|
doxycycline 100 mg SDV Inj
|
Facility
IP
|
$66.97
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43702126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$60.27 |
| Rate for Payer: Aetna of IA Commercial |
$60.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.27
|
| Rate for Payer: Cash Price |
$53.58
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.23
|
| Rate for Payer: Medical Associates Commercial |
$50.23
|
| Rate for Payer: Midlands Choice Commercial |
$46.88
|
| Rate for Payer: United Healthcare Commercial |
$60.27
|
|
|
doxycycline hyclate 100 mg Tab
|
Facility
OP
|
$1.74
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701896
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of IA Commercial |
$1.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.57
|
| Rate for Payer: Aetna of IA Medicare |
$0.99
|
| Rate for Payer: Amerigroup Medicaid |
$0.88
|
| Rate for Payer: Amerigroup Medicare |
$0.88
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.30
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.87
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.87
|
| Rate for Payer: Medical Associates Commercial |
$1.30
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.87
|
| Rate for Payer: Midlands Choice Commercial |
$1.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.30
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.03
|
|
|
doxycycline hyclate 100 mg Tab
|
Facility
IP
|
$1.74
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701896
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of IA Commercial |
$1.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.57
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.30
|
| Rate for Payer: Medical Associates Commercial |
$1.30
|
| Rate for Payer: Midlands Choice Commercial |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
|
|
DRAINAGE OF FINGER ABSCESS
|
Professional
|
$876.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
7982804
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$129.05 |
| Max. Negotiated Rate |
$613.20 |
| Rate for Payer: Aetna of IA Medicare |
$129.05
|
| Rate for Payer: Amerigroup Medicaid |
$133.44
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$154.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$131.63
|
| Rate for Payer: Medical Associates Commercial |
$245.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$129.05
|
| Rate for Payer: Midlands Choice Commercial |
$613.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$193.58
|
| Rate for Payer: Wellmark IA HMO |
$271.00
|
| Rate for Payer: Wellmark IA PPO |
$318.00
|
|
|
DRAINAGE OF GUM LESION
|
Professional
|
$931.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
7982772
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$651.70 |
| Rate for Payer: Aetna of IA Medicare |
$139.65
|
| Rate for Payer: Amerigroup Medicaid |
$144.40
|
| Rate for Payer: Cash Price |
$744.80
|
| Rate for Payer: Cash Price |
$744.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$167.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$142.44
|
| Rate for Payer: Medical Associates Commercial |
$265.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$139.65
|
| Rate for Payer: Midlands Choice Commercial |
$651.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$209.48
|
| Rate for Payer: Wellmark IA HMO |
$294.00
|
| Rate for Payer: Wellmark IA PPO |
$345.00
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Professional
|
$540.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
7982855
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$108.09 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of IA Medicare |
$108.09
|
| Rate for Payer: Amerigroup Medicaid |
$111.77
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$129.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$110.25
|
| Rate for Payer: Medical Associates Commercial |
$205.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$108.09
|
| Rate for Payer: Midlands Choice Commercial |
$378.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$162.14
|
| Rate for Payer: Wellmark IA HMO |
$224.00
|
| Rate for Payer: Wellmark IA PPO |
$262.00
|
|
|
DRAINAGE OF MOUTH LESION
|
Professional
|
$718.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
7982774
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$108.59 |
| Max. Negotiated Rate |
$502.60 |
| Rate for Payer: Aetna of IA Medicare |
$108.59
|
| Rate for Payer: Amerigroup Medicaid |
$112.28
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$130.31
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$110.76
|
| Rate for Payer: Medical Associates Commercial |
$206.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$108.59
|
| Rate for Payer: Midlands Choice Commercial |
$502.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$162.88
|
| Rate for Payer: Wellmark IA HMO |
$212.00
|
| Rate for Payer: Wellmark IA PPO |
$249.00
|
|
|
DRAINAGE OF PILONIDAL CYST
|
Professional
|
$425.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
7982858
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$95.56 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Aetna of IA Medicare |
$95.56
|
| Rate for Payer: Amerigroup Medicaid |
$98.81
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.67
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$97.47
|
| Rate for Payer: Medical Associates Commercial |
$181.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$95.56
|
| Rate for Payer: Midlands Choice Commercial |
$297.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$143.34
|
| Rate for Payer: Wellmark IA HMO |
$199.00
|
| Rate for Payer: Wellmark IA PPO |
$233.00
|
|
|
DRAINAGE OF PILONIDAL CYST
|
Professional
|
$890.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
7982857
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$154.07 |
| Max. Negotiated Rate |
$623.00 |
| Rate for Payer: Aetna of IA Medicare |
$154.07
|
| Rate for Payer: Amerigroup Medicaid |
$159.31
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$184.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$157.15
|
| Rate for Payer: Medical Associates Commercial |
$292.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$154.07
|
| Rate for Payer: Midlands Choice Commercial |
