer: Cash Price |
$3,064.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,872.50
|
| Rate for Payer: Medical Associates Commercial |
$2,872.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,681.00
|
| Rate for Payer: United Healthcare Commercial |
$3,447.00
|
|
|
HIP REPLACEMENT INSERT-36D
|
Facility
OP
|
$3,830.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,914.23 |
| Max. Negotiated Rate |
$3,447.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,447.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,447.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,183.10
|
| Rate for Payer: Amerigroup Medicaid |
$1,933.00
|
| Rate for Payer: Amerigroup Medicare |
$1,934.15
|
| Rate for Payer: Cash Price |
$3,064.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,872.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,915.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,914.23
|
| Rate for Payer: Medical Associates Commercial |
$2,872.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,915.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,681.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,943.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,872.50
|
| Rate for Payer: United Healthcare Commercial |
$3,447.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,259.70
|
|
|
HIP REPLACEMENT INSERT-36G
|
Facility
OP
|
$3,945.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,971.71 |
| Max. Negotiated Rate |
$3,550.50 |
| Rate for Payer: Aetna of IA Commercial |
$3,550.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,550.50
|
| Rate for Payer: Aetna of IA Medicare |
$2,248.65
|
| Rate for Payer: Amerigroup Medicaid |
$1,991.04
|
| Rate for Payer: Amerigroup Medicare |
$1,992.22
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,958.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,972.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,971.71
|
| Rate for Payer: Medical Associates Commercial |
$2,958.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,972.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,761.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,002.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,958.75
|
| Rate for Payer: United Healthcare Commercial |
$3,550.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,327.55
|
|
|
HIP REPLACEMENT INSERT-36G
|
Facility
IP
|
$3,945.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.50 |
| Max. Negotiated Rate |
$3,550.50 |
| Rate for Payer: Aetna of IA Commercial |
$3,550.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,550.50
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,958.75
|
| Rate for Payer: Medical Associates Commercial |
$2,958.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,761.50
|
| Rate for Payer: United Healthcare Commercial |
$3,550.50
|
|
|
HIP REPLACEMENT INSERT 36MM 0 POLYETHYL
|
Facility
IP
|
$4,082.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,857.40 |
| Max. Negotiated Rate |
$3,673.80 |
| Rate for Payer: Aetna of IA Commercial |
$3,673.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,673.80
|
| Rate for Payer: Cash Price |
$3,265.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,061.50
|
| Rate for Payer: Medical Associates Commercial |
$3,061.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,857.40
|
| Rate for Payer: United Healthcare Commercial |
$3,673.80
|
|
|
HIP REPLACEMENT INSERT 36MM 0 POLYETHYL
|
Facility
OP
|
$4,082.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.18 |
| Max. Negotiated Rate |
$3,673.80 |
| Rate for Payer: Aetna of IA Commercial |
$3,673.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,673.80
|
| Rate for Payer: Aetna of IA Medicare |
$2,326.74
|
| Rate for Payer: Amerigroup Medicaid |
$2,060.19
|
| Rate for Payer: Amerigroup Medicare |
$2,061.41
|
| Rate for Payer: Cash Price |
$3,265.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,061.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,041.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,040.18
|
| Rate for Payer: Medical Associates Commercial |
$3,061.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,041.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,857.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,071.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,061.50
|
| Rate for Payer: United Healthcare Commercial |
$3,673.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,408.38
|
|
|
HIP REPLACEMENT INSERT 36MM POLYETHYLENE
|
Facility
IP
|
$4,214.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.80 |
| Max. Negotiated Rate |
$3,792.60 |
| Rate for Payer: Aetna of IA Commercial |
$3,792.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,792.60
|
| Rate for Payer: Cash Price |
$3,371.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,160.50
|
| Rate for Payer: Medical Associates Commercial |
$3,160.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,949.80
|
| Rate for Payer: United Healthcare Commercial |
$3,792.60
|
|
|
HIP REPLACEMENT INSERT 36MM POLYETHYLENE
|
Facility
OP
|
$4,214.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.16 |
| Max. Negotiated Rate |
$3,792.60 |
| Rate for Payer: Aetna of IA Commercial |
$3,792.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,792.60
|
| Rate for Payer: Aetna of IA Medicare |
$2,401.98
|
| Rate for Payer: Amerigroup Medicaid |
$2,126.81
|
| Rate for Payer: Amerigroup Medicare |
$2,128.07
|
| Rate for Payer: Cash Price |
$3,371.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,160.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,107.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,106.16
|
| Rate for Payer: Medical Associates Commercial |
$3,160.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,107.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,949.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,138.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,160.50
|
| Rate for Payer: United Healthcare Commercial |
$3,792.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,486.26
|
|
|
HIP REPLACEMENT INSERT 36MM POLYETHYLENE-1
|
Facility
IP
|
$3,945.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.50 |
| Max. Negotiated Rate |
$3,550.50 |
| Rate for Payer: Aetna of IA Commercial |
$3,550.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,550.50
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,958.75
|
| Rate for Payer: Medical Associates Commercial |
$2,958.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,761.50
|
| Rate for Payer: United Healthcare Commercial |
$3,550.50
|
|
|
HIP REPLACEMENT INSERT 36MM POLYETHYLENE-1
|
Facility
OP
|
$3,945.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,971.71 |
| Max. Negotiated Rate |
$3,550.50 |
| Rate for Payer: Aetna of IA Commercial |
$3,550.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,550.50
|
| Rate for Payer: Aetna of IA Medicare |
$2,248.65
|
| Rate for Payer: Amerigroup Medicaid |
$1,991.04
|
| Rate for Payer: Amerigroup Medicare |
$1,992.22
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,958.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,972.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,971.71
|
| Rate for Payer: Medical Associates Commercial |
$2,958.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,972.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,761.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,002.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,958.75
|
| Rate for Payer: United Healthcare Commercial |
$3,550.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,327.55
|
|
|
HIP REPLACEMENT INSERT 36MM POLYETHYLENE-2
|
Facility
IP
|
$3,945.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.50 |
| Max. Negotiated Rate |
$3,550.50 |
| Rate for Payer: Aetna of IA Commercial |
$3,550.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,550.50
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,958.75
|
| Rate for Payer: Medical Associates Commercial |
$2,958.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,761.50
|
| Rate for Payer: United Healthcare Commercial |
$3,550.50
|
|
|
HIP REPLACEMENT INSERT 36MM POLYETHYLENE-2
|
Facility
OP
|
$3,945.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,971.71 |
| Max. Negotiated Rate |
$3,550.50 |
| Rate for Payer: Aetna of IA Commercial |
$3,550.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,550.50
|
| Rate for Payer: Aetna of IA Medicare |
$2,248.65
|
| Rate for Payer: Amerigroup Medicaid |
$1,991.04
|
| Rate for Payer: Amerigroup Medicare |
$1,992.22
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,958.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,972.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,971.71
|
| Rate for Payer: Medical Associates Commercial |
$2,958.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,972.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,761.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,002.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,958.75
|
| Rate for Payer: United Healthcare Commercial |
$3,550.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,327.55
|
|
|
Hip Replacement With Principal Diagnosis of Hip Fracture With MCC
|
Facility
IP
|
$29,026.26
|
|
|
Service Code
|
MS-DRG 521
|
| Hospital Charge Code |
338
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$29,026.26 |
| Rate for Payer: Amerigroup Medicaid |
$28,886.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28,605.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29,026.26
|
|
