|
IMPLANT TITANIUM LONG NAIL 11X440X125R
|
Facility
IP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.40 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
|
|
IMPLANT TITANIUM LONG NAIL 11X440X125R
|
Facility
OP
|
$2,212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.56 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,990.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,990.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,260.84
|
| Rate for Payer: Amerigroup Medicaid |
$1,116.40
|
| Rate for Payer: Amerigroup Medicare |
$1,117.06
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,105.56
|
| Rate for Payer: Medical Associates Commercial |
$1,659.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,106.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,548.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,122.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare Commercial |
$1,990.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.08
|
|
|
IMPLANT TITANIUM SET SCREW 8X17.5MM
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of IA Commercial |
$193.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$193.50
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$161.25
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
|
|
IMPLANT TITANIUM SET SCREW 8X17.5MM
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.46 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of IA Commercial |
$193.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$193.50
|
| Rate for Payer: Aetna of IA Medicare |
$122.55
|
| Rate for Payer: Amerigroup Medicaid |
$108.51
|
| Rate for Payer: Amerigroup Medicare |
$108.58
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$161.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$107.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.46
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$107.50
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$109.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$161.25
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$126.85
|
|
|
IMPLANT TITANIUM TROCHANTERIC 11X180X120
|
Facility
IP
|
$1,518.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,062.60 |
| Max. Negotiated Rate |
$1,366.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,366.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,366.20
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,138.50
|
| Rate for Payer: Medical Associates Commercial |
$1,138.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,062.60
|
| Rate for Payer: United Healthcare Commercial |
$1,366.20
|
|
|
IMPLANT TITANIUM TROCHANTERIC 11X180X120
|
Facility
OP
|
$1,518.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$758.70 |
| Max. Negotiated Rate |
$1,366.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,366.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,366.20
|
| Rate for Payer: Aetna of IA Medicare |
$865.26
|
| Rate for Payer: Amerigroup Medicaid |
$766.13
|
| Rate for Payer: Amerigroup Medicare |
$766.59
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,138.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$759.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$758.70
|
| Rate for Payer: Medical Associates Commercial |
$1,138.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$759.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,062.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$770.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,138.50
|
| Rate for Payer: United Healthcare Commercial |
$1,366.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$895.62
|
|
|
IMPLANT TITANIUM TROCHANTERIC 11X180X125
|
Facility
OP
|
$2,126.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,062.57 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,913.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,913.40
|
| Rate for Payer: Aetna of IA Medicare |
$1,211.82
|
| Rate for Payer: Amerigroup Medicaid |
$1,072.99
|
| Rate for Payer: Amerigroup Medicare |
$1,073.63
|
| Rate for Payer: Cash Price |
$1,700.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,594.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,063.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,062.57
|
| Rate for Payer: Medical Associates Commercial |
$1,594.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,063.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,488.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,078.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,594.50
|
| Rate for Payer: United Healthcare Commercial |
$1,913.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,254.34
|
|
|
IMPLANT TITANIUM TROCHANTERIC 11X180X125
|
Facility
IP
|
$2,126.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,913.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,913.40
|
| Rate for Payer: Cash Price |
$1,700.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,594.50
|
| Rate for Payer: Medical Associates Commercial |
$1,594.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,488.20
|
| Rate for Payer: United Healthcare Commercial |
$1,913.40
|
|
|
IMPLANT TITANIUM TROCHANTERIC 11X180X130
|
Facility
IP
|
$1,518.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,062.60 |
| Max. Negotiated Rate |
$1,366.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,366.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,366.20
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,138.50
|
| Rate for Payer: Medical Associates Commercial |
$1,138.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,062.60
|
| Rate for Payer: United Healthcare Commercial |
$1,366.20
|
|
|
IMPLANT TITANIUM TROCHANTERIC 11X180X130
|
Facility
OP
|
$1,518.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$758.70 |
