|
EXC FACE-MM B9+MARG 1.1-2 CM
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
7982973
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$366.75 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Aetna of IA Medicare |
$464.55
|
| Rate for Payer: Amerigroup Medicaid |
$470.09
|
| Rate for Payer: Amerigroup Medicare |
$370.42
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$366.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$465.53
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$366.75
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$472.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$421.76
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$480.85
|
|
|
EXC FACE-MM B9+MARG 2.1-3 CM
|
Facility
|
IP
|
$3,393.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
7982972
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,375.10 |
| Max. Negotiated Rate |
$3,053.70 |
| Rate for Payer: Aetna of IA Commercial |
$3,053.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,053.70
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,544.75
|
| Rate for Payer: Medical Associates Commercial |
$2,544.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,375.10
|
| Rate for Payer: United Healthcare Commercial |
$3,053.70
|
|
|
EXC FACE-MM B9+MARG 2.1-3 CM
|
Facility
|
OP
|
$3,393.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
7982972
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,526.85 |
| Max. Negotiated Rate |
$3,053.70 |
| Rate for Payer: Aetna of IA Commercial |
$3,053.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,053.70
|
| Rate for Payer: Aetna of IA Medicare |
$1,934.01
|
| Rate for Payer: Amerigroup Medicaid |
$1,957.08
|
| Rate for Payer: Amerigroup Medicare |
$1,542.12
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,544.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,526.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,938.08
|
| Rate for Payer: Medical Associates Commercial |
$2,544.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,526.85
|
| Rate for Payer: Midlands Choice Commercial |
$2,375.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,966.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,755.88
|
| Rate for Payer: United Healthcare Commercial |
$3,053.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,001.87
|
|
|
EXC FACE-MM B9+MARG 3.1-4 CM
|
Facility
|
OP
|
$3,393.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
7982971
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,526.85 |
| Max. Negotiated Rate |
$3,053.70 |
| Rate for Payer: Aetna of IA Commercial |
$3,053.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,053.70
|
| Rate for Payer: Aetna of IA Medicare |
$1,934.01
|
| Rate for Payer: Amerigroup Medicaid |
$1,957.08
|
| Rate for Payer: Amerigroup Medicare |
$1,542.12
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,544.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,526.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,938.08
|
| Rate for Payer: Medical Associates Commercial |
$2,544.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,526.85
|
| Rate for Payer: Midlands Choice Commercial |
$2,375.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,966.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,755.88
|
| Rate for Payer: United Healthcare Commercial |
$3,053.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,001.87
|
|
|
EXC FACE-MM B9+MARG 3.1-4 CM
|
Facility
|
IP
|
$3,393.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
7982971
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,375.10 |
| Max. Negotiated Rate |
$3,053.70 |
| Rate for Payer: Aetna of IA Commercial |
$3,053.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,053.70
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,544.75
|
| Rate for Payer: Medical Associates Commercial |
$2,544.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,375.10
|
| Rate for Payer: United Healthcare Commercial |
$3,053.70
|
|
|
EXC F/E/E/N/L MAL+MRG 0.5CM<
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
7982970
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$366.75 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Aetna of IA Medicare |
$464.55
|
| Rate for Payer: Amerigroup Medicaid |
$470.09
|
| Rate for Payer: Amerigroup Medicare |
$370.42
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$366.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$465.53
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$366.75
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$472.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$421.76
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$480.85
|
|
|
EXC F/E/E/N/L MAL+MRG 0.5CM<
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
7982970
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$570.50 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
|
|
EXC F/E/E/N/L MAL+MRG 0.6-1
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
7982969
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$570.50 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
|
|
EXC F/E/E/N/L MAL+MRG 0.6-1
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
7982969
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$366.75 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Aetna of IA Medicare |
$464.55
|
| Rate for Payer: Amerigroup Medicaid |
$470.09
|
| Rate for Payer: Amerigroup Medicare |
$370.42
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$366.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$465.53
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$366.75
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$472.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$421.76
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$480.85
|
|
|
EXC F/E/E/N/L MAL+MRG 1.1-2
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
7982968
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$570.50 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
|
|
EXC F/E/E/N/L MAL+MRG 1.1-2
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
7982968
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$366.75 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Aetna of IA Medicare |
$464.55
|
| Rate for Payer: Amerigroup Medicaid |
$470.09
|
| Rate for Payer: Amerigroup Medicare |
$370.42
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$366.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$465.53
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$366.75
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$472.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$421.76
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$480.85
|
|
|
EXC F/E/E/N/L MAL+MRG 2.1-3
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
CPT 11643
|
| Hospital Charge Code |
7982967
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,484.00 |
| Max. Negotiated Rate |
$1,908.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,908.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,908.00
|
| Rate for Payer: Cash Price |
$1,696.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,590.00
|
| Rate for Payer: Medical Associates Commercial |
$1,590.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,484.00
|
| Rate for Payer: United Healthcare Commercial |
$1,908.00
|
|
|
EXC F/E/E/N/L MAL+MRG 2.1-3
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
CPT 11643
|
| Hospital Charge Code |
7982967
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$954.00 |
| Max. Negotiated Rate |
$1,908.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,908.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,908.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,208.40
|
| Rate for Payer: Amerigroup Medicaid |
$1,222.82
|
| Rate for Payer: Amerigroup Medicare |
$963.54
|
| Rate for Payer: Cash Price |
$1,696.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,590.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$954.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,210.94
|
| Rate for Payer: Medical Associates Commercial |
$1,590.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$954.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,484.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,228.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,097.10
|
| Rate for Payer: United Healthcare Commercial |
$1,908.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,250.80
|
|
|
EXC F/E/E/N/L MAL+MRG 3.1-4
