|
K-WIRE 9X.062 TROCAR POINTS
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
K-WIRE 9X.062 TROCAR POINTS
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$18.46
|
| Rate for Payer: Amerigroup Medicare |
$14.54
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.28
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.40
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.56
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
K-WIRE GAMMA 3.2X450
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of IA Commercial |
$124.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$124.20
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.50
|
| Rate for Payer: Medical Associates Commercial |
$103.50
|
| Rate for Payer: Midlands Choice Commercial |
$96.60
|
| Rate for Payer: United Healthcare Commercial |
$124.20
|
|
|
K-WIRE GAMMA 3.2X450
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of IA Commercial |
$124.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$124.20
|
| Rate for Payer: Aetna of IA Medicare |
$78.66
|
| Rate for Payer: Amerigroup Medicaid |
$79.60
|
| Rate for Payer: Amerigroup Medicare |
$62.72
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$62.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$78.83
|
| Rate for Payer: Medical Associates Commercial |
$103.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.10
|
| Rate for Payer: Midlands Choice Commercial |
$96.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.42
|
| Rate for Payer: United Healthcare Commercial |
$124.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$81.42
|
|
|
K-WIRE STANDARD 0.035
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8463427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna of IA Commercial |
$22.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.50
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.75
|
| Rate for Payer: Medical Associates Commercial |
$18.75
|
| Rate for Payer: Midlands Choice Commercial |
$17.50
|
| Rate for Payer: United Healthcare Commercial |
$22.50
|
|
|
K-WIRE STANDARD 0.035
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8463427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna of IA Commercial |
$22.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.50
|
| Rate for Payer: Aetna of IA Medicare |
$14.25
|
| Rate for Payer: Amerigroup Medicaid |
$14.42
|
| Rate for Payer: Amerigroup Medicare |
$11.36
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.28
|
| Rate for Payer: Medical Associates Commercial |
$18.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.25
|
| Rate for Payer: Midlands Choice Commercial |
$17.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.94
|
| Rate for Payer: United Healthcare Commercial |
$22.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.75
|
|
|
K-WIRE W/17MM STOP
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
|
|
K-WIRE W/17MM STOP
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Aetna of IA Medicare |
$22.80
|
| Rate for Payer: Amerigroup Medicaid |
$23.07
|
| Rate for Payer: Amerigroup Medicare |
$18.18
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.85
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.70
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.60
|
|
|
K-WIRE W/LENGTH MARKINGS .045IN (1.143MM
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Aetna of IA Medicare |
$22.80
|
| Rate for Payer: Amerigroup Medicaid |
$23.07
|
| Rate for Payer: Amerigroup Medicare |
$18.18
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.85
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.70
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.60
|
|
|
K-WIRE W/LENGTH MARKINGS .045IN (1.143MM
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
|
|
L15 FRAME PLATE
|
Facility
|
IP
|
$2,006.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8955187
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,404.20 |
| Max. Negotiated Rate |
$1,805.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,805.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,805.40
|
| Rate for Payer: Cash Price |
$1,604.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,504.50
|
| Rate for Payer: Medical Associates Commercial |
$1,504.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,404.20
|
| Rate for Payer: United Healthcare Commercial |
$1,805.40
|
|
|
L15 FRAME PLATE
|
Facility
|
OP
|
$2,006.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8955187
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$902.70 |
| Max. Negotiated Rate |
$1,805.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,805.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,805.40
|
| Rate for Payer: Aetna of IA Medicare |
$1,143.42
|
| Rate for Payer: Amerigroup Medicaid |
$1,157.06
|
| Rate for Payer: Amerigroup Medicare |
$911.73
|
| Rate for Payer: Cash Price |
$1,604.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,504.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$902.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,145.83
|
| Rate for Payer: Medical Associates Commercial |
$1,504.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$902.70
|
| Rate for Payer: Midlands Choice Commercial |
$1,404.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,162.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,038.10
|
| Rate for Payer: United Healthcare Commercial |
$1,805.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,183.54
|
|
|
labetalol 100 mg Tab [VDMC]
|
Facility
|
OP
|
$2.04
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10398611
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: Aetna of IA Commercial |
$1.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.83
|
| Rate for Payer: Aetna of IA Medicare |
$1.16
|
| Rate for Payer: Amerigroup Medicaid |
$1.17
|
| Rate for Payer: Amerigroup Medicare |
$0.93
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.53
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.16
|
| Rate for Payer: Medical Associates Commercial |
$1.53
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.92
|
| Rate for Payer: Midlands Choice Commercial |
$1.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$1.83
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.20
|
|
|
labetalol 100 mg Tab [VDMC]
|
Facility
|
IP
|
$2.04
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10398611
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: Aetna of IA Commercial |
$1.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.83
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.53