| Max. Negotiated Rate |
$1,366.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,366.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,366.20
|
| Rate for Payer: Aetna of IA Medicare |
$865.26
|
| Rate for Payer: Amerigroup Medicaid |
$766.13
|
| Rate for Payer: Amerigroup Medicare |
$766.59
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,138.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$759.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$758.70
|
| Rate for Payer: Medical Associates Commercial |
$1,138.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$759.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,062.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$770.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,138.50
|
| Rate for Payer: United Healthcare Commercial |
$1,366.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$895.62
|
|
|
IMPLANT TOTAL KNEE CEMENTED STEM 12X100M
|
Facility
IP
|
$2,774.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,941.80 |
| Max. Negotiated Rate |
$2,496.60 |
| Rate for Payer: Aetna of IA Commercial |
$2,496.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,496.60
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,080.50
|
| Rate for Payer: Medical Associates Commercial |
$2,080.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,941.80
|
| Rate for Payer: United Healthcare Commercial |
$2,496.60
|
|
|
IMPLANT TOTAL KNEE CEMENTED STEM 12X100M
|
Facility
OP
|
$2,774.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,386.45 |
| Max. Negotiated Rate |
$2,496.60 |
| Rate for Payer: Aetna of IA Commercial |
$2,496.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,496.60
|
| Rate for Payer: Aetna of IA Medicare |
$1,581.18
|
| Rate for Payer: Amerigroup Medicaid |
$1,400.04
|
| Rate for Payer: Amerigroup Medicare |
$1,400.87
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,080.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,387.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,386.45
|
| Rate for Payer: Medical Associates Commercial |
$2,080.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,387.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,941.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,407.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,080.50
|
| Rate for Payer: United Healthcare Commercial |
$2,496.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,636.66
|
|
|
IMPLANT WASHER, 7 MM. SS
|
Facility
OP
|
$54.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Aetna of IA Commercial |
$48.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$48.60
|
| Rate for Payer: Aetna of IA Medicare |
$30.78
|
| Rate for Payer: Amerigroup Medicaid |
$27.25
|
| Rate for Payer: Amerigroup Medicare |
$27.27
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$40.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$26.99
|
| Rate for Payer: Medical Associates Commercial |
$40.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.00
|
| Rate for Payer: Midlands Choice Commercial |
$37.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$40.50
|
| Rate for Payer: United Healthcare Commercial |
$48.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$31.86
|
|
|
IMPLANT WASHER, 7 MM. SS
|
Facility
IP
|
$54.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Aetna of IA Commercial |
$48.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$48.60
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$40.50
|
| Rate for Payer: Medical Associates Commercial |
$40.50
|
| Rate for Payer: Midlands Choice Commercial |
$37.80
|
| Rate for Payer: United Healthcare Commercial |
$48.60
|
|
|
IMPL SYS, BIO-COMP ACHILLES MID-SUBSTANCE
|
Facility
IP
|
$1,755.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8784972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.50 |
| Max. Negotiated Rate |
$1,579.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,579.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,579.50
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,316.25
|
| Rate for Payer: Medical Associates Commercial |
$1,316.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,228.50
|
| Rate for Payer: United Healthcare Commercial |
$1,579.50
|
|
|
IMPL SYS, BIO-COMP ACHILLES MID-SUBSTANCE
|
Facility
OP
|
$1,755.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8784972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$877.15 |
| Max. Negotiated Rate |
$1,579.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,579.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,579.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,000.35
|
| Rate for Payer: Amerigroup Medicaid |
$885.75
|
| Rate for Payer: Amerigroup Medicare |
$886.28
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,316.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$877.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$877.15
|
| Rate for Payer: Medical Associates Commercial |
$1,316.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$877.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,228.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$890.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,316.25
|
| Rate for Payer: United Healthcare Commercial |
$1,579.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,035.45
|
|
|
Inborn and Other Disorders of Metabolism
|
Facility
IP
|
$8,401.49
|
|
|
Service Code
|
MS-DRG 642
|
| Hospital Charge Code |
428
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,401.49 |
| Rate for Payer: Amerigroup Medicaid |
$8,360.90
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,279.73
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,401.49
|
|
|
INCISE EXTERNAL HEMORRHOID
|
Professional
