|
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 |
$903.62 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$820.31
|
| Rate for Payer: Wellmark IA PPO |
$903.62
|
|
|
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 |
$2,975.61 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,701.29
|
| Rate for Payer: Wellmark IA PPO |
$2,975.61
|
|
|
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 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 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 |
$2,975.61 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,701.29
|
| Rate for Payer: Wellmark IA PPO |
$2,975.61
|
|
|
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 |
$5,511.52 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$5,003.41
|
| Rate for Payer: Wellmark IA PPO |
$5,511.52
|
|
|
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 |
$5,392.02 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$4,894.94
|
| Rate for Payer: Wellmark IA PPO |
$5,392.02
|
|
|
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 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 |
$2,975.61 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,701.29
|
| Rate for Payer: Wellmark IA PPO |
$2,975.61
|
|
|
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 0.6-1
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
7982988
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$366.75 |
| Max. Negotiated Rate |
$903.62 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$820.31
|
| Rate for Payer: Wellmark IA PPO |
$903.62
|
|
|
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 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 |
$2,975.61 |
| 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: 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 |
$524.74
|
| Rate for Payer: United Healthcare Commercial |
$912.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$598.26
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,701.29
|
| Rate for Payer: Wellmark IA PPO |
$2,975.61
|
|
|
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 2.1-3
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
7982987
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$366.75 |
| Max. Negotiated Rate |
$2,975.61 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,701.29
|
| Rate for Payer: Wellmark IA PPO |
$2,975.61
|
|
|
EXC H-F-NK-SP B9+MARG 2.1-3
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
7982987
|
|
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 3.1-4
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
7982986
|
|
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 H-F-NK-SP B9+MARG 3.1-4
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
7982986
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$954.00 |
| Max. Negotiated Rate |
$2,975.61 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,701.29
|
| Rate for Payer: Wellmark IA PPO |
$2,975.61
|
|
|
EXC H-F-NK-SP B9+MARG >4 CM
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
7982985
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$954.00 |
| Max. Negotiated Rate |
$5,511.52 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$5,003.41
|
| Rate for Payer: Wellmark IA PPO |
$5,511.52
|
|
|
EXC H-F-NK-SP B9+MARG >4 CM
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
7982985
|
|
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 HIP/PELV TUM DEEP 5 CM/>
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 27045
|
| Hospital Charge Code |
7982947
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Aetna of IA Commercial |
$586.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$586.80
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$489.00
|
| Rate for Payer: Medical Associates Commercial |
$489.00
|
| Rate for Payer: Midlands Choice Commercial |
$456.40
|
| Rate for Payer: United Healthcare Commercial |
$586.80
|
|
|
EXC HIP/PELV TUM DEEP 5 CM/>
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 27045
|
| Hospital Charge Code |
7982947
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.40 |
| Max. Negotiated Rate |
$4,029.18 |
| Rate for Payer: Aetna of IA Commercial |
$586.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$586.80
|
| Rate for Payer: Aetna of IA Medicare |
$371.64
|
| Rate for Payer: Amerigroup Medicaid |
$376.07
|
| Rate for Payer: Amerigroup Medicare |
$296.33
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$489.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$293.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$372.42
|
| Rate for Payer: Medical Associates Commercial |
$489.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$293.40
|
| Rate for Payer: Midlands Choice Commercial |
$456.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$377.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$337.41
|
| Rate for Payer: United Healthcare Commercial |
$586.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$384.68
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,657.73
|
| Rate for Payer: Wellmark IA PPO |
$4,029.18
|
|
|
EXCISE EXCESSIVE SKIN THIGH
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
CPT 15832
|
| Hospital Charge Code |
7982975
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,234.35 |
| Max. Negotiated Rate |
$5,511.52 |
| Rate for Payer: Aetna of IA Commercial |
$2,468.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,468.70
|
| Rate for Payer: Aetna of IA Medicare |
$1,563.51
|
| Rate for Payer: Amerigroup Medicaid |
$1,582.16
|
| Rate for Payer: Amerigroup Medicare |
$1,246.69
|
| Rate for Payer: Cash Price |
$2,194.40
|
| Rate for Payer: Cash Price |
$2,194.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,057.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,234.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,566.80
|
| Rate for Payer: Medical Associates Commercial |
$2,057.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,234.35
|
| Rate for Payer: Midlands Choice Commercial |
$1,920.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,589.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,419.50
|
| Rate for Payer: United Healthcare Commercial |
$2,468.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,618.37
|
| Rate for Payer: Wellmark IA HMO WHPI |
$5,003.41
|
| Rate for Payer: Wellmark IA PPO |
$5,511.52
|
|
