|
RECOVERY PHASE 2
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
8025190
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Medical Associates Commercial |
$1.50
|
| Rate for Payer: Aetna of IA Commercial |
$1.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.80
|
| Rate for Payer: Aetna of IA Medicare |
$1.14
|
| Rate for Payer: Amerigroup Medicaid |
$1.01
|
| Rate for Payer: Amerigroup Medicare |
$1.01
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.00
|
| Rate for Payer: Midlands Choice Commercial |
$1.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.50
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.18
|
|
|
Rectal Resection With CC
|
Facility
IP
|
$20,945.65
|
|
|
Service Code
|
MS-DRG 333
|
| Hospital Charge Code |
183
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$20,945.65 |
| Rate for Payer: Amerigroup Medicaid |
$20,844.46
|
| 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 |
$20,642.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20,945.65
|
|
|
Rectal Resection With MCC
|
Facility
IP
|
$40,952.32
|
|
|
Service Code
|
MS-DRG 332
|
| Hospital Charge Code |
182
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$40,952.32 |
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40,358.81
|
| Rate for Payer: Amerigroup Medicaid |
$40,754.48
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$40,952.32
|
|
|
Rectal Resection Without CC/MCC
|
Facility
IP
|
$13,803.00
|
|
|
Service Code
|
MS-DRG 334
|
| Hospital Charge Code |
184
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$13,803.00 |
| Rate for Payer: Amerigroup Medicaid |
$13,736.32
|
| 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 |
$13,602.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,803.00
|
|
|
Red Blood Cell Disorders With MCC
|
Facility
IP
|
$12,350.26
|
|
|
Service Code
|
MS-DRG 811
|
| Hospital Charge Code |
553
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$12,350.26 |
| Rate for Payer: Amerigroup Medicaid |
$12,290.60
|
| 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 |
$12,171.27
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,350.26
|
|
|
Red Blood Cell Disorders Without MCC
|
Facility
IP
|
$7,595.39
|
|
|
Service Code
|
MS-DRG 812
|
| Hospital Charge Code |
554
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,595.39 |
| Rate for Payer: Amerigroup Medicaid |
$7,558.70
|
| 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 |
$7,485.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,595.39
|
|
|
RE-EVALUATION OCC THERAPY
|
Facility
IP
|
$156.00
|
|
|
Service Code
|
CPT 97168 GO
|
| Hospital Charge Code |
5520782
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna of IA Commercial |
$140.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.40
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.00
|
| Rate for Payer: Medical Associates Commercial |
$117.00
|
| Rate for Payer: Midlands Choice Commercial |
$109.20
|
| Rate for Payer: United Healthcare Commercial |
$140.40
|
|
|
RE-EVALUATION OCC THERAPY
|
Facility
OP
|
$156.00
|
|
|
Service Code
|
CPT 97168 GO
|
| Hospital Charge Code |
5520782
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$77.97 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna of IA Commercial |
$140.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.40
|
| Rate for Payer: Aetna of IA Medicare |
$88.92
|
| Rate for Payer: Amerigroup Medicaid |
$78.73
|
| Rate for Payer: Amerigroup Medicare |
$78.78
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$78.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$77.97
|
| Rate for Payer: Medical Associates Commercial |
$117.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$78.00
|
| Rate for Payer: Midlands Choice Commercial |
$109.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$117.00
|
| Rate for Payer: United Healthcare Commercial |
$140.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.04
|
|
|
Rehabilitation With CC/MCC
|
Facility
IP
|
$22,041.10
|
|
|
Service Code
|
MS-DRG 945
|
| Hospital Charge Code |
651
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$22,041.10 |
| Rate for Payer: Amerigroup Medicaid |
$21,934.62
|
| 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 |
$21,721.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22,041.10
|
|
|
Rehabilitation Without CC/MCC
|
Facility
IP
|
$10,494.97
|
|
|
Service Code
|
MS-DRG 946
|
| Hospital Charge Code |
652
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$10,494.97 |
| Rate for Payer: Amerigroup Medicaid |
$10,444.27
|
| 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 |
$10,342.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,494.97
|
|
|
remdesivir 100 mg SDV Pow
|
Facility
OP
|
$1,298.96
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
43700560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$649.22 |
| Max. Negotiated Rate |
$1,169.06 |
| Rate for Payer: Aetna of IA Commercial |
$1,169.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,169.06
|
| Rate for Payer: Aetna of IA Medicare |