|
$588.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
7982770
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$99.65 |
| Max. Negotiated Rate |
$411.60 |
| Rate for Payer: Aetna of IA Medicare |
$99.65
|
| Rate for Payer: Amerigroup Medicaid |
$103.04
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$101.64
|
| Rate for Payer: Medical Associates Commercial |
$189.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.65
|
| Rate for Payer: Midlands Choice Commercial |
$411.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$149.48
|
| Rate for Payer: Wellmark IA HMO |
$210.00
|
| Rate for Payer: Wellmark IA PPO |
$246.00
|
|
|
INCISION AND DRAINAGE
|
Professional
|
$304.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
7982860
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$97.80 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna of IA Medicare |
$97.80
|
| Rate for Payer: Amerigroup Medicaid |
$101.13
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$99.76
|
| Rate for Payer: Medical Associates Commercial |
$185.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$97.80
|
| Rate for Payer: Midlands Choice Commercial |
$212.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$146.70
|
| Rate for Payer: Wellmark IA HMO |
$200.00
|
| Rate for Payer: Wellmark IA PPO |
$235.00
|
|
|
Incision and drainage of epididymis, testis and/or scrotal space (eg, abscess or hematoma)
|
Facility
OP
|
$3,386.81
|
|
|
Service Code
|
CPT 54700
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,078.92 |
| Max. Negotiated Rate |
$3,386.81 |
| Rate for Payer: Wellmark IA HMO |
$3,078.92
|
| Rate for Payer: Wellmark IA PPO |
$3,386.81
|
|
|
INCISION OF RECTAL ABSCESS
|
Professional
|
$1,788.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
7982771
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$383.48 |
| Max. Negotiated Rate |
$1,251.60 |
| Rate for Payer: Aetna of IA Medicare |
$383.48
|
| Rate for Payer: Amerigroup Medicaid |
$396.52
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$460.18
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$391.15
|
| Rate for Payer: Medical Associates Commercial |
$728.61
|
| Rate for Payer: Medical Associates Managed Medicare |
$383.48
|
| Rate for Payer: Midlands Choice Commercial |
$1,251.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$575.22
|
| Rate for Payer: Wellmark IA HMO |
$814.00
|
| Rate for Payer: Wellmark IA PPO |
$956.00
|
|
|
INCISION OF RECTAL ABSCESS
|
Facility
IP
|
$2,317.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
4864970
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,621.90 |
| Max. Negotiated Rate |
$2,085.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,085.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,085.30
|
| Rate for Payer: Cash Price |
$1,853.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,737.75
|
| Rate for Payer: Medical Associates Commercial |
$1,737.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,621.90
|
| Rate for Payer: United Healthcare Commercial |
$2,085.30
|
|
|
INCISION OF RECTAL ABSCESS
|
Facility
OP
|
$2,317.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
4864970
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,158.04 |
| Max. Negotiated Rate |
$4,960.19 |
| Rate for Payer: Aetna of IA Commercial |
$2,085.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,085.30
|
| Rate for Payer: Aetna of IA Medicare |
$1,320.69
|
| Rate for Payer: Amerigroup Medicaid |
$1,169.39
|
| Rate for Payer: Amerigroup Medicare |
$1,170.08
|
| Rate for Payer: Cash Price |
$1,853.60
|
| Rate for Payer: Cash Price |
$1,853.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,737.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,158.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,158.04
|
| Rate for Payer: Medical Associates Commercial |
$1,737.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,158.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,621.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,175.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,737.75
|
| Rate for Payer: United Healthcare Commercial |
$2,085.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,367.03
|
| Rate for Payer: Wellmark IA HMO |
$4,509.26
|
| Rate for Payer: Wellmark IA PPO |
$4,960.19
|
|
|
INC/REPL SPINE NSTIM PG/RCVR
|
Professional
|
$1,229.00
|
|
|
Service Code
|
CPT 63685
|
| Hospital Charge Code |
8015885
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$305.54 |
| Max. Negotiated Rate |
$860.30 |
| Rate for Payer: Aetna of IA Medicare |
$305.54
|
| Rate for Payer: Amerigroup Medicaid |
$315.93
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$366.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$311.65
|
| Rate for Payer: Medical Associates Commercial |
$580.53
|
| Rate for Payer: Medical Associates Managed Medicare |
$305.54
|
| Rate for Payer: Midlands Choice Commercial |
$860.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$458.31
|
| Rate for Payer: Wellmark IA HMO |
$648.00
|
| Rate for Payer: Wellmark IA PPO |
$761.00
|
|
|
indapamide 2.5 mg Tab
|
Facility
OP
|
$1.39
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Aetna of IA Commercial |
$1.25
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.25
|
| Rate for Payer: Aetna of IA Medicare |
$0.79
|
| Rate for Payer: Amerigroup Medicaid |
$0.70
|
| Rate for Payer: Amerigroup Medicare |
$0.70
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.69
|
| Rate for Payer: Medical Associates Commercial |
$1.04
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.70
|
| Rate for Payer: Midlands Choice Commercial |
$0.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.25
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.82
|
|