$623.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$231.10
|
| Rate for Payer: Wellmark IA HMO |
$325.00
|
| Rate for Payer: Wellmark IA PPO |
$381.00
|
|
|
DRAINAGE OF RECTAL ABSCESS
|
Professional
|
$917.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
7982863
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$147.62 |
| Max. Negotiated Rate |
$641.90 |
| Rate for Payer: Aetna of IA Medicare |
$147.62
|
| Rate for Payer: Amerigroup Medicaid |
$152.64
|
| Rate for Payer: Cash Price |
$733.60
|
| Rate for Payer: Cash Price |
$733.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$177.14
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$150.57
|
| Rate for Payer: Medical Associates Commercial |
$280.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$147.62
|
| Rate for Payer: Midlands Choice Commercial |
$641.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$221.43
|
| Rate for Payer: Wellmark IA HMO |
$319.00
|
| Rate for Payer: Wellmark IA PPO |
$375.00
|
|
|
DRAINAGE OF SKIN ABSCESS
|
Professional
|
$558.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
7982859
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$168.42 |
| Max. Negotiated Rate |
$409.00 |
| Rate for Payer: Aetna of IA Medicare |
$168.42
|
| Rate for Payer: Amerigroup Medicaid |
$174.15
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$171.79
|
| Rate for Payer: Medical Associates Commercial |
$320.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$168.42
|
| Rate for Payer: Midlands Choice Commercial |
$390.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$252.63
|
| Rate for Payer: Wellmark IA HMO |
$348.00
|
| Rate for Payer: Wellmark IA PPO |
$409.00
|
|
|
DRAIN BLOOD FROM UNDER NAIL
|
Professional
|
$163.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
7982848
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$114.10 |
| Rate for Payer: Aetna of IA Medicare |
$29.60
|
| Rate for Payer: Amerigroup Medicaid |
$30.61
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.19
|
| Rate for Payer: Medical Associates Commercial |
$56.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.60
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.40
|
| Rate for Payer: Wellmark IA HMO |
$61.00
|
| Rate for Payer: Wellmark IA PPO |
$71.00
|
|
|
DRAIN BL W/CATH INSERTION
|
Professional
|
$756.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
7982768
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$129.22 |
| Max. Negotiated Rate |
$529.20 |
| Rate for Payer: Aetna of IA Medicare |
$129.22
|
| Rate for Payer: Amerigroup Medicaid |
$133.61
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$155.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$131.80
|
| Rate for Payer: Medical Associates Commercial |
$245.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$129.22
|
| Rate for Payer: Midlands Choice Commercial |
$529.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$193.83
|
| Rate for Payer: Wellmark IA HMO |
$269.00
|
| Rate for Payer: Wellmark IA PPO |
$316.00
|
|
|
DRAIN CEREBRO SPINAL FLUID
|
Facility
OP
|
$1,120.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
7982915
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$559.78 |
| Max. Negotiated Rate |
$1,487.44 |
| Rate for Payer: Aetna of IA Commercial |
$1,008.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,008.00
|
| Rate for Payer: Aetna of IA Medicare |
$638.40
|
| Rate for Payer: Amerigroup Medicaid |
$565.26
|
| Rate for Payer: Amerigroup Medicare |
$565.60
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$840.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$560.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$559.78
|
| Rate for Payer: Medical Associates Commercial |
$840.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$560.00
|
| Rate for Payer: Midlands Choice Commercial |
$784.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$568.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$840.00
|
| Rate for Payer: United Healthcare Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$660.80
|
| Rate for Payer: Wellmark IA HMO |
$1,352.22
|
| Rate for Payer: Wellmark IA PPO |
$1,487.44
|
|
|
DRAIN CEREBRO SPINAL FLUID
|
Facility
IP
|
$1,120.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
7982915
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$784.00 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,008.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,008.00
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$840.00
|
| Rate for Payer: Medical Associates Commercial |
$840.00
|
| Rate for Payer: Midlands Choice Commercial |
$784.00
|
| Rate for Payer: United Healthcare Commercial |
$1,008.00
|
|
|
DRAIN EXTERNAL EAR LESION
|
Professional
|
$620.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
7982761
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$114.44 |
| Max. Negotiated Rate |
$434.00 |
| Rate for Payer: Aetna of IA Medicare |
$114.44
|
| Rate for Payer: Amerigroup Medicaid |
$118.33
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$137.33
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$116.73
|
| Rate for Payer: Medical Associates Commercial |
$217.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$114.44
|
| Rate for Payer: Midlands Choice Commercial |
$434.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$171.66
|
| Rate for Payer: Wellmark IA HMO |
$239.00
|
| Rate for Payer: Wellmark IA PPO |
$280.00
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Professional
|
$143.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
7982814
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$40.97 |
| Max. Negotiated Rate |
$100.10 |
| Rate for Payer: Aetna of IA Medicare |
$40.97
|
| Rate for Payer: Amerigroup Medicaid |
$42.36
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.79
|
| Rate for Payer: Medical Associates Commercial |
$77.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.97
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$61.46
|
| Rate for Payer: Wellmark IA HMO |
$80.00
|
| Rate for Payer: Wellmark IA PPO |
$94.00
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
IP
|
$402.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
