|
64624 Destruction by neurolytic agent genicular nerve branches inc imaging guidance
|
Professional
|
$1,350.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
8799214
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$134.03 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna of IA Medicare |
$134.03
|
| Rate for Payer: Amerigroup Medicaid |
$138.59
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$160.84
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$136.71
|
| Rate for Payer: Medical Associates Commercial |
$254.66
|
| Rate for Payer: Medical Associates Managed Medicare |
$134.03
|
| Rate for Payer: Midlands Choice Commercial |
$945.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$201.04
|
| Rate for Payer: Wellmark IA HMO |
$258.00
|
| Rate for Payer: Wellmark IA PPO |
$303.00
|
|
|
64625 Radiofrequency ablation of sacroiliac joint
|
Professional
|
$1,649.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
8801481
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$179.47 |
| Max. Negotiated Rate |
$1,154.30 |
| Rate for Payer: Aetna of IA Medicare |
$179.47
|
| Rate for Payer: Amerigroup Medicaid |
$185.57
|
| Rate for Payer: Cash Price |
$1,319.20
|
| Rate for Payer: Cash Price |
$1,319.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$215.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$183.06
|
| Rate for Payer: Medical Associates Commercial |
$340.99
|
| Rate for Payer: Medical Associates Managed Medicare |
$179.47
|
| Rate for Payer: Midlands Choice Commercial |
$1,154.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$269.20
|
| Rate for Payer: Wellmark IA HMO |
$344.00
|
| Rate for Payer: Wellmark IA PPO |
$404.00
|
|
|
64632 Destruction by neurolytic agent; plantar common digital nerve
|
Professional
|
$286.00
|
|
|
Service Code
|
CPT 64632
|
| Hospital Charge Code |
8799215
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna of IA Medicare |
$62.10
|
| Rate for Payer: Amerigroup Medicaid |
$64.21
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$63.34
|
| Rate for Payer: Medical Associates Commercial |
$117.99
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.10
|
| Rate for Payer: Midlands Choice Commercial |
$200.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.15
|
| Rate for Payer: Wellmark IA HMO |
$126.00
|
| Rate for Payer: Wellmark IA PPO |
$148.00
|
|
|
64633 Destruction by neurolytic agent paravertebral facet joint nerve w/imaging
|
Professional
|
$1,393.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
8799216
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$176.28 |
| Max. Negotiated Rate |
$975.10 |
| Rate for Payer: Aetna of IA Medicare |
$176.28
|
| Rate for Payer: Amerigroup Medicaid |
$182.27
|
| Rate for Payer: Cash Price |
$1,114.40
|
| Rate for Payer: Cash Price |
$1,114.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$211.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$179.81
|
| Rate for Payer: Medical Associates Commercial |
$334.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$176.28
|
| Rate for Payer: Midlands Choice Commercial |
$975.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$264.42
|
| Rate for Payer: Wellmark IA HMO |
$338.00
|
| Rate for Payer: Wellmark IA PPO |
$397.00
|
|
|
64634 Destruction by neurolytic agent paravertebral facet (ea addl facet joint)
|
Professional
|
$623.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
8799217
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$61.31 |
| Max. Negotiated Rate |
$436.10 |
| Rate for Payer: Aetna of IA Medicare |
$61.31
|
| Rate for Payer: Amerigroup Medicaid |
$63.39
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$62.54
|
| Rate for Payer: Medical Associates Commercial |
$116.49
|
| Rate for Payer: Medical Associates Managed Medicare |
$61.31
|
| Rate for Payer: Midlands Choice Commercial |
$436.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$91.96
|
| Rate for Payer: Wellmark IA HMO |
$118.00
|
| Rate for Payer: Wellmark IA PPO |
$138.00
|
|
|
64635 Destruction by neurolytic agent paravertebral facet joint nerve w/imaging
|
Professional
|
$1,375.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
8799218
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$176.58 |
| Max. Negotiated Rate |
$962.50 |
| Rate for Payer: Aetna of IA Medicare |
$176.58
|
| Rate for Payer: Amerigroup Medicaid |
$182.58
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$211.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$180.11
|
| Rate for Payer: Medical Associates Commercial |
$335.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$176.58
|
| Rate for Payer: Midlands Choice Commercial |
$962.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$264.87
|
| Rate for Payer: Wellmark IA HMO |
$339.00
|
| Rate for Payer: Wellmark IA PPO |
$397.00
|
|
|
64636 Destruction by neurolytic agent paravertebral facet (ea addl facet joint)
|
Professional
|
$568.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
8799219
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$397.60 |
| Rate for Payer: Aetna of IA Medicare |
$53.68
|
| Rate for Payer: Amerigroup Medicaid |
$55.51
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.75
|
| Rate for Payer: Medical Associates Commercial |
$101.99
|
| Rate for Payer: Medical Associates Managed Medicare |
$53.68
|
| Rate for Payer: Midlands Choice Commercial |
$397.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$80.52
|
| Rate for Payer: Wellmark IA HMO |
$104.00
|
| Rate for Payer: Wellmark IA PPO |
$122.00
|
|
|
64640 Destruction by neurolytic agent; other perpheral nerve or branch
|
Professional
|
$822.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
8799220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$575.40 |
| Rate for Payer: Aetna of IA Medicare |
$108.93
|
| Rate for Payer: Amerigroup Medicaid |
$112.63
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$130.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$111.11
|
| Rate for Payer: Medical Associates Commercial |
$206.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$108.93
|
| Rate for Payer: Midlands Choice Commercial |
$575.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$163.40
|
| Rate for Payer: Wellmark IA HMO |
$209.00
|
| Rate for Payer: Wellmark IA PPO |
$246.00
|
|
|
6 HOLE PLATE MINI
|
Facility
OP
|
$1,476.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$737.70 |
| Max. Negotiated Rate |