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
CPT 11644
|
| Hospital Charge Code |
7982966
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$954.00 |
| Max. Negotiated Rate |
$1,908.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,908.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,908.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,208.40
|
| Rate for Payer: Amerigroup Medicaid |
$1,222.82
|
| Rate for Payer: Amerigroup Medicare |
$963.54
|
| Rate for Payer: Cash Price |
$1,696.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,590.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$954.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,210.94
|
| Rate for Payer: Medical Associates Commercial |
$1,590.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$954.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,484.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,228.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,097.10
|
| Rate for Payer: United Healthcare Commercial |
$1,908.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,250.80
|
|
|
EXC F/E/E/N/L MAL+MRG 3.1-4
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
CPT 11644
|
| Hospital Charge Code |
7982966
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,484.00 |
| Max. Negotiated Rate |
$1,908.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,908.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,908.00
|
| Rate for Payer: Cash Price |
$1,696.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,590.00
|
| Rate for Payer: Medical Associates Commercial |
$1,590.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,484.00
|
| Rate for Payer: United Healthcare Commercial |
$1,908.00
|
|
|
EXC F/E/E/N/L MAL+MRG >4 CM
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
CPT 11646
|
| Hospital Charge Code |
7982965
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,484.00 |
| Max. Negotiated Rate |
$1,908.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,908.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,908.00
|
| Rate for Payer: Cash Price |
$1,696.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,590.00
|
| Rate for Payer: Medical Associates Commercial |
$1,590.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,484.00
|
| Rate for Payer: United Healthcare Commercial |
$1,908.00
|
|
|
EXC F/E/E/N/L MAL+MRG >4 CM
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
CPT 11646
|
| Hospital Charge Code |
7982965
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$954.00 |
| Max. Negotiated Rate |
$1,908.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,908.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,908.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,208.40
|
| Rate for Payer: Amerigroup Medicaid |
$1,222.82
|
| Rate for Payer: Amerigroup Medicare |
$963.54
|
| Rate for Payer: Cash Price |
$1,696.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,590.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$954.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,210.94
|
| Rate for Payer: Medical Associates Commercial |
$1,590.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$954.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,484.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,228.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,097.10
|
| Rate for Payer: United Healthcare Commercial |
$1,908.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,250.80
|
|
|
EXC FOOT/TOE TUM SC 1.5 CM/>
|
Facility
|
IP
|
$2,788.00
|
|
|
Service Code
|
CPT 28039
|
| Hospital Charge Code |
7982950
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,951.60 |
| Max. Negotiated Rate |
$2,509.20 |
| Rate for Payer: Aetna of IA Commercial |
$2,509.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,509.20
|
| Rate for Payer: Cash Price |
$2,230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,091.00
|
| Rate for Payer: Medical Associates Commercial |
$2,091.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,951.60
|
| Rate for Payer: United Healthcare Commercial |
$2,509.20
|
|
|
EXC FOOT/TOE TUM SC 1.5 CM/>
|
Facility
|
OP
|
$2,788.00
|
|
|
Service Code
|
CPT 28039
|
| Hospital Charge Code |
7982950
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,254.60 |
| Max. Negotiated Rate |
$2,509.20 |
| Rate for Payer: Aetna of IA Commercial |
$2,509.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,509.20
|
| Rate for Payer: Aetna of IA Medicare |
$1,589.16
|
| Rate for Payer: Amerigroup Medicaid |
$1,608.12
|
| Rate for Payer: Amerigroup Medicare |
$1,267.15
|
| Rate for Payer: Cash Price |
$2,230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,091.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,254.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,592.51
|
| Rate for Payer: Medical Associates Commercial |
$2,091.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,254.60
|
| Rate for Payer: Midlands Choice Commercial |
$1,951.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,615.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,442.79
|
| Rate for Payer: United Healthcare Commercial |
$2,509.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,644.92
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
7982989
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$570.50 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
7982989
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$366.75 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Aetna of IA Medicare |
$464.55
|
| Rate for Payer: Amerigroup Medicaid |
$470.09
|
| Rate for Payer: Amerigroup Medicare |
$370.42
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$366.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$465.53
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$366.75
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$472.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$421.76
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$480.85
|
|
|
EXC H-F-NK-SP B9+MARG 0.6-1
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
7982988
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$570.50 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
|
|
EXC H-F-NK-SP B9+MARG 0.6-1
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
7982988
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$366.75 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Aetna of IA Medicare |
$464.55
|
| Rate for Payer: Amerigroup Medicaid |
$470.09
|
| Rate for Payer: Amerigroup Medicare |
$370.42
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$366.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$465.53
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$366.75
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$472.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$421.76
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$480.85
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
|
IP
|
$1,014.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
4862821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$709.80 |
| Max. Negotiated Rate |
$912.60 |
| Rate for Payer: Aetna of IA Commercial |
$912.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$912.60
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$760.50
|
| Rate for Payer: Medical Associates Commercial |
$760.50
|
| Rate for Payer: Midlands Choice Commercial |
$709.80
|
| Rate for Payer: United Healthcare Commercial |
$912.60
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
|
OP
|
$1,014.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
4862821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.30 |
| Max. Negotiated Rate |
$912.60 |
| Rate for Payer: Aetna of IA Commercial |
$912.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$912.60
|
| Rate for Payer: Aetna of IA Medicare |
$577.98
|
| Rate for Payer: Amerigroup Medicaid |
$584.88
|
| Rate for Payer: Amerigroup Medicare |
$460.86
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$760.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$456.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$579.20
|
| Rate for Payer: Medical Associates Commercial |
$760.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$456.30
|
| Rate for Payer: Midlands Choice Commercial |
$709.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$587.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$524.75
|
| Rate for Payer: United Healthcare Commercial |
$912.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$598.26
|
|