|
| Rate for Payer: Medical Associates Commercial |
$1.53
|
| Rate for Payer: Midlands Choice Commercial |
$1.42
|
| Rate for Payer: United Healthcare Commercial |
$1.83
|
|
|
labetalol 5 mg/mL 20 ml IV MDV [VDMC]
|
Facility
|
IP
|
$33.28
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
10398680
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$29.95 |
| Rate for Payer: Aetna of IA Commercial |
$29.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.95
|
| Rate for Payer: Cash Price |
$26.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.96
|
| Rate for Payer: Medical Associates Commercial |
$24.96
|
| Rate for Payer: Midlands Choice Commercial |
$23.30
|
| Rate for Payer: United Healthcare Commercial |
$29.95
|
|
|
labetalol 5 mg/mL 20 ml IV MDV [VDMC]
|
Facility
|
OP
|
$33.28
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
10398680
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$29.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.95
|
| Rate for Payer: Aetna of IA Medicare |
$18.97
|
| Rate for Payer: Amerigroup Medicaid |
$19.20
|
| Rate for Payer: Amerigroup Medicare |
$15.13
|
| Rate for Payer: Cash Price |
$26.62
|
| Rate for Payer: Cash Price |
$26.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.96
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.01
|
| Rate for Payer: Medical Associates Commercial |
$24.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.98
|
| Rate for Payer: Midlands Choice Commercial |
$23.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$17.22
|
| Rate for Payer: United Healthcare Commercial |
$29.95
|
| Rate for Payer: United Healthcare Managed Medicare |
$19.64
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
LABOR DIRECT ADMIT
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
7984750
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna of IA Commercial |
$414.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$414.00
|
| Rate for Payer: Aetna of IA Medicare |
$262.20
|
| Rate for Payer: Amerigroup Medicaid |
$265.33
|
| Rate for Payer: Amerigroup Medicare |
$209.07
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$345.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$207.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$262.75
|
| Rate for Payer: Medical Associates Commercial |
$345.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$207.00
|
| Rate for Payer: Midlands Choice Commercial |
$322.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$266.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$238.05
|
| Rate for Payer: United Healthcare Commercial |
$414.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$271.40
|
|
|
LABOR DIRECT ADMIT
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
7984750
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$322.00 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna of IA Commercial |
$414.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$414.00
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$345.00
|
| Rate for Payer: Medical Associates Commercial |
$345.00
|
| Rate for Payer: Midlands Choice Commercial |
$322.00
|
| Rate for Payer: United Healthcare Commercial |
$414.00
|
|
|
LABOR PER HOUR
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
7984749
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$2,049.34 |
| Rate for Payer: Aetna of IA Commercial |
$55.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$55.80
|
| Rate for Payer: Aetna of IA Medicare |
$35.34
|
| Rate for Payer: Amerigroup Medicaid |
$35.76
|
| Rate for Payer: Amerigroup Medicare |
$28.18
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.41
|
| Rate for Payer: Medical Associates Commercial |
$46.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.90
|
| Rate for Payer: Midlands Choice Commercial |
$43.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$32.08
|
| Rate for Payer: United Healthcare Commercial |
$55.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$36.58
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,860.42
|
| Rate for Payer: Wellmark IA PPO |
$2,049.34
|
|
|
LABOR PER HOUR
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
7984749
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna of IA Commercial |
$55.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$55.80
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.50
|
| Rate for Payer: Medical Associates Commercial |
$46.50
|
| Rate for Payer: Midlands Choice Commercial |
$43.40
|
| Rate for Payer: United Healthcare Commercial |
$55.80
|
|
|
LAC COMPLEX <2.5 CM CHOLE CHARGE
|
Professional
|
Both
|
$828.00
|
|
| Hospital Charge Code |
8069097
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$579.60 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Medical Associates Commercial |
$621.00
|
| Rate for Payer: Midlands Choice Commercial |
$579.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$621.00
|
|
|
LAC COMPLEX 2.6-7.5 CM CHARGE
|
Professional
|
Both
|
$1,152.00
|
|
| Hospital Charge Code |
8069062
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$806.40 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Medical Associates Commercial |
$864.00
|
| Rate for Payer: Midlands Choice Commercial |
$806.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$864.00
|
|
|
LAC COMPLEX EACH ADDT'L >7.6CM CHARGE
|
Professional
|
Both
|
$472.00
|
|
| Hospital Charge Code |
8069182
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$330.40 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Cash Price |
$377.60
|
| Rate for Payer: Medical Associates Commercial |
$354.00
|
| Rate for Payer: Midlands Choice Commercial |
$330.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$354.00
|
|
|
LAC INTERMEDIATE 12.6-20 CM CHARGE
|
Professional
|
Both
|
$1,006.00
|
|
| Hospital Charge Code |
8069136
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$704.20 |
| Max. Negotiated Rate |
$754.50 |
| Rate for Payer: Cash Price |
$804.80
|
| Rate for Payer: Medical Associates Commercial |
$754.50
|
| Rate for Payer: Midlands Choice Commercial |
$704.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$754.50
|
|
|
LAC INTERMEDIATE 20.1-30 CM CHARGE
|
Professional
|
Both
|
$930.00
|
|
| Hospital Charge Code |
8069157
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$651.00 |
| Max. Negotiated Rate |
$697.50 |
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Medical Associates Commercial |
$697.50
|
| Rate for Payer: Midlands Choice Commercial |
$651.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$697.50
|
|