$1,328.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,328.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,328.40
|
| Rate for Payer: Aetna of IA Medicare |
$841.32
|
| Rate for Payer: Amerigroup Medicaid |
$744.94
|
| Rate for Payer: Amerigroup Medicare |
$745.38
|
| Rate for Payer: Cash Price |
$1,180.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,107.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$738.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$737.70
|
| Rate for Payer: Medical Associates Commercial |
$1,107.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$738.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,033.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$749.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,107.00
|
| Rate for Payer: United Healthcare Commercial |
$1,328.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$870.84
|
|
|
6 HOLE PLATE MINI
|
Facility
IP
|
$1,476.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,033.20 |
| Max. Negotiated Rate |
$1,328.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,328.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,328.40
|
| Rate for Payer: Cash Price |
$1,180.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,107.00
|
| Rate for Payer: Medical Associates Commercial |
$1,107.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,033.20
|
| Rate for Payer: United Healthcare Commercial |
$1,328.40
|
|
|
7.00MM MALYUGIN RING
|
Facility
IP
|
$157.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8884867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of IA Commercial |
$141.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.75
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$118.12
|
| Rate for Payer: Medical Associates Commercial |
$118.12
|
| Rate for Payer: Midlands Choice Commercial |
$110.25
|
| Rate for Payer: United Healthcare Commercial |
$141.75
|
|
|
7.00MM MALYUGIN RING
|
Facility
OP
|
$157.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8884867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of IA Commercial |
$141.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.75
|
| Rate for Payer: Aetna of IA Medicare |
$89.78
|
| Rate for Payer: Amerigroup Medicaid |
$79.49
|
| Rate for Payer: Amerigroup Medicare |
$79.54
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$118.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$78.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$78.72
|
| Rate for Payer: Medical Associates Commercial |
$118.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$78.75
|
| Rate for Payer: Midlands Choice Commercial |
$110.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$118.12
|
| Rate for Payer: United Healthcare Commercial |
$141.75
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.92
|
|
|
76942 Ultrasound needle guidance
|
Facility
OP
|
$511.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
8801480
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$255.40 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna of IA Commercial |
$459.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$459.90
|
| Rate for Payer: Aetna of IA Medicare |
$291.27
|
| Rate for Payer: Amerigroup Medicaid |
$257.90
|
| Rate for Payer: Amerigroup Medicare |
$258.06
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$383.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$255.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$255.40
|
| Rate for Payer: Medical Associates Commercial |
$383.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$255.50
|
| Rate for Payer: Midlands Choice Commercial |
$357.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$259.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$383.25
|
| Rate for Payer: United Healthcare Commercial |
$459.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$301.49
|
| Rate for Payer: Wellmark IA HMO |
$352.78
|
| Rate for Payer: Wellmark IA PPO |
$388.06
|
|
|
76942 Ultrasound needle guidance
|
Facility
IP
|
$511.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
8801480
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$357.70 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna of IA Commercial |
$459.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$459.90
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$383.25
|
| Rate for Payer: Medical Associates Commercial |
$383.25
|
| Rate for Payer: Midlands Choice Commercial |
$357.70
|
| Rate for Payer: United Healthcare Commercial |
$459.90
|
|
|
77002 Fluoroscopic guidance for needle placement
|
Facility
OP
|
$735.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
8801478
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$367.35 |
| Max. Negotiated Rate |
$720.87 |
| Rate for Payer: Aetna of IA Commercial |
$661.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$661.50
|
| Rate for Payer: Aetna of IA Medicare |
$418.95
|
| Rate for Payer: Amerigroup Medicaid |
$370.95
|
| Rate for Payer: Amerigroup Medicare |
$371.18
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$551.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$367.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$367.35
|
| Rate for Payer: Medical Associates Commercial |
$551.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$367.50
|
| Rate for Payer: Midlands Choice Commercial |
$514.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$373.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$551.25
|
| Rate for Payer: United Healthcare Commercial |
$661.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$433.65
|
| Rate for Payer: Wellmark IA HMO |
$655.34
|
| Rate for Payer: Wellmark IA PPO |
$720.87
|
|
|
77002 Fluoroscopic guidance for needle placement
|
Facility
IP
|
$735.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
8801478
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$514.50 |
| Max. Negotiated Rate |
$661.50 |
| Rate for Payer: Aetna of IA Commercial |
$661.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$661.50
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$551.25
|
| Rate for Payer: Medical Associates Commercial |
$551.25
|
| Rate for Payer: Midlands Choice Commercial |
$514.50
|
| Rate for Payer: United Healthcare Commercial |
$661.50
|
|
|
77003 Fluoroscopic guidance for needle placement with spinal or paraspinal injections
|
Facility
IP
|
$437.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
8801479
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$305.90 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna of IA Commercial |
