|
Herpes Simplex PCR Qual Stat DMCL
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8037870
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
Herpes Simplex Virus by PCR DMCL
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8037872
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$114.21
|
| Rate for Payer: Amerigroup Medicare |
$89.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$89.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.10
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.10
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.47
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
Herpes Simplex Virus by PCR DMCL
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8037872
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
Herpes Simplex Virus IgM Antibody DMCL
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
8037873
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna of IA Commercial |
$106.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$106.20
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$88.50
|
| Rate for Payer: Medical Associates Commercial |
$88.50
|
| Rate for Payer: Midlands Choice Commercial |
$82.60
|
| Rate for Payer: United Healthcare Commercial |
$106.20
|
|
|
Herpes Simplex Virus IgM Antibody DMCL
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
8037873
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.10 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna of IA Commercial |
$106.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$106.20
|
| Rate for Payer: Aetna of IA Medicare |
$67.26
|
| Rate for Payer: Amerigroup Medicaid |
$68.06
|
| Rate for Payer: Amerigroup Medicare |
$53.63
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$88.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$53.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.40
|
| Rate for Payer: Medical Associates Commercial |
$88.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$53.10
|
| Rate for Payer: Midlands Choice Commercial |
$82.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$61.06
|
| Rate for Payer: United Healthcare Commercial |
$106.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.62
|
|
|
HERPES SIMPLEX VIRUS PCR
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8093935
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$114.21
|
| Rate for Payer: Amerigroup Medicare |
$89.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$89.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.10
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.10
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.47
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
HERPES SIMPLEX VIRUS PCR
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8093935
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
hetastarch 60 mg/mL-NS IV Sol [VDMC]
|
Facility
|
OP
|
$112.26
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10393629
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.52 |
| Max. Negotiated Rate |
$101.03 |
| Rate for Payer: Aetna of IA Commercial |
$101.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$101.03
|
| Rate for Payer: Aetna of IA Medicare |
$63.99
|
| Rate for Payer: Amerigroup Medicaid |
$64.75
|
| Rate for Payer: Amerigroup Medicare |
$51.02
|
| Rate for Payer: Cash Price |
$89.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$84.19
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$50.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.12
|
| Rate for Payer: Medical Associates Commercial |
$84.19
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.52
|
| Rate for Payer: Midlands Choice Commercial |
$78.58
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$65.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$58.09
|
| Rate for Payer: United Healthcare Commercial |
$101.03
|
| Rate for Payer: United Healthcare Managed Medicare |
$66.23
|
|
|
hetastarch 60 mg/mL-NS IV Sol [VDMC]
|
Facility
|
IP
|
$112.26
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10393629
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$101.03 |
| Rate for Payer: Aetna of IA Commercial |
$101.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$101.03
|
| Rate for Payer: Cash Price |
$89.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$84.19
|
| Rate for Payer: Medical Associates Commercial |
$84.19
|
| Rate for Payer: Midlands Choice Commercial |
$78.58
|
| Rate for Payer: United Healthcare Commercial |
$101.03
|
|
|
Hgb A1C
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
1383763
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.65 |
| 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: Aetna of IA Medicare |
$43.89
|
| Rate for Payer: Amerigroup Medicaid |
$44.41
|
| Rate for Payer: Amerigroup Medicare |
$35.00
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.98
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.65
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.85
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.43
|
|
|
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
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
5338934
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$74.25 |
| 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: Aetna of IA Medicare |
$94.05
|
| Rate for Payer: Amerigroup Medicaid |
$95.17
|
| Rate for Payer: Amerigroup Medicare |
$74.99
|
| 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 |
$74.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$94.25
|
| Rate for Payer: Medical Associates Commercial |
$123.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$74.25
|
| Rate for Payer: Midlands Choice Commercial |
$115.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$95.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.39
|
| Rate for Payer: United Healthcare Commercial |
$148.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$97.35
|
|
|
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
|
|
|
HIP FEMORAL HEAD 32MM
|
Facility
|
IP
|
$1,510.00
|
|
|
Service Code
|
HCPCS 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 FEMORAL HEAD 32MM
|
Facility
|
OP
|
$1,510.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8025900
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.50 |
| 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 |
$870.97
|
| Rate for Payer: Amerigroup Medicare |
$686.29
|
| 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 |
$679.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$862.51
|
| Rate for Payer: Medical Associates Commercial |
$1,132.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$679.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,057.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$875.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$781.42
|
| Rate for Payer: United Healthcare Commercial |
$1,359.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$890.90
|
|
|
HIP REPLACEMENT
|
Facility
|
OP
|
$3,945.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,775.25 |
| 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 |
$2,275.48
|
| Rate for Payer: Amerigroup Medicare |
$1,793.00
|
| 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 |
$1,775.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,253.38
|
| Rate for Payer: Medical Associates Commercial |
$2,958.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,775.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,761.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,286.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,041.54
|
| Rate for Payer: United Healthcare Commercial |
$3,550.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,327.55
|
|
|
HIP REPLACEMENT
|
Facility
|
IP
|
$3,945.00
|
|
|
Service Code
|
HCPCS 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 INSERT 32MM 0 POLYETHYL
|
Facility
|
IP
|
$3,739.00
|
|
|
Service Code
|
HCPCS 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 32MM 0 POLYETHYL
|
Facility
|
OP
|
$3,739.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,682.55 |
| 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 |
$2,156.66
|
| Rate for Payer: Amerigroup Medicare |
$1,699.38
|
| 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 |
$1,682.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,135.72
|
| Rate for Payer: Medical Associates Commercial |
$2,804.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,682.55
|
| Rate for Payer: Midlands Choice Commercial |
$2,617.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,167.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,934.93
|
| Rate for Payer: United Healthcare Commercial |
$3,365.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,206.01
|
|
|
HIP REPLACEMENT INSERT-36D
|
Facility
|
OP
|
$3,830.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,723.50 |
| 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 |
$2,209.14
|
| Rate for Payer: Amerigroup Medicare |
$1,740.73
|
| 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 |
$1,723.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,187.70
|
| Rate for Payer: Medical Associates Commercial |
$2,872.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,723.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,681.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,219.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,982.03
|
| Rate for Payer: United Healthcare Commercial |
$3,447.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,259.70
|
|
|
HIP REPLACEMENT INSERT-36D
|
Facility
|
IP
|
$3,830.00
|
|
|
Service Code
|
HCPCS 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-36G
|
Facility
|
OP
|
$3,945.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,775.25 |
| 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 |
$2,275.48
|
| Rate for Payer: Amerigroup Medicare |
$1,793.00
|
| 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 |
$1,775.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,253.38
|
| Rate for Payer: Medical Associates Commercial |
$2,958.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,775.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,761.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,286.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,041.54
|
| 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
|
HCPCS 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
|
OP
|
$4,082.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,836.90 |
| 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 |
$2,354.50
|
| Rate for Payer: Amerigroup Medicare |
$1,855.27
|
| 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 |
$1,836.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,331.64
|
| Rate for Payer: Medical Associates Commercial |
$3,061.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,836.90
|
| Rate for Payer: Midlands Choice Commercial |
$2,857.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,365.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,112.43
|
| Rate for Payer: United Healthcare Commercial |
$3,673.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,408.38
|
|
|
HIP REPLACEMENT INSERT 36MM 0 POLYETHYL
|
Facility
|
IP
|
$4,082.00
|
|
|
Service Code
|
HCPCS 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
|
|