4864802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.40 |
| Max. Negotiated Rate |
$361.80 |
| Rate for Payer: Aetna of IA Commercial |
$361.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$361.80
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$301.50
|
| Rate for Payer: Medical Associates Commercial |
$301.50
|
| Rate for Payer: Midlands Choice Commercial |
$281.40
|
| Rate for Payer: United Healthcare Commercial |
$361.80
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Professional
|
$111.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
7982815
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$77.70 |
| Rate for Payer: Aetna of IA Medicare |
$32.52
|
| Rate for Payer: Amerigroup Medicaid |
$33.63
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.17
|
| Rate for Payer: Medical Associates Commercial |
$61.79
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.52
|
| Rate for Payer: Midlands Choice Commercial |
$77.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.78
|
| Rate for Payer: Wellmark IA HMO |
$63.00
|
| Rate for Payer: Wellmark IA PPO |
$74.00
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
OP
|
$402.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
4864802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.92 |
| Max. Negotiated Rate |
$705.87 |
| Rate for Payer: Aetna of IA Commercial |
$361.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$361.80
|
| Rate for Payer: Aetna of IA Medicare |
$229.14
|
| Rate for Payer: Amerigroup Medicaid |
$202.89
|
| Rate for Payer: Amerigroup Medicare |
$203.01
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$301.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$201.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$200.92
|
| Rate for Payer: Medical Associates Commercial |
$301.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$201.00
|
| Rate for Payer: Midlands Choice Commercial |
$281.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$204.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$301.50
|
| Rate for Payer: United Healthcare Commercial |
$361.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$237.18
|
| Rate for Payer: Wellmark IA HMO |
$641.70
|
| Rate for Payer: Wellmark IA PPO |
$705.87
|
|
|
DRAIN LOWER LEG LESION
|
Professional
|
$1,761.00
|
|
|
Service Code
|
CPT 27603
|
| Hospital Charge Code |
7982865
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$354.08 |
| Max. Negotiated Rate |
$1,232.70 |
| Rate for Payer: Aetna of IA Medicare |
$354.08
|
| Rate for Payer: Amerigroup Medicaid |
$366.12
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$424.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$361.16
|
| Rate for Payer: Medical Associates Commercial |
$672.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$354.08
|
| Rate for Payer: Midlands Choice Commercial |
$1,232.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$531.12
|
| Rate for Payer: Wellmark IA HMO |
$750.00
|
| Rate for Payer: Wellmark IA PPO |
$880.00
|
|
|
DRAIN THIGH/KNEE LESION
|
Professional
|
$2,238.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
7982796
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$460.74 |
| Max. Negotiated Rate |
$1,566.60 |
| Rate for Payer: Aetna of IA Medicare |
$460.74
|
| Rate for Payer: Amerigroup Medicaid |
$476.41
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$552.89
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$469.95
|
| Rate for Payer: Medical Associates Commercial |
$875.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$460.74
|
| Rate for Payer: Midlands Choice Commercial |
$1,566.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$691.11
|
| Rate for Payer: Wellmark IA HMO |
$975.00
|
| Rate for Payer: Wellmark IA PPO |
$1,144.00
|
|
|
DRESS/DEBRID P-THICK BURN M
|
Professional
|
$489.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
7982817
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$100.48 |
| Max. Negotiated Rate |
$342.30 |
| Rate for Payer: Aetna of IA Medicare |
$100.48
|
| Rate for Payer: Amerigroup Medicaid |
$103.90
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$102.49
|
| Rate for Payer: Medical Associates Commercial |
$190.91
|
| Rate for Payer: Medical Associates Managed Medicare |
$100.48
|
| Rate for Payer: Midlands Choice Commercial |
$342.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$150.72
|
| Rate for Payer: Wellmark IA HMO |
$209.00
|
| Rate for Payer: Wellmark IA PPO |
$245.00
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Professional
|
$219.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
7982818
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$50.46 |
| Max. Negotiated Rate |
$153.30 |
| Rate for Payer: Aetna of IA Medicare |
$50.46
|
| Rate for Payer: Amerigroup Medicaid |
$52.18
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$60.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.47
|
| Rate for Payer: Medical Associates Commercial |
$95.87
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.46
|
| Rate for Payer: Midlands Choice Commercial |
$153.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.69
|
| Rate for Payer: Wellmark IA HMO |
$105.00
|
| Rate for Payer: Wellmark IA PPO |
$123.00
|
|
|
DRILL BIT 4.2X180MM AO SMALL
|
Facility
OP
|
$214.00
|
|
| Hospital Charge Code |
8046331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.96 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Aetna of IA Commercial |
$192.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$192.60
|
| Rate for Payer: Aetna of IA Medicare |
$121.98
|
| Rate for Payer: Amerigroup Medicaid |
$108.01
|
| Rate for Payer: Amerigroup Medicare |
$108.07
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$160.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$107.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$106.96
|
| Rate for Payer: Medical Associates Commercial |
$160.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$107.00
|
| Rate for Payer: Midlands Choice Commercial |
$149.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$108.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$160.50
|
| Rate for Payer: United Healthcare Commercial |
$192.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$126.26
|
|