$393.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$393.30
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$327.75
|
| Rate for Payer: Medical Associates Commercial |
$327.75
|
| Rate for Payer: Midlands Choice Commercial |
$305.90
|
| Rate for Payer: United Healthcare Commercial |
$393.30
|
|
|
77003 Fluoroscopic guidance for needle placement with spinal or paraspinal injections
|
Facility
OP
|
$437.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
8801479
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.41 |
| Max. Negotiated Rate |
$720.87 |
| Rate for Payer: Aetna of IA Commercial |
$393.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$393.30
|
| Rate for Payer: Aetna of IA Medicare |
$249.09
|
| Rate for Payer: Amerigroup Medicaid |
$220.55
|
| Rate for Payer: Amerigroup Medicare |
$220.68
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$327.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$218.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$218.41
|
| Rate for Payer: Medical Associates Commercial |
$327.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$218.50
|
| Rate for Payer: Midlands Choice Commercial |
$305.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$221.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$327.75
|
| Rate for Payer: United Healthcare Commercial |
$393.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$257.83
|
| Rate for Payer: Wellmark IA HMO |
$655.34
|
| Rate for Payer: Wellmark IA PPO |
$720.87
|
|
|
7 HOLE VL TIBIA PLATE
|
Facility
IP
|
$2,052.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8831365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.40 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
|
|
7 HOLE VL TIBIA PLATE
|
Facility
OP
|
$2,052.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8831365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,025.59 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,169.64
|
| Rate for Payer: Amerigroup Medicaid |
$1,035.64
|
| Rate for Payer: Amerigroup Medicare |
$1,036.26
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,026.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,025.59
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,026.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,041.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,539.00
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,210.68
|
|
|
8 HOLE LATERAL FIBULA PLATE SYMMETRIC
|
Facility
OP
|
$2,475.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8908711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.00 |
| Max. Negotiated Rate |
$2,227.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,227.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,227.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,410.75
|
| Rate for Payer: Amerigroup Medicaid |
$1,249.13
|
| Rate for Payer: Amerigroup Medicare |
$1,249.88
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,856.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,237.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,237.00
|
| Rate for Payer: Medical Associates Commercial |
$1,856.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,237.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,732.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,256.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,856.25
|
| Rate for Payer: United Healthcare Commercial |
$2,227.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,460.25
|
|
|
8 HOLE LATERAL FIBULA PLATE SYMMETRIC
|
Facility
IP
|
$2,475.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8908711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,732.50 |
| Max. Negotiated Rate |
$2,227.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,227.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,227.50
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,856.25
|
| Rate for Payer: Medical Associates Commercial |
$1,856.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,732.50
|
| Rate for Payer: United Healthcare Commercial |
$2,227.50
|
|
|
92960 Cardioversion electric external
|
Professional
|
$526.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
8799221
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$98.53 |
| Max. Negotiated Rate |
$368.20 |
| Rate for Payer: Aetna of IA Medicare |
$98.53
|
| Rate for Payer: Amerigroup Medicaid |
$101.88
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$118.24
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.50
|
| Rate for Payer: Medical Associates Commercial |
$187.21
|
| Rate for Payer: Medical Associates Managed Medicare |
$98.53
|
| Rate for Payer: Midlands Choice Commercial |
$368.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$147.80
|
| Rate for Payer: Wellmark IA HMO |
$203.00
|
| Rate for Payer: Wellmark IA PPO |
$239.00
|
|
|
93224 HOLTER MONITOR UP TO 48 HOURS
|
Facility
OP
|
$380.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
8398129
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$189.92 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of IA Commercial |
$342.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$342.00
|
| Rate for Payer: Aetna of IA Medicare |
$216.60
|
| Rate for Payer: Amerigroup Medicaid |
$191.79
|
| Rate for Payer: Amerigroup Medicare |
$191.90
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$285.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$190.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$189.92
|
| Rate for Payer: Medical Associates Commercial |
$285.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$190.00
|
| Rate for Payer: Midlands Choice Commercial |
$266.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$192.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$285.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$224.20
|
| Rate for Payer: Wellmark IA HMO |
$281.48
|
| Rate for Payer: Wellmark IA PPO |
$309.63
|
|
|
93224 HOLTER MONITOR UP TO 48 HOURS
|
Facility
IP
|
$380.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
8398129
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of IA Commercial |
$342.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$342.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$285.00
|
| Rate for Payer: Medical Associates Commercial |
$285.00
|
| Rate for Payer: Midlands Choice Commercial |
$266.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
|