$740.41
|
| Rate for Payer: Amerigroup Medicaid |
$655.59
|
| Rate for Payer: Amerigroup Medicare |
$655.97
|
| Rate for Payer: Cash Price |
$1,039.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$974.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$649.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$649.22
|
| Rate for Payer: Medical Associates Commercial |
$974.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$649.48
|
| Rate for Payer: Midlands Choice Commercial |
$909.27
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$659.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$974.22
|
| Rate for Payer: United Healthcare Commercial |
$1,169.06
|
| Rate for Payer: United Healthcare Managed Medicare |
$766.39
|
|
|
remdesivir 100 mg SDV Pow
|
Facility
IP
|
$1,298.96
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
43700560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$909.27 |
| Max. Negotiated Rate |
$1,169.06 |
| Rate for Payer: Aetna of IA Commercial |
$1,169.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,169.06
|
| Rate for Payer: Cash Price |
$1,039.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$974.22
|
| Rate for Payer: Medical Associates Commercial |
$974.22
|
| Rate for Payer: Midlands Choice Commercial |
$909.27
|
| Rate for Payer: United Healthcare Commercial |
$1,169.06
|
|
|
Remote Services Individual Psychotherapy
|
Facility
OP
|
$181.00
|
|
|
Service Code
|
CPT C7900
|
| Hospital Charge Code |
8945619
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$90.46 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Aetna of IA Medicare |
$103.17
|
| Rate for Payer: Amerigroup Medicaid |
$91.35
|
| Rate for Payer: Amerigroup Medicare |
$91.40
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.46
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.50
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.75
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.79
|
|
|
Remote Services Individual Psychotherapy
|
Facility
IP
|
$181.00
|
|
|
Service Code
|
CPT C7900
|
| Hospital Charge Code |
8945619
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.75
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
|
|
REMOVAL FOREIGN BODY FOOT SUBQ
|
Professional
|
$868.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
8825540
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$122.32 |
| Max. Negotiated Rate |
$607.60 |
| Rate for Payer: Aetna of IA Medicare |
$122.32
|
| Rate for Payer: Amerigroup Medicaid |
$126.48
|
| Rate for Payer: Cash Price |
$694.40
|
| Rate for Payer: Cash Price |
$694.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$146.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$124.77
|
| Rate for Payer: Medical Associates Commercial |
$232.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$122.32
|
| Rate for Payer: Midlands Choice Commercial |
$607.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$183.48
|
| Rate for Payer: Wellmark IA HMO |
$235.00
|
| Rate for Payer: Wellmark IA PPO |
$276.00
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Professional
|
$865.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
7982793
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$122.32 |
| Max. Negotiated Rate |
$605.50 |
| Rate for Payer: Aetna of IA Medicare |
$122.32
|
| Rate for Payer: Amerigroup Medicaid |
$126.48
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$146.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$124.77
|
| Rate for Payer: Medical Associates Commercial |
$232.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$122.32
|
| Rate for Payer: Midlands Choice Commercial |
$605.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$183.48
|
| Rate for Payer: Wellmark IA HMO |
$235.00
|
| Rate for Payer: Wellmark IA PPO |
$276.00
|
|
|
Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)
|
Facility
OP
|
$3,847.84
|
|
|
Service Code
|
CPT 20680
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,498.04 |
| Max. Negotiated Rate |
$3,847.84 |
| Rate for Payer: Wellmark IA HMO |
$3,498.04
|
| Rate for Payer: Wellmark IA PPO |
$3,847.84
|
|
|
REMOVAL OF NAIL BED
|
Professional
|
$350.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
7982847
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$94.04 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna of IA Medicare |
$94.04
|
| Rate for Payer: Amerigroup Medicaid |
$97.24
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$112.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$95.92
|
| Rate for Payer: Medical Associates Commercial |
$178.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$94.04
|
| Rate for Payer: Midlands Choice Commercial |
$245.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$141.06
|
| Rate for Payer: Wellmark IA HMO |
$179.00
|
| Rate for Payer: Wellmark IA PPO |
$210.00
|
|
|
REMOVAL OF NAIL PLATE
|
Professional
|
$270.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
7982849
