|
STERISHIELD II DUAL LAYER AMNION PATCH 4X4
|
Facility
OP
|
$4,131.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8578902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,064.67 |
| Max. Negotiated Rate |
$3,717.90 |
| Rate for Payer: Aetna of IA Commercial |
$3,717.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,717.90
|
| Rate for Payer: Aetna of IA Medicare |
$2,354.67
|
| Rate for Payer: Amerigroup Medicaid |
$2,084.92
|
| Rate for Payer: Amerigroup Medicare |
$2,086.16
|
| Rate for Payer: Cash Price |
$3,304.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,098.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,065.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,064.67
|
| Rate for Payer: Medical Associates Commercial |
$3,098.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,065.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,891.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,096.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,098.25
|
| Rate for Payer: United Healthcare Commercial |
$3,717.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,437.29
|
|
|
STERISHIELD II DUAL LAYER AMNION PATCH 4X4
|
Facility
IP
|
$4,131.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8578902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,891.70 |
| Max. Negotiated Rate |
$3,717.90 |
| Rate for Payer: Aetna of IA Commercial |
$3,717.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,717.90
|
| Rate for Payer: Cash Price |
$3,304.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,098.25
|
| Rate for Payer: Medical Associates Commercial |
$3,098.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,891.70
|
| Rate for Payer: United Healthcare Commercial |
$3,717.90
|
|
|
STIM SUP
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
CPT G0283 GO
|
| Hospital Charge Code |
1373552
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.48 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of IA Commercial |
$76.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.50
|
| Rate for Payer: Aetna of IA Medicare |
$48.45
|
| Rate for Payer: Amerigroup Medicaid |
$42.90
|
| Rate for Payer: Amerigroup Medicare |
$42.92
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.48
|
| Rate for Payer: Medical Associates Commercial |
$63.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.50
|
| Rate for Payer: Midlands Choice Commercial |
$59.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$63.75
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.15
|
|
|
STIM SUP
|
Facility
IP
|
$85.00
|
|
|
Service Code
|
CPT G0283 GO
|
| Hospital Charge Code |
1373552
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of IA Commercial |
$76.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.50
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.75
|
| Rate for Payer: Medical Associates Commercial |
$63.75
|
| Rate for Payer: Midlands Choice Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
|
|
Stomach, Esophageal and Duodenal Procedures With CC
|
Facility
IP
|
$17,237.02
|
|
|
Service Code
|
MS-DRG 327
|
| Hospital Charge Code |
177
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$17,237.02 |
| Rate for Payer: Amerigroup Medicaid |
$17,153.75
|
| 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 |
$16,987.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17,237.02
|
|
|
Stomach, Esophageal and Duodenal Procedures With MCC
|
Facility
IP
|
$33,003.58
|
|
|
Service Code
|
MS-DRG 326
|
| Hospital Charge Code |
176
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$33,003.58 |
| Rate for Payer: Amerigroup Medicaid |
$32,844.15
|
| 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 |
$32,525.27
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33,003.58
|
|
|
Stomach, Esophageal and Duodenal Procedures Without CC/MCC
|
Facility
IP
|
$9,486.12
|
|
|
Service Code
|
MS-DRG 328
|
| Hospital Charge Code |
178
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,486.12 |
| Rate for Payer: Amerigroup Medicaid |
$9,440.29
|
| 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 |
$9,348.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,486.12
|
|
|
Stone (Calculus) Analysis DMCL
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
8505620
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
Stone (Calculus) Analysis DMCL
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
8505620
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
STOOL CULTURE
|
Facility
OP
|
$77.00
|
|
|
Service Code
|
CPT 87045
|
| Hospital Charge Code |
633904
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of IA Commercial |
$69.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.30
|
| Rate for Payer: Aetna of IA Medicare |
$43.89
|
| Rate for Payer: Amerigroup Medicaid |
$38.86
|
| Rate for Payer: Amerigroup Medicare |
$38.88
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.48
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.50
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$57.75
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.43
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
STOOL CULTURE
|
Facility
IP
|
$77.00
|
|
|
Service Code
|
CPT 87045
|
| Hospital Charge Code |
633904
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of IA Commercial |
$69.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.30
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.75
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
|
|
Stool Pathogen PCR Panel
|
Facility
OP
|
$750.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
7812190
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$314.34 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna of IA Commercial |
$675.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$675.00
|
| Rate for Payer: Aetna of IA Medicare |
$427.50
|
| Rate for Payer: Amerigroup Medicaid |
$378.52
|
| Rate for Payer: Amerigroup Medicare |
$378.75
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$562.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$375.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$374.85
|
| Rate for Payer: Medical Associates Commercial |
$562.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$375.00
|
| Rate for Payer: Midlands Choice Commercial |
$525.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$380.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$562.50
|
| Rate for Payer: United Healthcare Commercial |
$675.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$442.50
|
| Rate for Payer: Wellmark IA HMO |
$314.34
|
| Rate for Payer: Wellmark IA PPO |
$345.77
|
|
|
Stool Pathogen PCR Panel
|
Facility
IP
|
$750.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
7812190
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna of IA Commercial |
$675.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$675.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$562.50
|
| Rate for Payer: Medical Associates Commercial |
$562.50
|
| Rate for Payer: Midlands Choice Commercial |
$525.00
|
| Rate for Payer: United Healthcare Commercial |
$675.00
|
|
|
Stool Pathogen PCR Panel Shortened
|
Facility
IP
|
$338.00
|
|
|
Service Code
|
CPT 87505
|
| Hospital Charge Code |
8906330
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna of IA Commercial |
$304.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$304.20