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$49.48 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna of IA Medicare |
$49.48
|
| Rate for Payer: Amerigroup Medicaid |
$51.16
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$59.38
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$50.47
|
| Rate for Payer: Medical Associates Commercial |
$94.01
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.48
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.22
|
| Rate for Payer: Wellmark IA HMO |
$101.00
|
| Rate for Payer: Wellmark IA PPO |
$119.00
|
|
|
REMOVAL/REVISION OF CAST
|
Professional
|
$210.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
7982784
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$29.73 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of IA Medicare |
$29.73
|
| Rate for Payer: Amerigroup Medicaid |
$30.74
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.68
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.32
|
| Rate for Payer: Medical Associates Commercial |
$56.49
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.73
|
| Rate for Payer: Midlands Choice Commercial |
$147.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.60
|
| Rate for Payer: Wellmark IA HMO |
$62.00
|
| Rate for Payer: Wellmark IA PPO |
$73.00
|
|
|
REMOVAL TNL CV CATH CHARGE
|
Professional
|
$465.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
8068937
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$121.90 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna of IA Medicare |
$121.90
|
| Rate for Payer: Amerigroup Medicaid |
$126.04
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$146.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$124.34
|
| Rate for Payer: Medical Associates Commercial |
$231.61
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.90
|
| Rate for Payer: Midlands Choice Commercial |
$325.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$182.85
|
| Rate for Payer: Wellmark IA HMO |
$257.00
|
| Rate for Payer: Wellmark IA PPO |
$302.00
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
$148.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
7982763
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$26.66 |
| Max. Negotiated Rate |
$103.60 |
| Rate for Payer: Aetna of IA Medicare |
$26.66
|
| Rate for Payer: Amerigroup Medicaid |
$27.57
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.19
|
| Rate for Payer: Medical Associates Commercial |
$50.65
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.66
|
| Rate for Payer: Midlands Choice Commercial |
$103.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.99
|
| Rate for Payer: Wellmark IA HMO |
$55.00
|
| Rate for Payer: Wellmark IA PPO |
$64.00
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
$161.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
7982762
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$37.45 |
| Max. Negotiated Rate |
$112.70 |
| Rate for Payer: Aetna of IA Medicare |
$37.45
|
| Rate for Payer: Amerigroup Medicaid |
$38.72
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.20
|
| Rate for Payer: Medical Associates Commercial |
$71.16
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.45
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.18
|
| Rate for Payer: Wellmark IA HMO |
$78.00
|
| Rate for Payer: Wellmark IA PPO |
$92.00
|
|
|
REMOVE SPINE ELTRD PERQ ARAY
|
Professional
|
$1,929.00
|
|
|
Service Code
|
CPT 63661
|
| Hospital Charge Code |
8015896
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$296.70 |
| Max. Negotiated Rate |
$1,350.30 |
| Rate for Payer: Aetna of IA Medicare |
$296.70
|
| Rate for Payer: Amerigroup Medicaid |
$306.79
|
| Rate for Payer: Cash Price |
$1,543.20
|
| Rate for Payer: Cash Price |
$1,543.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$356.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$302.63
|
| Rate for Payer: Medical Associates Commercial |
$563.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$296.70
|
| Rate for Payer: Midlands Choice Commercial |
$1,350.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$445.05
|
| Rate for Payer: Wellmark IA HMO |
$586.00
|
| Rate for Payer: Wellmark IA PPO |
$688.00
|
|
|
REMOVE SPINE ELTRD PLATE
|
Professional
|
$2,838.00
|
|
|
Service Code
|
CPT 63662
|
| Hospital Charge Code |
8015894
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$749.64 |
| Max. Negotiated Rate |
$1,986.60 |
| Rate for Payer: Aetna of IA Medicare |
$749.64
|
| Rate for Payer: Amerigroup Medicaid |
$775.13
|
| Rate for Payer: Cash Price |
$2,270.40
|
| Rate for Payer: Cash Price |
$2,270.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$899.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$764.63
|
| Rate for Payer: Medical Associates Commercial |
$1,424.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$749.64
|
| Rate for Payer: Midlands Choice Commercial |
$1,986.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,124.46
|
| Rate for Payer: Wellmark IA HMO |
$1,532.00
|
| Rate for Payer: Wellmark IA PPO |
$1,799.00
|
|