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$253.50
|
| Rate for Payer: Medical Associates Commercial |
$253.50
|
| Rate for Payer: Midlands Choice Commercial |
$236.60
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
|
|
Stool Pathogen PCR Panel Shortened
|
Facility
OP
|
$338.00
|
|
|
Service Code
|
CPT 87505
|
| Hospital Charge Code |
8906330
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$168.93 |
| Max. Negotiated Rate |
$345.77 |
| Rate for Payer: Aetna of IA Commercial |
$304.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$304.20
|
| Rate for Payer: Aetna of IA Medicare |
$192.66
|
| Rate for Payer: Amerigroup Medicaid |
$170.59
|
| Rate for Payer: Amerigroup Medicare |
$170.69
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$253.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$169.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$168.93
|
| Rate for Payer: Medical Associates Commercial |
$253.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$169.00
|
| Rate for Payer: Midlands Choice Commercial |
$236.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$171.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$253.50
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$199.42
|
| Rate for Payer: Wellmark IA HMO |
$314.34
|
| Rate for Payer: Wellmark IA PPO |
$345.77
|
|
|
STRAPPING ANKLE FOOT
|
Facility
IP
|
$117.00
|
|
|
Service Code
|
CPT 29540 GP
|
| Hospital Charge Code |
6344976
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of IA Commercial |
$105.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.30
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.75
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
|
|
STRAPPING ANKLE FOOT
|
Facility
OP
|
$117.00
|
|
|
Service Code
|
CPT 29540 GP
|
| Hospital Charge Code |
6344976
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.48 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of IA Commercial |
$105.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.30
|
| Rate for Payer: Aetna of IA Medicare |
$66.69
|
| Rate for Payer: Amerigroup Medicaid |
$59.05
|
| Rate for Payer: Amerigroup Medicare |
$59.08
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$58.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$58.48
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.50
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$59.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$87.75
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.03
|
|
|
STRAPPING HAND/FINGER
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
CPT 29280 GO
|
| Hospital Charge Code |
1374354
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna of IA Commercial |
$91.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$91.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$76.50
|
| Rate for Payer: Medical Associates Commercial |
$76.50
|
| Rate for Payer: Midlands Choice Commercial |
$71.40
|
| Rate for Payer: United Healthcare Commercial |
$91.80
|
|
|
STRAPPING HAND/FINGER
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
CPT 29280 GO
|
| Hospital Charge Code |
1374354
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$50.98 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna of IA Commercial |
$91.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$91.80
|
| Rate for Payer: Aetna of IA Medicare |
$58.14
|
| Rate for Payer: Amerigroup Medicaid |
$51.48
|
| Rate for Payer: Amerigroup Medicare |
$51.51
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$76.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$50.98
|
| Rate for Payer: Medical Associates Commercial |
$76.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.00
|
| Rate for Payer: Midlands Choice Commercial |
$71.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$51.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$76.50
|
| Rate for Payer: United Healthcare Commercial |
$91.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$60.18
|
|
|
STRAPPING KNEE
|
Facility
OP
|
$106.00
|
|
|
Service Code
|
CPT 29530 GP
|
| Hospital Charge Code |
1374356
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.98 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna of IA Commercial |
$95.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$95.40
|
| Rate for Payer: Aetna of IA Medicare |
$60.42
|
| Rate for Payer: Amerigroup Medicaid |
$53.50
|
| Rate for Payer: Amerigroup Medicare |
$53.53
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$79.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$53.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$52.98
|
| Rate for Payer: Medical Associates Commercial |
$79.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$53.00
|
| Rate for Payer: Midlands Choice Commercial |
$74.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$53.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$79.50
|
| Rate for Payer: United Healthcare Commercial |
$95.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$62.54
|
|
|
STRAPPING KNEE
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT 29530 GP
|
| Hospital Charge Code |
1374356
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna of IA Commercial |
$95.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$95.40
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$79.50
|
| Rate for Payer: Medical Associates Commercial |
$79.50
|
| Rate for Payer: Midlands Choice Commercial |
$74.20
|
| Rate for Payer: United Healthcare Commercial |
$95.40
|
|
|
STRAPPING OF SHOULDER
|
Professional
|
$76.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
7822785
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$16.66 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Aetna of IA Medicare |
$16.66
|
| Rate for Payer: Amerigroup Medicaid |
$17.23
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.99
|
| Rate for Payer: Medical Associates Commercial |
$31.65
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.66
|
| Rate for Payer: Midlands Choice Commercial |
$53.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.99
|
| Rate for Payer: Wellmark IA HMO |
$34.00
|
| Rate for Payer: Wellmark IA PPO |
$40.00
|
|
|
STRAPPING SHOULDER
|
Facility
OP
|
$129.00
|
|
|
Service Code
|
CPT 29240 GP
|
| Hospital Charge Code |
1374352
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.47 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Aetna of IA Medicare |
$73.53
|
| Rate for Payer: Amerigroup Medicaid |
$65.11
|
| Rate for Payer: Amerigroup Medicare |
$65.14
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.47
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$65.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$96.75
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.11
|
|
|
STRAPPING SHOULDER
|
Facility
IP
|
$129.00
|
|
|
Service Code
|
CPT 29240 GP
|
| Hospital Charge Code |
1374352
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
|
|
STRAPPING TOES
|
Facility
IP
|
$94.00
|
|
|
Service Code
|
CPT 29550 GP
|
| Hospital Charge Code |
1374358
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of IA Commercial |
$84.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$84.60
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$70.50
|
| Rate for Payer: Medical Associates Commercial |
$70.50
|
| Rate for Payer: Midlands Choice Commercial |
$65.80
|
| Rate for Payer: United Healthcare Commercial |
$84.60
|
|
